Circle of Responsibility

 A queasy stomach, hives, a rash, or even difficulty breathing… could this be a food allergy?  Food allergies are becoming increasingly common in the United States. Scientists estimate that approximately 12 million Americans today suffer from true food allergies (1).

 

Because different people react to foods in varying degrees, it is important to find out exactly what foods you’re allergic to (if any) for your safety and well being.  About two percent of adults suffer from food allergies, and although six percent of children are diagnosed with food allergies, many outgrow the symptoms before adulthood (1). So, if food allergies are fairly uncommon, why do millions of adults report that they are allergic to certain foods? The bottom line is allergies are easily misdiagnosed and the term is often applied very liberally to most any physical symptom associated with food intake.

First, let’s clarify what we mean by food allergy, which is different than food intolerance.  Many people think the terms food allergy and food intolerance mean the same thing; however, there is a difference.

 

A food intolerance is an adverse food-induced reaction that does not involve the immune system. Lactose intolerance is one example of a food intolerance. A person with lactose intolerance lacks an enzyme that is needed to digest milk sugar. When the person eats milk products, symptoms such as gas, bloating, and abdominal pain may occur. Other common intolerances include gluten, sulfites and monosodium glutamate (MSG).

 

A food allergy occurs when the immune system reacts to a certain food that the body mistakenly believes is harmful. The most common form of an immune system reaction occurs when the body creates immunoglobulin E (IgE) antibodies to the food. The next time that food is consumed, the immune system releases massive amounts of chemicals, including histamine, in order to protect the body. These chemicals trigger a host of allergic symptoms that can affect the respiratory system, gastrointestinal tract, skin, or cardiovascular system.

 

At the present time, there is no cure for food allergies. Allergic reactions range from the mild discomfort of a rash or runny nose to more serious and potentially fatal anaphylactic reactions where breathing can become difficult. Avoidance is the only way to prevent an allergic reaction. Although an individual could be allergic to any food, such as fruits, vegetables, and meats, they are not as common as the following eight foods, which account for 90 percent of all food-allergic reactions (1):

 

Top Food Allergens

Milk, egg, peanut, tree nuts (walnuts, cashews), fish, shellfish, soy, wheat

 

Making Choices with Your Allergies in Mind*

*The following is a partial list of ingredients to be used as a general guide. Consult your health care professional for more information.

 

Ingredients that indicate milk: artificial butter flavor, butter, butter fat, butter oil, buttermilk, casein, caseinates, cheese, cream, cottage cheese, curds, ghee, half & half, lactalbumin, lactulose, milk (in all forms), nougat, pudding, rennet casein, sour cream, sour cream solids, whey, ice cream, sherbet, yogurt. Milk protein: caramel, chocolate, flavorings, high protein flour, lactic acid starter culture, lactose, some luncheon meats, hotdogs and sausages, margarine, non-dairy margarine.

 

Ingredients that indicate egg: albumin, albumen, egg (all forms), eggnog, globulin, livetin, lysozyme, mayonnaise, meringue, surimi, custard, soufflé, quiche, Caesar dressings, some egg replacers.

Egg protein: flavoring, lecithin, macaroni, marzipan, marshmallows, nougat, pasta.

Ingredients that indicate peanut: artificial nuts, beer nuts, cold pressed, expelled or extruded peanut oil, goobers, ground nuts, mandelonas, mixed nuts, monkey nuts, nutmeat, nut pieces, peanut, peanut butter, peanut flour, peanut protein, hydrolyzed peanut protein.

Peanut protein: African, Chinese, Indonesian, Mexican, Thai and Vietnamese dishes as well as baked goods, candy, chili, eggs rolls, dried soups, enchilada sauce, flavoring, marzipan, nougat.

 

Other considerations….
Artificial nuts can be peanuts that have been deflavored and reflavored with a nut, such as pecan or walnut.

Arachis oil is refined peanut oil that is used in non-food products such as skin creams.
It is advised that people with a peanut allergy should peanut-allergic patients avoid chocolate candies unless they are absolutely certain there is no risk of cross-contact during manufacturing procedures.
Experts advise patients with peanut allergy to avoid tree nuts as well.
Many brands of sunflower seeds are produced on equipment shared with peanuts.
Peanuts can cause severe allergic reactions. If prescribed, carry epinephrine at all times.

 

Ingredients that indicate tree nuts: almonds, artificial nuts, Brazil nuts, caponata, cashews, chestnuts, filbert/hazelnuts, gianduja, hickory nuts, macadamia nuts, mandelonas, marzipan, almond paste, natural nut extracts, nan-gai nuts, nut butters, nut meal, nutmeat, nut oil, nut paste, nut pieces, pecans, pesto, pine nuts (also Indian, piono, pinyon, pignoli, pignolia or pignon nuts), pistachios, pralines, walnuts.

 

Some Hidden Sources of Tree Nuts
Artificial nuts can be peanuts that have been deflavored and reflavored with a nut, such as pecan or walnut. Mandelonas are peanuts soaked in almond flavoring.
“Natural” and “artificial flavoring” may contain tree nuts.
Mortadella, a version of smoked sausage, may contain pistachio nuts.
Tree nuts have been used in many foods including barbecue sauce, cereals, crackers, and ice cream.

 

Ingredients that indicate wheat: bran, bread crumbs, bulgur, couscous, cracker meal, durum, farina, flour (all-purpose, bread, cake, durum, enriched, graham, high-gluten, high-protein, instant, pastry, self-rising, soft-wheat, steel ground, stone ground, whole wheat), gluten, kamut, matzoh, matzoh meal, pasta, seitan, semolina, spelt, vital gluten, wheat (bran, germ, gluten, malt), whole wheat berries, vegetable gum.

Wheat protein: flavoring, hydrolyzed protein, soy sauce, starch, surimi.

 

Allergic reactions to fish and shellfish are commonly reported in both adults and children. It is generally recommended that individuals who have had an allergic reaction to one species of fish, avoid all fish. The same rule applies to shellfish. If you have a fish allergy but would like to have fish in your diet, speak with your allergist about the possibility of being challenged with various types of fish.

 

Ingredients that indicate shellfish: abalone, clams, cockle, crab, crawfish (crayfish, ecrevisse), lobster, mollusks, mussels, octopus, prawns, scallops, shrimp, snails, squid.

Shellfish protein: bouillabaisse, cuttlefish ink, fish stock, flavoring, seafood flavoring, surimi.

 

Allergic reactions to fish and shellfish can be severe and are often a cause of anaphylaxis (potentially fatal) so keep in mind:
Cross-contamination may occur with any other seafood during the catching and storing processes.
Caesar salad dressings and steak or Worcestershire sauces often contain anchovies.
Carry medications in case of accidental exposure.

Ingredients that indicate soy: edamame, hydrolyzed soy protein, miso, natto, shoyu sauce, soy (albumin, soy fiber, soy flour, soy grits, soy milk, soy nuts, soy sprouts), soya, soybean, soy protein, soy sauce, Tamari, Tempeh, texturized vegetable protein (TVP), tofu, many Asian cuisines, vegetable broth, vegetable gum, vegetable starch.

Soybeans and soy products are found in baked goods, canned tuna, cereals, crackers, infant formulas, sauces, and soups. At least one brand of peanut butter lists soy on the label.

 

Studies show that most soy-allergic individuals may safely eat soybean oil (not cold pressed, expeller pressed, or extruded oil) and soy lecithin. Patients should ask their doctors whether or not to avoid these ingredients. Soybeans alone are not a major food in the diet, but because they're in so many products, eliminating all those foods can result in an unbalanced diet. Consult with a dietitian to help you plan for proper nutrition.

 

How can you determine if you have a food allergy or intolerance?

Well, the first step is to seek professional advice from an allergist certified by the American Board of Allergy and Immunology. You may be able to “scratch” the surface of your symptoms on your own, but to truly get to the root of the problem, it’s best to go to the experts. Once you identify your individual issues, you will want to seek the advice of a registered dietitian to really understand your dietary needs. Simply eliminating foods based on self-diagnosis or a hunch can leave you frustrated as well as nutrient deficient.

 

If you know you have a food allergy, follow these steps:

• Know what you're eating and drinking. Be sure to read food labels and don’t be afraid to ask questions. The Bon Appétit chefs are your best source of information about foods served in our cafés.
• If you have already had a severe reaction, wear a medical alert bracelet or necklace. Make sure people you spend time with are aware of your allergy and know what to do in case of emergency. No matter how cautious you are, talk with your doctor about carrying emergency medications in case of accidental exposure.

Bon Appétit’s approach to food is unique in the industry. We are dedicated to providing the freshest, highest quality selections that are planned specifically for each of our sites. As a result, we do not operate from a corporate recipe book that outlines all of our ingredients. If you have concerns, however, our chefs and/or registered dietitian will be glad to work with you on your personal choices. Since everything is cooked from scratch onsite, they can easily tell you what ingredients are in a specific dish and make modifications if necessary. Food allergens are present in all Bon Appétit cafés. If you have a food allergy, it is important that you talk with the manager at your site about how to safely eat in our café.