1. Food AllergiesKarlijn Koudstaal
Crowne Plaza South – Attend
Amsterdam May 16, 2014
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2. This presentation
• Introduction
• Legislation on food allergens
• In practice: Exercise 1
• Short movie
• Into the deep
• In practice: Exercise 2
• The end
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3. About me
• Karlijn Koudstaal (28yr)
 Nutrition and Dietetics
 Master Health Sciences
• Working at a women’s healthclub in
Amsterdam
• Worked parttime for Crowne Plaza Hotel
(food and beveridge department)
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4. Let’s find out some more…
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5. An allergy is…
 .. an abnormal reaction by a person's
immune system against a normally harmless
substance
 .. a multi-organ disease affecting
approximately one third of the population
• Skin Allergies
• Respiratory Allergies (nasal allergies/hay fever)
• Food Allergies
• Insect Allergies
• Drug and Medicine Allergies
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6. Allergies in the hotel
• In many forms and from many resources!!!
• Just a few examples:
o Dust
o House mites
o Perfumed sprays
o Washing powders
o Food
o Etc…
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7. Today: all about food
• Food allergen labelling
 From December 13, 2014:
“The new regulation, which was published in October 2011,
will build on current allergen labelling provisions for
prepacked foods and will introduce a new requirement for
allergen information to be provided for foods sold non-
packed or prepacked for direct sale.”
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8. The 14 food allergens which must be
declared whenever they are used
1. Eggs
2. Milk
3. Fish
4. Crustaceans (e.g. crab,
lobster, crayfish, shrimp,
prawn)
5. Molluscs (e.g. mussels,
oysters, squid)
6. Peanuts
7. Tree nuts (almonds,
hazelnuts, walnuts, cashews,
pecans, Brazils, pistachios,
macadamia nuts,
Queensland nuts)
8. Sesame seeds
9. Cereals containing gluten
(i.e. wheat, rye, barley, oats,
spelt, kamut, or their
hybridised strains)
10. Soybeans
11. Celery and celeriac
12. Mustard
13. Lupin
14. Sulphites (at concentration (
of > 10mg/kg)
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9. Exercise 1:
What’s on your menu?
1. Which allergenic foods can you find?
2. Do we know some products to replace
them?
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10. Movie
http://www.youtube.com/watch?v=7jXDMcqsc38
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11. What is a food allergy?
• An immune reaction that occurs after
eating a particular food of food
component, that body thinks is harmful
• Also known as a food hypersensitivity
 Auto immune disease
• Elicits an abnormal immune response to a harmless
food substance
• Allergen is usually a protein
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12. Classification and Response
• Allergic reactions are classified into non-IgE-
mediated, IgE-mediated or mixed response:
Non-IgE
- Slower in onset, primarily gastrointestinal reactions
IgE mediated
- Causes histamine and other chemicals to be released
which trigger allergy symptoms
- Rapid in onset, symptoms include anaphylaxis
https://www.youtube.com/watch?v=AKVjKC3u9hk
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13. Symptoms 1
• Symptoms may vary from
person to person and not all
reactions appear the same
• They can occur seconds to
hours after ingestion of the
allergen
Skin Respiratory Tract Gastrointestinal
Tract
Swelling of lips,
tongue and face
Itching or tightness
of throat
Abdominal pain
Itchy eyes Shortness of breath Nausea
Hives Dry of raspy cough Vomiting
Rash Runny nose Diarrhea
Eczema Wheezing May 16, 2014 13

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15. Anaphylactic shock /
Anaphylaxis
• Most severe allergic reaction
• Within minutes of exposure
• Involves multiple systems at the same time
• Potentially fatal if medication not given
promptly
• Peanut/ tree nut allergies in combi with
asthma give the highest risk
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16. May 16, 2014Food Allergies 16

17. Anaphylaxis First Aid
1. Place victim in comfortable position
& call an ambulance immediately.
2. Victim needs epinephrine to
counteract reaction. If victim is a
known sufferer he/she may have an
epinephrine injection. Help to
administer this or you give the
injection.
3. If victim becomes unconscious
place in recovery position. Monitor
victim’s breathing and circulation, and be
prepared to resuscitate if necessary.
http://www.youtube.com/watch?v=b-87XDNeoGI
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18. Food Allergy vs
Food Intolerance
Examples: Coeliac disease (gluten)Examples: milk, egg, peanut etc
Examples: lactose (milk)intolerance
hypersensitivity toward sulphites
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19. Allergenic foods
De famous 8 food allergens:
 Milk
 Eggs
 Soy
 Peanuts
 Tree nuts
 Fish
 Shellfish
 Wheat (Gluten)
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20. Cow’s milk allergy
• Is the most common food allergy
• Common among infants/young children
 It usually outgrow during childhood, occasionally it can be
lifelong and severe
• Milk can cause life-threatening (anaphylactic)
reaction, so any amount might cause problems!
 Goat’s and sheep’s milk are usually not suitable. Horse and
camel milk is often tolerated. Alternatives: soybean, oat
and rice milk.
• See list for products!
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21. Lactose intolerance
• Cow’s milk allergy often confused with lactose
intolerance (non immune reactions) - more often
in adulthood
o Inability or insufficient ability to digest lactose, the sugar
found in milk(products), because of a deficiency of the
enzyme lactase.
• Not all people with lactose intolerance have
digestive symptoms, but those who do, may have
lactose intolerance.
• Most people can tolerate some amount in their diet
(might feel uncomfortable).
• See list for products!
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22. (Chicken) egg allergy
• Common among young children(2%)vs adults(<1%)
 It usually outgrow during childhood, occasionally it can be
lifelong and severe.
• More (violent) reactions to egg white than to egg
yolk
• Raw or cooked:
 some egg-allergic children can eat well-cooked egg (in cake),
but not raw/lightly cooked egg. Others are also allergic to well-
cooked eggs (this type more likely to be severe)
 Cross reactive with other birds (duck eggs, goose eggs and
quail eggs)
• See list for products!
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23. Soy allergy
• It is not known how common soy allergy is.
 Children with eczema and suspected food allergy
have 1-4 % chance of soy allergy. Adults less likely to
have soy allergy.
• Soy is added to prosecessed and
commercial foods to improve nutritional
quality
• Soy oil and soy lecithin usually safe. If very
sentive, then avoid
• See list for products!
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24. Peanuts and Tree nuts
• About 0.5-1% of all children in western countries
has peanut allergies. Most children (±75%) do
not outgrow this allergy. Prevalence seems to
increase.
• Peanuts are not related to tree nuts, but there is
high chance of cross-contamination.
• A minimal amount: might have severe reactions
 Refined peanut oil should be safe, but no guarantee,
so avoid by high risk
 Seeds or seed butters may be alternatives
• See list for products!
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25. Fish and Shellfish allergy
• About 1% of population allergy to fish or shellfish.
 Is more common in countries where people often
eat fish
• Usually someone does not outgrow these allergies
• After peanuts & tree nuts allergy this is most
common cause of anaphylaxis
• The allergenic protein in fish is very heat stable. The
protein remains allergen, even after cooking.
• Fish oil likely to be contaminated with protein, so
avoid if allergic
• See list for products!
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26. Wheat allergy
• Wheat allergy is not as
common as gluten
sensitivity. Precise
numbers are unknown.
 possibly more common in
children
• Allergic reactions to
wheat are known to lead
to anaphylaxis.
• Other grains are well
tolerated.
• In contrast to Celiac
disease.
Non-Wheat Grains Gluten Free Grains
Amaranth Amaranth
Arrowroot Arrowroot
Barley Buckwheat/Kasha
Buckwheat/Kasha Corn
Corn Lentil or pea flour
Lentil or pea flour Millet
Millet Nuts/seed meal or flours
Nuts/seed meal or flours Potato
Oat Quinoa
Potato Rice
Quinoa Soy flour
Rice Tapioca
Rye Pre-made wheat/gluten
free flour mixes
Soy flour
Tapioca
Pre-made wheat/gluten
free flour mixes
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27. Gluten intolerance
(gluten sensitivity)
• It is not an allergic disorder, but a common
intestinal disease (also known as Celiac disease)
 In the Netherlands 16,000 people are diagnosed
 Symptoms are not always recognized
• Gluten is a type of protein found in most grains,
cereals and breads
 Found in grains like: wheat, balrey, rye and spelt
• Any amount of gluten can cause symptoms
• See list for products!
https://www.youtube.com/watch?v=EmZczwtsbVc
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28. So…allergies…What to do?
 The smallest amount: can cause severe symptoms!
 Read the food labels!
 Know about the allergens on the menu!
 Always discuss with the guest!
 Ensure: all work equipment is cleaned
 Wash hands!
 Ensure: no cross contamination during preparation and
serving. If a dish comes into contact with that specific
allergen, you can’t present it to the allergic guest
 Know the anaphylaxis First Aid!
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29. Exercise 2:
How would you do it?
• A table with 8 people
 2 of them have food hypersensitivity
o 1 has lactose intolerance
o 1 has peanut allergy
• How to handle this?
• We start with the waiter, continue to the
kitchen and end with happy and satisfied
guests.
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30. The End
Any questions?
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31. Thank you for your attention
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