Finding a Path to Safety in Food Allergy Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy (2017) / Chapter Skim
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8 Managing Food Allergies in Retail, Food Service, Schools, Higher Education, and Travel Settings
8 Managing Food Allergies in Retail, Food Service, Schools, Higher Education, and Travel Settings
Pages 333-364
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From page 333... ...
The food processing industry also has an essential role in preventing food allergies, with their ability to inform individuals at risk about the presence of allergens in packaged foods, and this was discussed in Chapter 7. However, in order for an individual with food allergy to manage his or her food allergy successfully, it is vital to acknowledge the individual's interactions with many social systems beyond those directly providing health care.
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From page 334... ...
Although most severe reactions from food allergens originate from consumption of the relevant food and the risk of an allergic reaction from environmental contact is rather low (see Box 8-1) , less severe food allergic reactions also have been reported in food establishments (see Chapter 6; Furlong et al., 2001)
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The authors concluded that casual exposure to peanut butter (through skin contact or air exposure) is unlikely to elicit significant allergic reactions (Simonte et al., 2003)
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Instead, it is a model code and reference document for state, city, county, and tribal agencies that regulate operations such as restaurants, retail food stores, food vendors, and foodservice operations in institutions, such as schools, hospitals, assisted living, nursing homes, and child care centers. It is developed by the Conference of Food Protection, a nonprofit organization created to provide a formal process to develop food safety guidance. Members of industry, regulatory, academia, and consumer and professional organizations contribute to the development of the Food Code.
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The areas of knowledge include the identification of major food allergens and food allergy symptoms in a sensitive individual who has an allergic reaction. The Food Code also references the need for restaurant and food service managers "to be aware of the serious nature of food allergies" and "to avoid cross-contact during food preparation and service." In addition, the Food Code indicates that the person in charge shall ensure that employees are properly trained in food allergy awareness.
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. However, the majority of food allergic reactions that occur in preschooland school-aged children are not anaphylaxis (Boros et al., 2000; Gold and Sainsbury, 2000)
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Accordingly, in 2013, the CDC, in consultation with the U.S. Department of Education and others, developed the Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs (CDC, 2013)
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Putting Guidelines into Practice: Actions for School Boards and District Staff School Board Members School District Superintendent Health Services Director Student Support Services Director District School Food Service Director The Voluntary Guidelines for Managing Food Allergies calls for Food Allergy Management and Prevention Plans (FAMPPs) to • Meet the requirements of federal, state, and local laws and regulations; • Reflect clear goals, purposes, and expectations for food allergy management that are consistent with the school's or early child hood education program's mission and policies; • Be clear and easy to understand and implement; • Be responsive to the needs of any child with food allergy by taking into account the different and unique requirements of each child; and
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From page 341... ...
Putting Guidelines into Practice: Actions for Early Care and Education Administrators and Staff Program Directors and Family Child Care Providers C hild Care Providers, Preschool Teachers, Teaching Assistants, Volunteers, Aides, and Other Staff Nutrition Services Staff Health Services Staff Section 5. Federal Laws and Regulations That Govern Food Allergies in Schools and Early Care and Education Programs Section 6.
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However, it has been documented that the use of emergency care plans is less than desirable. For example, in a study of the Chicago Public School district, the third largest public school district in the United States, only half of students with food allergy had filed a health management plan with their school (Gupta et al., 2014)
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These guidelines include a section on managing food allergies with references to many resources (USDA, 2016)
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The 2013 FDA Food Code recognizes the importance of restaurant and retail food service managers by adding a provision to ensure that the food safety training of employees includes food allergy awareness. FALCPA also requires that the FDA works in cooperation with the Conference for Food Protection to pursue revision of the Food Code to provide guidelines for preparing allergen free foods in food establishments, including elementary and secondary school cafeterias.
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After concluding that violations had occurred, the DOJ entered into an agreement with the university "to ensure that its students with celiac disease and other food allergies can fully and equally enjoy the university's meal plan and food services" (DOJ, 2012)
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FOOD ALLERGIES AND THE TRAVEL INDUSTRY Flying with Food Allergies14 Patients with food allergy can have serious reactions to small quantities of an allergen and, as previously discussed, allergen avoidance is currently the only management approach to minimize the risk of an allergic reaction. When flying, avoidance might appear more difficult because spending hours in a closed environment might increase the risk of contact with a food allergen when food is served or other passengers bring food.
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. Based on these limited studies and reported cases on environmental exposure to food allergens, the risk of a severe reaction from aerosolized food allergens appears to be very low, except for children with both asthma and food allergies.15 Likewise, the risk from skin exposure is low.
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. The Air Carrier Access Act18 (ACAA)
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However, these complaints are not separated by allergy, so it is likely that some allergy complaints were not food-related. Department of Transportation and Related Agencies Appropriations Act of 2000 and Buffer Zones In 1998, to deal with an increasing concern over food allergic reactions on planes, the DOT suggested that airlines create buffer zones.
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Policies enforcing the labeling of food allergens for meals served on airplanes are only currently being finalized. The FDA Food Code (see above and Annex)
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The 1:10,000 vials are labeled for the treatment of cardiac arrest. However, the 1:1,000 vials, which would be typically used for severe food allergic reactions, are not labeled specifically for this use.
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One study analyzed the records of in-flight emergency calls from five domestic and international airlines from January 2008 to October 2010. This study found that in total 11,920 in-flight medical emergencies resulted in calls to medical professionals on the ground and 265 of these calls were related to an allergic reaction (Peterson et al., 2013)
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From page 353... ...
combined with precautionary behaviors from the side of those at risk of having an allergic reaction. In general, however, only a few federal policies directly or indirectly apply to food allergies at the settings of concern described in this chapter (e.g., a recent federal policy allowing schools to stock epinephrine to manage severe allergic reactions)
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.30 However, gaps in managing food allergies exist. First, because schools are not reporting in a systematic fashion the occurrence of severe reactions or the number of children with IEPs due to a food allergy diagnosis, the scope of the problem in schools is unknown.
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In doing so, the committee recognized that its task did not include recommendations for therapeutic intervention or clinical management of food allergies. RECOMMENDATIONS Training Food Industry Personnel The committee recommends that food industry leaders provide the necessary resources for integrating food allergy training (e.g., food allergen identification and preventive controls, effective risk com munication with customers)
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Working in collaboration with other stakeholders, the agencies also should propose that the next Food Code requires that the person in charge in food establish ments pass an accredited food safety certification program that includes basic food allergy management in order to decrease or prevent the risk of food allergen exposure. In addition, agencies should develop guidance on effective approaches to inform con sumers with food allergies in food service establishments.
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From page 357... ...
Best practices for managing food allergies in settings of concern where food is served have not been studied. For example, management plans for food allergy in early care and education settings, schools, camps, or other places where children are served food include providing instructions for safe meals, recognizing and managing reactions, and assigning roles and responsibilities.
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• Define best practices regarding food allergy management (e.g., epinephrine storage) at settings where food is served, particularly in early care and education settings, schools, camps, and food establishments in additional settings of concern, including restau rants, cafeterias, grocery stores, and commercial airliners (or other commercial means of travel)
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2013. Voluntary guidelines for managing food allergies in schools and early care and education programs.
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Presented at the Workshop of the Commit tee on Food Allergies: Global Burden, Causes, Treatment, Prevention, and Public Policy, September 1, 2015, Washington, DC.
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2015. Frequency, severity and causes of unexpected allergic reactions to food: A systematic literature review.
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Any ingredient that is exempt under the petition or notification process specified in the Food Allergen Labeling and Consumer Protection Act of 2004 (Public Law 108-282)
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The PERSON IN CHARGE shall ensure that: (M) EMPLOYEES are properly trained in FOOD safety, including FOOD allergy awareness, as it relates to their assigned duties; Chapter 3 Food 3-6 FOOD IDENTITY, PRESENTATION, AND ON-PREMISES LABELING Labeling 3-602.11 Food Labels (B)
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From page 364... ...
now applies only to raw meat and poultry. Annex 3 Public Health Reasons/Administrative Guidelines Restaurant and retail food service managers need to be aware of the serious nature of food allergies, including allergic reactions, anaphylaxis, and death; to know the eight major food allergens; to understand food allergen ingredient identities and labeling; and to avoid cross-contact during food preparation and service.
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