Food Allergen Management

Food Allergens

A food allergy is an adverse immune response to certain kinds of food. They are distinct from other adverse responses to food, such as food intolerance, pharmacological reactions and toxin-mediated reactions. The protein in the food is the most common allergic component. These kinds of allergies occur when the body's immune system mistakenly identifies a protein as harmful. Some proteins or fragments of proteins are resistant to digestion and those that are not broken down in the digestive process are tagged by the Immunoglobulin E (IgE). These tags fool the immune system into thinking that the protein is an invader. The immune system, thinking the organism (the individual) is under attack, sends white blood cells to attack and that triggers an allergic reaction. These reactions can range from mild to severe. Allergic responses include dermatitis, gastrointestinal and respiratory distress, including such life threatening anaphylactic responses as biphasic anaphylaxis and vasodilation; these require immediate emergency intervention. Individuals with protein allergies commonly avoid contact with the problematic protein. Some medications may prevent, minimize or treat protein allergy reactions. There is no cure. Treatment consists of either immunotherapy (desensitization) or avoidance, in which the allergic person avoids all forms of contact with the food to which they are allergic. Areas of research include anti-IgE antibody (omalizumab, or Xolair) and specific oral tolerance induction (SOTI), which have shown some promise for treatment of certain food allergies. People diagnosed with a food allergy may carry an injectable form of epinephrine such as an EpiPen, or wear some form of medical alert jewelry, or develop an emergency action plan, in accordance with their doctor.

                                                                                                

Each year, millions of people have allergic reactions to food. Although most food allergies cause relatively mild and minor symptoms, some food allergies can cause severe reactions, and may even be life-threatening and there is no cure for food allergies. Strict avoidance of food allergens and early recognition and management of allergic reactions to food are important measures to prevent serious health consequences. A food allergy may affect the skin, the gastrointestinal tract, or the respiratory or cardiovascular systems. Many types of foods can be allergens, but certain foods are much more likely than others to trigger an allergic reaction.

Symptoms of Food Allergies

Symptoms of food allergies may range from mild to severe and they may come on suddenly or develop over several hours. Because a person's immune system may react to a very small amount of the allergen, food allergies are particularly dangerous and potentially life threatening, especially if breathing is affected. Because of this, people with asthma are at an increased risk for a fatal allergic reaction to food.

Mild symptoms related to a food allergy may include:

Sneezing

Stuffy or runny nose

Itchy, watery eyes

Swelling

Rash

Stomach cramps

Diarrhea

Severe symptoms of an allergic reaction to food are:

Difficulty breathing, including wheezing

Swelling of the lips, tongue or throat

Hives (an itchy, blotchy and raised rash)

Dizziness or faintness

Nausea or vomiting

Major Food Allergens

While more than 160 foods can cause allergic reactions in people with food allergies, the law identifies the eight most common allergenic foods. These foods account for 90 percent of food allergic reactions, and are the food sources from which many other ingredients are derived.

The eight foods identified by the law are:

Milk

Eggs

Fish (e.g., bass, flounder, cod)

Crustacean shellfish (e.g. crab, lobster, shrimp)

Tree nuts (e.g., almonds, walnuts, pecans)

Peanuts

Wheat

Soybeans

These eight foods, and any ingredient that contains protein derived from one or more of them, are designated as “major food allergens” by FALCPA.

                

Milk Allergies

A milk allergy is a reaction to whey or casein, the proteins found in cow's milk. It’s not the same as lactose intolerance. Milk allergies have been studied more than any other food allergy. The bad news is that children with milk allergies are much more likely to develop allergic reactions to other foods including eggs, soy, and peanuts. Most children with milk allergies also develop one or more other atopic diseases such as asthma, allergic rhinitis, or eczema.

Egg Allergies

Egg allergies occur most often in children and usually resolve at a very young age. However some people may remain allergic to eggs for their entire lives. A person may be allergic to a certain protein in either the yolk or the egg whites. A person with an allergy to the egg yolk may be able to tolerate egg whites and vice versa.  Some people are allergic to both.

Peanut Allergies

Children with peanut allergies rarely grow out of their sensitivity to peanuts, so a peanut allergy is usually a lifelong disorder. Because of this, peanut allergies are particularly serious. Accidental exposure can occur at any time during a person's life. Though rare, a peanut allergy may result in anaphylaxis. This is a severe allergic reaction that can restrict breathing or cause cardiac arrest. Anaphylaxis requires immediate medical attention in the form of a shot of epinephrine (EpiPen). A patient should be watched for several hours after the shot to make sure symptoms don’t return.

Other Common Allergies

Less is known about soy and wheat allergies than the more common allergies discussed above. Likewise, little is known about fish, shellfish, and tree nut allergies except that, like a peanut allergy, they are generally lifelong disorders.

Diagnosis

Food allergies are usually diagnosed depending on the severity of symptoms. If a patient's symptoms are mild, a doctor may recommend keeping a food diary to record all of the foods you eat or drink to pinpoint the culprit. Another way to diagnose a mild food allergy is to remove certain foods from the diet and then slowly reintroduce them to find out if symptoms return. In the case of more severe allergies, skin or blood tests can identify egg, milk, nut, and shellfish allergies.

Treatment Options

As with other types of allergies, avoidance is most often the best medicine. Anyone with a food allergy should be careful when purchasing food at a supermarket or restaurant to make sure there are no traces of the allergen in a food or meal.

Milder symptoms may not require any treatment at all, or a simple over-the-counter antihistamine may resolve the symptoms.

For more serious allergic reactions, a doctor may prescribe steroid medications. Steroids may have serious side effects and shouldn't be used for more than a few days at a time.

Allergen Management in food Manufacturing Facilities

If allergens are included in any products within the facility, then an allergen management program must be developed to address potential cross contact by allergens. Each facility is required to compile a current master list of allergens within the production environment. The general listing of accepted allergens includes peanuts, tree nuts, milk, eggs, soybean, shellfish, fish, and wheat. In Canada, sulfites and sesame seeds are also considered allergens. If these are included in any products produced within the facility, then consideration must be made to address cross contact by allergens. Allergens are managed by two possible methods:

Product labeling: Include all potential allergens on the label of all products produced within the facility (“This item may contain…”)

Allergen control: Includes the management of the production schedule to list products with allergens produced prior to sanitation activities.  It also includes the proper cleaning and sanitizing of equipment contacting allergens.

A verification program is needed to insure compliance with allergen control procedures. Facilities having allergens must have a documented allergen rework program. Products that contain rework must also be considered when potential allergenic ingredients are used. Appropriate allergen controls must be applied to the rework as well. Additional controls that should be included in the allergen management program are:

Storage of allergens in dry storage, all allergens need to be segregated from non-allergens and non-like allergens

Ingredient storage, all allergens need to have a dedicated storage bin, and dedicated dispensing utensil and weigh vessel, if applicable.

Documented change over procedures for switching from allergens to non-allergens. This should include a Sanitation Standard Operating Procedure, monitoring to ensure product removal, and verification of the SSOP. Appropriate testing methods should be used to ensure effective allergen removal. A label reconciliation program is established to ensure that all product labels accurately reflect the presence of allergens based on product formulations, and random audits of products with allergens to ensure that the labels are accurate. Facilities under FDA regulation must comply with the US FDA Food Allergen Labeling and Protection Act of 2004.