Nutrition Connection: Food Intolerances and Allergies

(reprinted from Dietary Manager, April 2010)

As dietary managers visit newly-admitted clients to learn about food preferences, they are increasingly confronted with food dislikes, food intolerances, and food allergies. The question is, how do you know the difference between these? If an individual says they are allergic to milk, are they really allergic to it, do they have intolerance to it, or do they just not want to drink milk?

Food Allergies
A food allergy is an abnormal reaction to food that involves the immune system. This reaction may vary in severity from mild to fatal. A mild reaction may be hives or eczema around the mouth. If the allergy affects the GI tract, nausea, vomiting, or diarrhea may occur. A more severe allergic reaction may result in difficulty breathing, coughing, or wheezing. The most severe reactions can result in anaphylaxis and can be fatal. The most common food allergies, often called the “Big 8,” are:

• eggs
• fish
• milk
• peanuts
• shellfish
• soy
• tree nuts
• wheat

Only 1-3 percent of adults actually have true food allergies. There is a 50 percent increase in peanut allergies in the US. Food allergies do not cause migraines, behavior problems, developmental disorders, arthritis, seizures, or inflammatory bowel disease.

Food Intolerances
A food intolerance is an abnormal response to a food that does not involve the immune system. While the symptoms may be similar to food allergies – hives or GI problems – they are generally mild and may only be inconvenient. Rarely are they fatal. The most common food intolerances are lactose, gluten, and monosodium glutamate (MSG). A person with an intolerance to the sugar in milk – lactose – may experience nausea, cramping, and diarrhea after eating dairy foods. These individuals can usually drink milk or eat dairy foods in small amounts without having any reaction. When a person with gluten intolerance (or celiac disease) eats foods containing gluten, an immune reaction occurs in the small intestine resulting in an inability to absorb nutrients from food. Celiac disease affects an estimated 1 out of 133 people. MSG is commonly found in soups, sauces, and Chinese foods and may cause headaches in people who have an intolerance to MSG.

Food Dislikes
A food dislike is a food that the individual avoids by personal preference. There is no intolerance or allergic reaction when this food is consumed. Liver frequently is a dislike.

Identifying a Food Allergy
If an individual believes they have a food allergy, it’s important to identify the true food allergies before eliminating any food from the diet. A good food record or diet history indicates the food, the timing of the reaction after eating the food, the reaction symptoms, and whether the reaction is repeatable. This is all valuable information to take to an allergist. Blood and skin testing can be done by an allergist to correctly diagnose the food allergy. Food allergies can also be diagnosed in part by a double blind “food challenge”. During this supervised test, foods are introduced and the patient is observed for an allergic reaction to that food.

The only treatment for a food allergy is to avoid the food that the individual is allergic to. This is not an easy task. Food labels must be carefully read to uncover all the forms of that food. In addition, kitchen staff must be careful to not cross-contaminate foods so allergens are not transferred from food containing an allergen to the food served to an individual. Some ways that cross-contact occurs are cooking different types of food in the same fryer oil and putting food on surfaces that have touched allergens.

The Bottom Line
If you are responsible for providing food to an individual with a food allergy, know the extent of their allergy, read food labels carefully, and train your employees in safe food practices.

Highly Allergenic Ingredients
Following are technical and scientific names of highly allergenic ingredients, as well as ingredients to avoid:

The following foods may contain highly allergic ingredients:

Foods Containing Corn or Corn Products
Corn/corn products are found in many foods. It is important to carefully and consistently review labels to look for products that contain corn. These foods most likely contain corn:

• Alcohol, including bourbon, blended scotch, and some beers
• Cereals
• Chocolate milk
• Baked goods
• Candies
• Canned fruits
• Confectioners’ sugar
• Ice cream
• Jams and jellies
• Pickles
• Tartar sauce
• Deli meats
• Processed meats, including hot dogs
• Egg substitutes
• Peanut butter
• Sodas and other bottled beverages
• Fruit drinks and sweetened fruit juices
• Taco shells
• Packaged potatoes
• Pasta products
• Polenta
• Frozen pancakes
• Frozen waffles
• Frozen breads
• Canned or dried soups
• Margarines
• Salad dressings
• Caramel and vanilla extracts
• Spaghetti sauce
• Ketchup
• Powdered coffee creamers
• Teas
• Yeast
• Snack foods
• Syrups
• Flavored yogurt
• Processed fried foods, such as fish sticks, potato puffs, French fries, etc
• Some produce (some produce is coated with a corn-based wax)

Ingredients to Avoid
The following ingredients do not definitely contain corn, but are likely to. For instance, malt sometimes is made from barley, but sometimes it’s made from corn. Corn oil has caused a reaction in a few people, but it is rare. Ingredients to avoid include:

• Acetic acid
• Ascorbic acid
• Baking powder
• Bleached flour
• Caramel coloring or flavoring
• Citric acid
• Corn
• Corn alcohol
• Corn flour
• Corn meal
• Cornstarch
• Corn sweetener
• Corn syrup
• Corn syrup solids
• Crystalline fructose
• Dextrin
• Dextrose
• Food starch
• Fructose
• Golden syrup
• Grain alcohol
• Grits
• Hominy
• Inositol
• Invert sugar
• Lysine
• Maize
• Malt
• Maltodextrins
• Masa
• Modified food starch
• Modified gum starch
• Monosodium glutamine
• Olestra/Olean®
• Polydextrose
• Popcorn
• Sorbitol
• Treacle
• Vanilla extract
• Vegetable monoglycerides or diglycerides
• Vegetable gum
• Vegetable protein
• Vegetable starch
• Vinegar
• Xanthan gum
  

Foods Most Likely to Contain Tree Nuts
If you have food nut allergies, these are foods that may contain tree nuts (check the labels):

• Cereals
• Crackers
• Cookies
• Candy
• Chocolates
• Energy bars
• Granola bars
• Trail mixes
• Baked goods, such as doughnuts and muffins
• Flavored coffee
• Frozen desserts
• Marinades
• Barbecue sauce
• Some cold cuts, such as mortadella
• Popcorn
• Specialty cheese spreads
• Some alcoholic beverages (Because the FDA does not have jurisdiction over alcohol, manufacturers of alcoholic beverages do not need to follow the same labeling laws regarding listing of pine nuts as ingredients.)

In addition to avoiding actual pine nuts, individuals with pine nut allergies also should watch out for the following ingredients:

• Marzipan/almond paste
• Gianduja
• Nougat
• Nu-Nuts™
• Artificial nuts
• Pesto
• Nut meal
• Tree nut oil, such as walnut oil or pecan oil
• Natural extracts, such as pure almond or wintergreen extract (artificial or imitation extracts are usually safe)
• Nut paste
• Nutella®
• Pesto sauce
• Hazlenut liqueur and coffee
• Frangelico® liqueur
• Almond mocha
• Amaretto
• Nutmeat
• Praline
• Caponata

Cross-contamination is most likely found in the following foods:

• Cookies
• Candies
• Cereals
• Ice cream, especially chocolate and mint flavors
• Dried soups
• Nut butters
• European chocolates

Want to learn more? Check out these resources:
American Academy of Allergy, Asthma and Immunology – www.aaaai.org
Food Allergy & Anaphylaxis Network – www.foodallergy.org
Food Allergy Initiative – www.faiusa.org
Food Allergy Labeling and Consumer Protection Act – www.cfsan.fda.gov

Sources
1. ADA FNCE 2009 session: The Rising Tide of Food Allergies…Are you Ready? Session presented by Marion Groctch, MS, RD, CDN and Lynn Christie, MS, RD
2. RD411.com

By Linda S. Eck Mills, MBA, RD, LDN, FADA

Linda S. Eck Mills, MBA, RD, LDN, FADA is a professional speaker, career and life coach, and author of the book From Mundane to Ah Ha! Effective Training Objects. Mills directs the DMA Program at Lehigh Carbon Community College (Schnecksville, PA), and is a consulting dietitian in long-term care. Contact her at Linda@dycomserv.com or www.dycomserv.com