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FOOD N° 8 09/2012 FOOD N° 5

NEST LÉ PROFESSIONAL

FOOD

ALLERGIES CONTENTS A short introduction to food allergies Tips for managing: • Allergies in general • MILK allergy

FOOD ALLERGIES

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• TREE NUT/SOY allergy • PEANUT allergy • FISH/SHELLFISH allergy • EGG allergy • WHEAT allergy

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Rare food allergies

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FOOD ALLERGIES 1. Hypersensitivity

A short introduction to food allergies

EDITORIAL

2. Symptoms

Food allergy A true food allergy is an immune response to a food protein that the body mistakenly believes is harmful. When a person consumes a food with a protein they are allergic to, an immune response is triggered causing the release of antibodies to attack the protein. Depending on the sensitivity of the individual, the body‘s response can lead to anaphylaxis and breathing difficulties, gastrointestinal upsets and vomiting, skin rashes and swelling or heart rate disturbances.

Non-allergic food hypersensitivity Examples: • Food additives e.g. salph • Food chemicals

(naturally occurring e.g. salicylates)

lgE (Immunoglobulin E antibody) antibody mediated food allergy Examples: • Milk, egg, peanuts etc. • Pollen related. • Latex related.

Non-IgE antibody mediated food allergy Examples: • Gluten intolerance (Celiac disease). • Systemic allergic contact dermatitis.

Antibodies are cells/proteins in the body produced by the immune system to destroy harmful cells. IgE cells are a type of antibody produced when a food allergic person consumes a food they are allergic to.

Symptoms usually occur immediately, or within two hours of eating. They can range from being mild to severe. Typically, symptoms experienced can include: SYSTEMIC • Anaphylaxis. The most severe allergic reaction that is potentially life threatening when involving more than one body system. Includes restriction of the airways and a fall in blood pressure

RESPIRATORY TRACT • Rhinitis (sneezing, nasal blockage) • Asthma • Swelling of larynx

GASTRO INTESTINAL TRACT • Swelling and itching of lips, mouth and throat • Nausea • Vomiting • Abdominal pain, cramp or colic • Diarrhoea

SKIN • Itching (Pruritus) • Reddening of skin (Erythema) • Hives (Urticaria) • Swelling of the eyelids, lips, tongue and face (Angioedema) • Eczema

There are no cures for food allergies with complete avoidance the only way to prevent a reaction. With over 170 foods known to trigger severe allergic reactions, the most common foods to cause reactions include peanuts, tree nuts, milk, eggs, sesame seeds, fish and shell fish, soy, wheat and gluten. It is not uncommon to hear from our channel partners that more and more consumers are avoiding foods because of intolerances or food allergies. In this edition we look at food allergies in more detail and how food service operations can better serve this growing consumer base. Happy reading! Jennifer Madz Brand Nutritionist, Nestlé Professional

NutriPro Food No.5

GOOD TO KNOW Food allergy versus food intolerance A true food allergy, occurs when the immune system mistakenly believes that a food is harmful to the body. Food intolerance on the other hand, may be due to a metabolic disorder (e.g. lactose intolerance), to a sensitivity to some substances (chemicals, preservatives and additives in food and drink, sulfites, salicylates and monosodium glutamate) or to a mechanism which is presently completely unknown. The main difference is the involvement of the immune system, although both conditions require food avoidance to prevent reactions.

3. Cross-reactivity Normally, an antibody reacts specifically to only one protein. If another protein, however, has a very similar structure (called an epitope) it is possible that it can also react with the same antibody. This reaction is called crossreactivity or cross-allergenicity and is only possible if the individual is already sensitive to the first protein.

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An example of cross-reactivity is an allergy to shrimps, which could also cause allergic responses to prawns, crab and lobster. The reasons for these crossreactions are diverse and sometimes still unclear.

4. Reducing the risk Currently, there is no way to guarantee a person will not develop an allergy. Furthermore, there is no evidence that avoiding specific food such as milk, egg or peanuts during pregnancy prevents the development of an allergy in babies.

How food allergies develop 1. Food allergen consumed for the first time. 2. Immune System recognises the allergen as harmful and produces antibodies to destroy it. 3. Second contact with the same food allergen. 4. Antibodies are released to attach the allergen causing symptoms as described above.

FOOD ALLERGIES

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Tips for managing food allergies in the kitchen Education and cooperation with guests are the key elements in managing food allergies in restaurants. The following outlines some general tips for preparing a meal for guests with food allergies.

General tips

• Create a food allergy management plan which includes training the kitchen staff on:

• Food allergens. • How to answer guests questions on food allergens. • How to check ingredients used in meal preparation. • How to prevent cross contamination in the cooking and preparation process.

• The key to a nearly “allergy-free” menu is to avoid food or products which contain food allergens. • Complete safety in the production of an allergy-free menu in a kitchen, however is not possible. • Read the food label carefully and pay attention to hidden sources. For example canned tuna fish may contain milk protein.

• For guests with food allergies, ask if there are any known cross reactions. • Avoid fried food in the menu as the oil is often used for many different foods, increasing the risk of contamination. • Be careful with equipment (e.g. pan, pots, and woks) and utensils (e.g. knifes, spatulas, spoons and dishes).  Clean thoroughly before using and use fresh ones for each menu. •T  ake care to avoid cross contamination for the whole preparation time. Don´t prepare or cook the allergen-free menu near foods containing the known allergen.

Milk Cow’s milk is a common food allergy in Australian children under the age of two. With most outgrowing the allergy by four years of age*.

Cooking tips •Avoid milk and all dairy products in the menu. Some individuals (children and adults) are extremely allergic to cow´s milk protein so the reactivity threshold can be less than 0.1 mL of milk. • Read the food label carefully before you use a product because sometimes only one kind of milk protein is used in the product (see the box). • Use rice milk whenever possible in desserts, baking or as a thickening agent. • In some recipes, water, broth or juice can be substituted for cow’s milk.

New scientific research, however, indicates that an increasing number will retain their allergy into school age and even into adolescence. Individuals who are allergic to cow‘s milk are very likely to also react to sheep‘s or goat‘s milk. Milk from other species such as horse or camel may sometimes be tolerated.

*Australian Society of Clinical Immunology and Allergy.

GOOD TO KNOW Foods that contain cow‘s milk protein

Foods that MAY contain cow‘s milk protein

• Milk, skimmed milk, buttermilk

• Processed meats such as hot dogs, sausages, frankfurters and luncheon meats

• Cream, evaporated or condensed milk

• Canned or dehydrated soups

• Butter, margarine, mayonnaise

Some useful resources that may assist you in effectively managing food allergies in your establishment: NutriPro Food No.5

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• www.nestleprofessional.com.au • www.allergyfacts.org.au • www.foodallergyaware.com.au • www.foodauthority.nsw.gov.au/ industry/food-business-issues/ allergies-and-intolerances.

If milk and other dairy products are completely eliminated from the diet, appropriate alternatives for calcium intake need to be introduced to the diet. These include canned salmon with bones, fortified soy or rice milks and green leafy vegetables.

Furthermore, people with an allergy to milk are often also allergic to other food, including soy. A majority of children with cows milk allergy can tolerate soy based products.

• Canned tuna fish

• Cheese, yoghurt, sour cream, curd, quark For more information visit Anaphylaxis Australia or the NSW Food Authority to obtain a Food Service Manual on dealing with food allergies (2012)

Milk is an essential source of calcium. Milk contains many essential nutrients, such as protein, calcium, iodine, Vitamins D, B2 and B12 that promote health and prevent disease. Especially for infants and young children, an important ingredient is calcium, which is essential for bone growth and development.

• Gravy sauces

• Ice cream, chocolate, nougat

• Most commercially prepared bread, hamburger and hot dog buns

• Products with “milk solids“ or “non-fat milk solids“

• Salad dressings, custard

• Whey or products with whey powder

• Cakes, cookies, candies, biscuits, doughnuts, muffins, pancakes, waffles, zwieback, crackers, chips

• Products with lactose, casein/ caseinate, lactalbumin, lactoglobulin

• Processed desserts, puddings

Note: This list is not complete and may change.

FOOD ALLERGIES

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Peanuts

Tree nuts

Peanut allergy is most common in infants but may also appear in adults. Peanut allergy causes more problems than any other food allergen due to it's incidence (affecting 1 in 50 infants), widespread use in the food supply and minute amounts required in some cases to cause symptoms.

The tree nut allergy is a common food allergy in children and adults. It tends to be a lifelong allergy, as only around ten per cent of children eventually outgrow it. People are seldom allergic to just one type of tree nut, but the most common allergic reactions are caused by walnuts and cashew nuts. Tree nuts: Almonds, Brazil nuts, cashews, chestnuts, filberts/hazelnuts, hickory nuts, macadamia nuts, pecans, pine nuts (pignolia, pinion), pistachios, shea, nuts, walnuts.

Note: The risk of an allergic reaction to these tree nuts is unknown: beechnut, butternut, chinquapin, ginkgo, pili nut. Neither coconut, nutmeg nor water chestnuts are tree nuts.

Given the fact that only 20 per cent of people suffering from a peanut allergy will outgrow it and adults may also develop one, this type of allergy is a lifelong problem for many. .

GOOD TO KNOW Foods that contain or MAY contain tree nuts

Cooking tips

• Breakfast cereals, e.g. muesli/ snack bars • Baked goods, such as biscuits, crackers, some cakes, pancakes, waffles • Marinades, barbeque sauces, salad dressings, tapenade, pesto • Gianduja (a creamy mixture of chocolate and chopped nuts) • Ice cream, frozen desserts • Soups

• Avoid all tree nuts and tree nut products in the menu • Read the food label carefully, because tree nuts or tree nut products can be hidden in many processed foods. • Avoid tree nut oil, because it may contain nut protein. • Avoid alcoholic beverages containing nut flavouring.

• Sweets such as baklava, chocolate, candy, marzipan (almond paste), nougat, popcorn, pralines, turrón • Artificial nut products • Beverages, such as flavoured coffee, nut liqueurs • Some commercially processed ethnic foods • Some cold cuts, such as mortadella

Cooking tips • Avoid peanuts and peanut products in the menu (List at the bottom of page). • Read the food label carefully (see the box). If other nuts (e.g. tree nuts are present as ingredients, it is important to check the label for cross contamination warnings.

Note: This list is not complete and may change.

SOY (soybean) Soy allergy is seen mainly in young children with atopic dermatitis and is one of three allergies children are most likely to outgrow. On the other hand, as soybeans are legumes there may be a cross-reactivity to other legumes such as peanuts.

Some children with cow‘s milk allergy (around 15 per cent) may also develop an allergy to soy.

Foods that MAY contain soy • Baked goods such as bread, crackers, cakes, rolls, biscuits • Meat, cheese, milk, margarine or butter substitutes • Processed meat, e.g. sausages, sausage rolls, frankfurters, pork link sausage, deli/ luncheon meats, crumbed meats or fish, pizza

Words on labels to look for • Soy flour, soy meal, soy fibre, soy albumin, lecithin • Textured/ Hydrolysed vegetable protein or starch • Edamame, tofu • Fermented products such as miso, tempeh, tamari, shoyu, bean curd, teriyaki, soy protein isolate

GOOD TO KNOW Foods that MAY contain peanuts • Ethnic dishes such as Thai, Chinese, Indonesian or African processed dishes • Baked goods such as biscuits, cakes, pastries, cookies

Cooking tips

GOOD TO KNOW • Breakfast cereals • Soups • Commercial vegetarian products • Salad dressing, mayonnaise, sauces, or gravies • Chocolates and sweets • Taco shells

As the peanut is a legume, a cross-reactivity to other legumes such as beans, peas or soy is possible. In rare cases, there may also be an allergy to tree nuts.

• Breakfast cereals

• Avoid soy and soybean products such as soy grits, soy milk, soy cheese, soy ice cream • Read the label carefully, as soy or soybean products are contained in many processed foods. • Don’t use soy-based marinade. • Be aware of the word “vegetable” in the context of the word “protein” or “starch” – if it is unspecified in a product it could indicate soy.

• Be cautious with peanut oil. Although the problem with peanut allergy is peanut protein and not the oil itself, it is not guaranteed that the oil is sufficiently free of all traces of peanut protein.

Words on labels to look for • Peanuts, peanut butter, peanut powder • Cold pressed, expressed or expelled peanut oil/ Arachis oil • Ground nut, beer nuts, monkey nuts, mixed nuts, artificial nut products

• Spaghetti sauce, chilli's, pesto, soups • Marzipan, nougat, chocolate, candies, pralines Note: This list is not complete and may change.

Note: This list is not complete and may change.

NutriPro Food No.5

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FOOD ALLERGIES

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NESTLÉ PROFESSIONAL Nutrition Magazine


Eggs

Fish/Shellfish

Egg allergies are most common in children under one year of age. Although can persist into early school years.

Seafood allergies are more common in adults than children, with the allergy remaining a life long problem and usually restricted to a single seafood group. Three types of seafood can trigger allergic reactions:

It is estimated that two-thirds of children out-grow their egg allergy by the time they are five years old. Both egg yolk and egg white can cause egg allergy but an allergy to egg white is most common. Some children or adults are able to eat cooked eggs or cooked food containing small amounts of egg, although this is the exception and not the general rule.

1. Fish: Such as salmon, cod (the most widely reported fish allergy), tuna, haddock, anchovies, herring, snapper, shark. Note: Most people who are allergic to one type of fish also react to other fish, so it is better to avoid all fish.

2. Crustaceans: Such as crab, lobster, shrimps, prawns, crawfish

Individuals who are allergic to hen’s eggs can also be allergic to other kind of eggs such as duck or quail. Furthermore, egg allergy occurs in association with allergies to other food such as chicken (“bird-egg-syndrome”), cow´s milk or peanuts.

3. M  olluscs: Such as mussels, oysters, clams, cockles, octopus, scallops, snails. The term “shellfish“, a subset of seafood, includes crustaceans and molluscs. If someone is allergic to one group of shellfish, they may be able to eat some varieties from the other groups. Furthermore, fish and shellfish do not originate from related families, so being allergic to one type of seafood does not mean that someone is unable to tolerate the other.

Cooking tips • Avoid all fish and fish products as well as all shellfish and shellfish products in the menu. • Read the label carefully. • Be cautious with fish oil.

GOOD TO KNOW

Words on labels to look for Egg white, egg yolk, dried egg, egg lecithin or only lecithin (usually this may be soy lecithin), powdered egg, albumin, globulin, livetin, words starting with “ova” or “ovo” such as ovalbumin or ovomucoid

Cooking tips • Avoid egg in any form and food which contains egg in the recipe. • Read the food label carefully. • Don´t serve soup stocks, consommés or bouillons which are clarified with egg whites. • Use egg-free products, commercial egg substitutes or try to substitute egg as follows.

Foods that MAY contain seafood • Prepared sauces such as Worcestershire sauce (contains anchovies), steak sauce, and marinara sauce • Salad dressings

Each suggestion will replace one egg in most baking recipes:

1 teaspoon (tsp) baking powder, 1 tablespoon (tbsp) water and 1 tbsp vinegar 1 tsp yeast dissolved in ¼ cup warm water 1 tbsp water, 1½ tbsp oil and 1 tsp baking powder 1 packet gelatine and 2 tbsp warm water (do not mix until ready to use) Beer – can be used instead of egg when making batter

• Hot dogs, bologna and ham • Spring rolls • Caponata • Gelatine-based food (e.g. marshmallows)

½ large mashed banana – for cakes and muffins

GOOD TO KNOW

Note: This list is not complete and may change.

Words on labels to look for • Fish flour • Seafood flavouring • Roe (fish eggs) • Surimi (imitation of shellfish but often contains shellfish extracts)

Foods that contain egg or egg components

Foods that MAY contain egg or egg components

• Quiche, egg and bacon pie, spinach pie • Egg noodles and other forms of pasta • Certain sauces, such as béarnaise, hollandaise and tartare • Salad dressing and mayonnaise (unless egg-free) • Desserts, such as meringues & macaroons • Eggnog

• Baked goods, e.g. bread, waffles, pancakes, doughnuts, éclairs, scones and baking powder • Meatballs, meat loaf, croquettes, some sausages • Commercially breaded meats, fish (e.g. fish fingers) or poultry • Fried rice, spring rolls, dumplings • Pizza bases • Pudding, custard, ice cream, dessert powders, malted drinks

Note: This list is not complete and may change.

NutriPro Food No.5

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WHEAT

QUIZ

Wheat allergy commonly affects children under the age of three and generally resolve themselves within the first few years of life. Wheat allergy in adults is less common. Most people with wheat allergy are able to consume other grains. Wheat and wheat derivatives are present in a wide variety of food and are sometimes declared on the label under a different name. Grains other than wheat include rice, barley, oats, rye to name a few.

Cooking tips • Avoid all wheat products (such as wheat flour or bran) and all wheat derivatives in the menu (see the list). • Read the food label carefully, because wheat products can be hidden in many processed foods (see the box).

It is important, however, to note that wheat allergy and coeliac disease are different conditions. Coeliac disease is an autoimmune disorder affecting the body´s ability to process the protein gluten which is found in wheat and other grains.

Those with diagnosed coeliac disease are required to avoid all gluten in their diet. Grains and substitutions suitable for coeliacs include rice, amaranth, buckwheat, quinoa and corn (see box below).

• Try substituting 1 cup wheat flour with one of the following:

1 1/3 cups rolled oats or oat flour*

1 - 1 ¼ cups rye flour*

½ cup potato flour & ½ cup rye flour*

7/8 -1 cup rice flour

5/8 cup rice flour & 1/3 cup rye flour*

1 cup maize corn flour

5/8 cup rice flour & 1/3 cup maize flour

1 cup potato flour

1 cup soy flour & ¼ cup potato starch

5/8 cup potato starch

½ cup soy flour & ½ cup rice flour

1. Food allergy is characterised as E: Food prevalence S: An adverse reaction to food W: Food intolerance

Rare food allergies Besides the food allergies described, there are many other foods which are allergenic to fewer people. • Seasame seed allergy: it appears to be on the increase in many countries. • Meat allergy: most of the time the reason is a cross-reactivity with egg or milk allergy. • Vegetables: the most important allergens are celeriac, potatoes, tomatoes and lupins.

• Fruit: the most important allergens are apple, strawberry, bananas, kiwi, pear and nectarine. • Spices and herbs: such as curry, pepper (black and green), paprika powder, coriander, cardamom and mustard.

*Not suitable for Coeliacs.

Foods that contain or MAY contain wheat • Baked goods such as breads, biscuits, cakes, crackers, doughnuts, muffins, pancakes, pretzels

• Marinade, salad dressing and sauce such as soy sauce, Worcestershire sauce, mustard, prepared ketchup

• Breakfast cereals

• Milk and dairy products such as malted milk, milk drinks containing powdered wheat cereals or products, cottage cheese, yoghurt

• Soups such as cream soup, soups with noodles

• All breaded or floured meats, meats containing filler such as meatloaf, frankfurters, sausages, • Desserts such as commercial frosting, ice cream, soufflés, luncheon meats, bologna, pastries hot dogs • Sweets such as chocolate and • Seafood and poultry, such as candies fish sticks, chicken nuggets, fried chicken

• Potatoes and pasta/noodles such as scalloped potatoes, noodles, spaghetti, macaroni

• Beverages such as beer, coffee substitutes, instant chocolate drink mixes

Other names for wheat or wheat derivatives on a food label Atta, bulgur, couscous, durum, einkorn, emmer, farina, gluten, graham flour, high gluten/protein flour, kamut, seitan, semolina, spelt, triticale (a cross between wheat and rye) Triticum aestivum

Wheat substitutes include: Amaranth, arrowroot, buckwheat, corn (includes cornmeal, maize corn flour), millet, oats/oatmeal, potato, quinoa, rice/rice bran, rye, soy, sago, tapioca, legumes such as chickpeas and lentils

What does it mean: “may contain traces of...”?

This normally indicates that the food is prepared in a factory that also makes food containing these allergens. However, the food itself does not contain the allergen as an ingredient.

4. Is it possible to use peanut oil for a menu for people with peanut allergy without any risk? B: Yes A: No 5. Lobster is a kind of: L: Crustacean T: Mollusc S: Fish 6. The following food may contain seafood: A: Gianduja B: Tempeh L: Hot dog

GOOD TO KNOW

A lot of food carries a warning on the label “may contain traces of tree nuts/peanuts/ soy/celeriac/milk”.

3. Which of the following foods may contain egg or egg components: G: Buttermilk E: Worcestershire sauce Y: Pancakes

This statement advises allergic consumers that there is likely cross contamination risk at levels that may trigger a reaction depending on individual sensitivity. If you use these products, always ask the guest if he or she agrees.

7. Are walnuts a kind of tree nut? E: Yes L: No 8. One alternative for wheat is: L: Couscous M: Bulgur R: Quinoa 9. Could cooking prevent a food allergy reaction? E: Yes G: No 10. Could curry be an allergen? Y: Yes X: No

Answer: soy allergy

GOOD TO KNOW

2. People with milk allergy have to be careful with O: Soymilk G: Camel milk H: Horse milk

Note: This list is not complete and may change.

NutriPro Food No.5

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FOOD ALLERGIES

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MAGGI & NESTLé

Gluten Free Range

Product Description

Weight

NZ Code

12026958 12026958 MAGGI Classic Gluten Free Pumpkin Soup Mix

6 x 1.8kg

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6 x 2kg

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NZ Code

AUS Code

AUS Code

Product Description

Weight

6 x 1.8kg

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Get in touch with us today. In Australia call 1800 20 30 50 or in New Zealand call 0800 830 840. For recipes and nutrition tips or to download a copy of NUTRI PRO visit www.nestleprofessional.com Nestlé Australia Ltd ABN 77 000 011 316 Head Office: 1 Homebush Bay Drive, Rhodes, NSW 2138 Nestlé New Zealand Ltd Head Office: Level 3, Building 1 & 2, Carlaw Park Commercial, 12-16 Nicholls Lane, Parnell, Auckland


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