Dealing With Allergens: School Foodservice

While studying the ABCs of food allergens, no lesson is as vitally important as anaphylaxis. Various sources attribute between 100 and 500 deaths annually in the United States caused by anaphylactic shock, or a strong, life-threatening immunological reaction to an allergen. One medical report in Canada tracking six children who died from anaphylaxis stated that four of the six fatal reactions occurred at school. It shouldn’t come as a surprise then, that school foodservice operators face special challenges when trying to protect the student body from potential food allergens.

The environment

The first important factor is the school environment itself. Any institutional kitchen poses a potential risk for cross-contamination. In school, add the chance of a child sharing a common table, encountering a smear of peanut butter or sharing a forbidden snack brought by a classmate and the potential for risk increases substantially. And when was the last time a food fight broke out in a corporate dining room? Despite best efforts, children are more likely than adults to ingest or touch a forbidden food.

Secondly, school foodservice programs must meet federally mandated standards for certain nutritional requirements. Food manufacturers working to comply with these requirements, while still designing foods to appeal to a younger palate, utilize creative methods of incorporating nutrient-rich ingredients into school formulations. However slight, any formulation change can cause potentially life-threatening reactions in a student allergic to a particular food.

Such was the case when a student allergic to legumes experienced an adverse reaction after eating cheese pizza from the cafeteria. The reason? The manufacturer had added dried navy beans to the crust to increase protein levels to meet the nutritional standards. The pizza label did list beans as an ingredient; however, foodservice operators did not expect that type of ingredient to be included in a pizza and never checked the label.

The most important tool for manufacturers, as well as school foodservice personnel, is the labels carried by all foods and beverages. As of Jan. 2006, FDA has required food labels to state if the products contain ingredients that contain protein derived from the eight major allergenic foods. Per the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA), the presence of ingredients that contain protein derived from milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, or soybeans must be identified in plain English in the ingredient list or it must say “contains” followed by name of the source of the food allergen after or adjacent to the list of ingredients. For example, if a product contains casein, the label must use the term “milk” in addition to the term “casein.”

As illustrated, ingredients in standard food items can change without warning, so vigilance on the part of the school is required.

The allergenic culprits

The student’s reaction to navy beans is an example of cross-reactivity. When an individual develops an allergy to a particular food, allergists generally recommend that person avoid any foods within a similar group. For example, someone allergic to shrimp should generally avoid other shellfish, such as lobster, crab and the like.

Children tend to be more highly allergic to eggs, milk and peanuts, whereas adults more commonly react to shellfish, peanuts, tree nuts, fish and eggs. Soy, wheat and sulfites can also bring on an allergic reaction in certain individuals.

In some cases, students experience allergic reactions to foods without any known allergenic ingredients, only to find out later that those foods were processed in a dairy plant, or in an environment where peanuts or other allergenic substances were present on other equipment. Somehow, the cross-contamination occurred at the plant level.

The most severe and potentially life-threatening reaction, anaphylactic shock, usually occurs almost immediately after ingesting an allergenic food. However, some allergic reactions manifest themselves minutes, or even hours, later; strenuous exercise may even stimulate allergic reactions to food. This emphasizes the importance of teaching the entire school staff and all volunteers to recognize the symptoms of severe allergic reaction and to react immediately.

Schools can implement several safety measures to help protect the student population from adverse allergic reactions to food:

• As the first line of defense, parents should notify the school of any child’s particular allergy and supply the school nurse with necessary remedies, as provided by a family physician.

• School nursing staff should carry on-hand a supply of epinephrine or antihistamines to reverse allergic reactions. According to H. Sampson et al. (“Fatal and near-fatal anaphylactic reactions to food in children and adolescents,” New England Journal of Medicine 327:380-384), prompt administration of epinephrine to children suffering anaphylactic reactions to food increases their chance of survival.

• Schools should develop an allergy action plan that involves the entire school faculty and staff.

• Food formulations can change at any time. School foodservice staff, in particular, should carefully and regularly read the labels of all incoming prepared foods and ingredients, and familiarize themselves with the various terms used by the food industry to identify different forms of potentially allergenic foods.

• School foodservice staff can watch for opportunities to participate in HACCP training programs related to allergens.

• The American School Food Service Association hosts an annual national conference in July, offering sessions that sometimes deal with the topics of food allergens or food safety.

• Search the Internet for information sources about allergic reactions, causes, cures and safety plans. Two good resources are www.foodallergy.org, the website for the Food Allergy and Anaphylaxis Network, Fairfax, VA; and www.aafa.org, the website for the Asthma and Allergy Foundation of America, Washington, D.C.

While the task is challenging, schools possess the unique potential to develop and implement effective policies to deal with food allergens that can serve as a model to the rest of the institutional-hospitality industry.

Jeanne Turner is a freelance writer with more than 10 years of experience writing about the functional properties of food ingredients.