“Did you know that in the UK an estimated 2 million people are living with a diagnosed food allergy?”
And there is evidence that the number of people who have adverse reactions to foods such as cows’ milk, tree nuts and peanuts is increasing.
The most at risk groups include young people, those in their teens and early twenties as they start to make their own independent food choices.
Virtually all known food allergens are proteins; they can be present in the food in large amounts and often survive food-processing, including cooking.
Very small amounts of an allergen, sometimes less than one milligram (one thousandth of a gram), can trigger a reaction which can be severe and on rare occasions fatal.
Allergic reactions are characterised by the rapid release of chemicals in the body that cause the signs and symptoms, including;
- tingling or itching in the mouth
- a raised, itchy red rash (hives) – in some cases, the skin can turn red and itchy, but without a raised rash
- swelling of the face, mouth (angioedema), throat or other areas of the body
- difficulty swallowing
- wheezing or shortness of breath
- feeling dizzy and lightheaded
- feeling sick (nausea) or vomiting
- abdominal pain or diarrhoea
- hay fever-like symptoms, such as sneezing or itchy eyes (allergic conjunctivitis)
The symptoms of a severe allergic reaction (anaphylaxis) can be sudden and get worse very quickly.
The initial symptoms of anaphylaxis are often the same as those listed above and can lead to:
- swollen tongue
- breathing difficulties
- tight chest
- trouble swallowing or speaking
- feeling dizzy or faint
which can occur within minutes or may take an hour or more after ingestion of the allergen.
However, one of the problems the food allergen sufferer faces are the common misconceptions surrounding the condition such as;
- They’re just ‘fussy eaters’
- Food allergy isn’t that serious…
- A little bit won’t harm you…
- They can pick out or eat around the nuts…
- If I cook it properly it will be fine…
However, the reality is far different to the individual concerned as a food related allergic reaction can be life threatening.
Although, at the time of writing this article, there have been a number of high-profile tragedies in recent months, thankfully the number of deaths is low, approximately ten per year.
Whilst deaths from allergic reactions make the news headlines what does not is that more people per year are hospitalised due to food hypersensitivity (which includes allergic reactions) than through foodborne disease, including food poisoning.
The most common allergens associated with illness and deaths are Milk (22%), Peanuts (19.5%), Gluten (14.6%), Tree-nuts (14.6%) and eggs (12.2%).
The sufferer has to manage their condition through a strict avoidance diet, needing to obtain food ingredients information to avoid the food containing the allergen which would trigger off their reaction.
Eating out requires some organisation, potentially limiting where they can eat and the choice of menu dishes available to them, often leading to higher prices.
The key element for the consumer is that they have trust in the food business that they intend to use.
Therefore, providing accurate allergen information is vital to ensure the consumer can make correct choices in the food available to them.
Any customers with a food allergy, or their family / carers, should, ideally, notify you of any allergies, either when booking, or immediately on arrival.
Catering businesses are now legally required to comply with the Food Information to Consumers Regulations which means that allergen information must be available upon request.
You need to inform your customers if any food products you sell or provide contain any of the main fourteen allergens as an ingredient.
The 14 allergens are:
- cereals containing gluten – including wheat (such as spelt and Khorasan), rye, barley and oats
- crustaceans – such as prawns, crabs and lobsters
- molluscs – such as mussels and oysters
- tree nuts – including almonds, hazelnuts, walnuts, brazil nuts, cashews, pecans, pistachios and macadamia nuts
- sesame seeds
- sulphur dioxide and sulphites (if they are at a concentration of more than ten parts per million)
If you are selling, or providing, food direct to the customer, such as in a restaurant or café then the allergen information must be available in writing, this could be on a menu, chalkboard for example or by a written notice placed in a clearly visible position explaining how the customer can obtain that advice – for example speaking to a member of staff.
However, if this information is to be provided verbally by a member of staff then it needs to be backed up by the written information to ensure that it is accurate, consistent and verifiable.
Some of the challenges that a business may face in getting this information across include a number of factors such as:
- Cultural differences – allergies are thought of as a ‘western disease’ with far lower instances in other areas of the world, leading to a potential lack of understanding of the importance of allergies by chefs or food handlers who may have come from those cultures
- Language and literacy – leading to difficulty in fully understanding the available information
- Engaging the consumer – often there is not enough dialogue or information available at an early stage for the business to better understand the consumer’s needs
- Last minute substitutions – a change of ingredient leading to a potential allergen being introduced unbeknownst to those responsible for informing consumers
- Communication between kitchen staff and shifts – poor passing of information from the kitchen to its own staff and those who ultimately have the final responsibility of providing the consumer with accurate information
- Recording information – recording the information in a way that is accurate, clear, concise, easily accessible and able to be understood by everyone concerned and importantly kept up-to-date
Getting it wrong, whilst having potentially devastating consequences for the consumer, can have a significant impact on the food business owner and their business;
- Mohammed Kalique Zaman, owner of the Indian Garden Restaurant, Easingwold, received six years imprisonment for Gross Negligent Manslaughter and six food safety offences after Paul Wilson (28) died having eaten a dish containing peanut when he had specifically informed the staff that he was allergic to it. The restaurant had deliberately substituted the more expensive almond powder for the cheaper mixed nut powder which contained peanut.
- Huran Rashid (Manager) and Mohammed Abdul Kuddus (Owner) of the Royal Spice Restaurant, Ostaldtwistle were imprisoned (Rashid, 3 years and Kuddus 2 years) for manslaughter and breaching health and safety and food safety regulations, after Megan Lee (15) died in 2017 after eating a takeaway noting ‘no nuts or prawns’ on her order.
Subsequent investigation found a replica meal contained peanut protein in seekh kebab, peshwari naan and onion bhaji
- Riad Benotman who is the only Director of Al Falafel Takeaway Ltd on Monmouth Street was ordered to pay £2,880 in fines and costs after Chloe Gilbert (15) allergic to dairy products, died from anaphylactic shock after eating a kebab containing yogurt
- Pret a Manger suffered negative publicity after Natasha Ednan-Laperouse (15) died from anaphylaxis in 2016 after eating an artichoke, olive and tapenade baguette which contained sesame, to which she was allergic. Whilst not contravening the law, there was no specific allergen information on the baguette packaging or on the (food display cabinet) and Natasha had been reassured by no mention of sesame
- A second person, Celia Marsh (42) is believed to have died following an allergic reaction triggered by a ‘super-veg rainbow flatbread’ from the Pret a Manger chain in December 2017.
The sandwich consumed by Ms Marsh contained yoghurt that was meant to be dairy-free, but had later been found to be contaminated. At the time of this article the full inquest has not been concluded
Good allergen management relies on knowledge from food safety training, including allergen awareness, accurate collation of recipes and ingredient information using Hazard Analysis and Critical Control Points (HACCP) systems to identify control points.
There needs to be good processes / systems in place, including dedicated storage, equipment and spaces to avoid inadvertently cross-contaminating other foods with allergens.
Communication with all stakeholders, suppliers, staff and consumers is also another vital management tool in order to communicate clear information with a good understanding of the issues by the person preparing food is essential and awareness of any changes that may have a detrimental effect on the allergy sufferer.
If a customer explains that they have a food allergy, listen to them carefully and if practicable let them speak directly to the chef or a senior member of staff, making sure that the customer’s allergy is noted clearly on their order.
If there is any doubt about whether a food is free from of a certain ingredient, admit to the customer that you are unsure but assure them that you will find out, do not offer to cater for the customer if you are unable to do so safely.
Careful consideration has to be given to all food and drink that may be part of a meal i.e. if someone orders a coffee for example, and has already informed you that they have a milk allergy, the customer will feel reassured that you have understood their needs if you remember not to include milk or a biscuit on the side, offer a milk alterative
There are many other ways that the food business can consider to help the food allergy sufferer make informed choices and remain safe;
- If a dish is meant to contain nuts, why not make sure this is reflected in the name: e.g. nut and carrot salad
- Loose foods must also be labelled with allergen information, this includes buffets, deli counters, self-serve etc.
- It may seem obvious but ensure that the right dish is served to the right customer and double check
- Avoid the indiscriminate use of allergens as garnishes e.g. nuts or cheese, unless this is an essential part of the recipe
- If a customer receives their meal and finds a garnish to which they are allergic, you must not just remove the garnish and return the dish to customer. Tiny traces that remain after the garnish has been removed may be enough to cause a severe reaction. A new meal without the garnish must be prepared and served
- Handwashing is paramount, preventing cross contamination of allergens
- Separate utensils should be used for food containing allergens
- Utensils, cutlery and work surfaces should be washed scrupulously after preparing foods containing allergens – they should even be washed thoroughly before they are put in a dishwasher if they are sticky e.g. peanut butter, mayonnaise, chocolate sauce etc.
- Cooking in unrefined oils e.g. groundnut oil (peanut oil) or sesame oil may leave traces of nut protein in food
- Any oil that has previously been used to cook products containing nuts / egg / fish etc. may contain traces of these foods so they should not be used to cook for anyone who is allergic to these foods
By having allergy awareness at the forefront of your food safety management system and communicating it clearly with your staff, risk can be minimised and the customer is able to make an informed decision as to what dishes would be suitable for them and ultimately have trust in your business.
Give the customer the reassurance that you are taking their allergy seriously and they will become repeat customers and spread the word to other food allergy sufferers who are your potential customers.
Health and Safety Consultant