something to be rejected and not tolerated by the body. This process is called ‘sensitization.’ As a result, the body responds by exhibiting symptoms.

These symptoms* can include:

• Skin system: hives, swelling, itching, warmth, redness, rash
• Respiratory system (breathing): coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny itchy nose and watery eyes, sneezing), trouble swallowing
• Gastrointestinal system (stomach): nausea, pain/cramps, vomiting, diarrhea
• Cardiovascular system (heart): pale/blue colour, weak pulse, passing out, dizzy/lightheaded, shock
• Other: anxiety, feeling of “impending doom,” headache, uterine cramps, metallic taste

*Source: www.allergysafecommunities.ca

The most dangerous symptoms and those that can be life-threatening are difficulty breathing or loss of blood pressure. These symptoms should never be ignored and should be treated immediately.

Once an individual has been sensitized to an allergen, each additional time he/she comes in contact with that allergen, it may result in an allergic reaction. In the most severe case, the allergic reaction may cause death. 

Although the actual amount of an allergen that can cause a reaction may change, it can be extremely small (milligrams or less) for some allergic individuals. Even the smallest amount of contact as a result of cross-contamination can produce an allergic reaction.

Common food allergens in Canada

An individual can be allergic to any food, however, Health Canada has identified the most common foods that are known to cause approximately 90 per cent of all food related allergic reactions.

Currently, the list includes:

• Egg
• Milk
• Mustard*
• Peanut 
• Seafood (fish, crustaceans, shellfish)
• Sesame
• Soy 
• Tree Nuts (almonds, Brazil nuts, cashews, hazelnuts, macadamia nuts, pecans, pine nuts, pistachios and walnuts)
• Wheat

*Mustard has been identified as a priority allergen by Health Canada as part of the upcoming amendments to the food labelling regulations on pre-packaged food, which will come into effect on August 4, 2012. (http://www.hc-sc.gc.ca/fn-an/label-etiquet/allergen/project_1220_info-eng.php)

Sulphite, a food additive, has also been identified by Health Canada as a priority allergen that can cause life-threatening allergic reactions. Possible sources of sulphites include dried fruits (such as apricots) and dried vegetables (such as sun-dried tomatoes), and alcoholic beverages such as wine, beer and cider. For more information on sulphites, click here: Sulphite Sensitivity.

Common Food Allergens

A reference chart for Canadian restaurants  - coming soon!

Other types of reactions to foods

While your prime concern is the seriousness of food allergies, you should be also be aware of other types of food reactions, such as intolerances, as they affect the comfort and satisfaction of consumers and can lead to questions about the ingredients used in menu items.

The most common food intolerances are:
 

• Gluten intolerance - this condition is related to celiac disease, a serious auto-immune disorder that causes an individual to be intolerant to the gluten portion in grains and cereals such as wheat, rye, barley and oats. Celiac disease affects approximately one per cent of the Canadian population. It causes severe stomach discomfort in the short term and has been linked to many long-term health problems such as anaemia, osteoporosis and certain cancers.
   
• Lactose intolerance - this painful condition is caused by the inability to digest the natural sugar found in milk/dairy products. Symptoms include cramps, bloating and flatulence.                              

What this means for restaurant operators

Since the 1970s, Canada’s Food and Drug Regulations have specified that pre-packaged foods must include a complete list of ingredients on the package label. Several kinds of food operations, such as restaurants, delis and bakeries, were exempted from these regulations due to the nature of the industry. It was assumed that when food is made on the property, the information could be provided first-hand by the chef or another reliable staff member. If you   sell your product off-premise or pre-package and label it for sale the package must have an ingredient label in accordance with the existing legislation. 

Due to the risks faced by allergic consumers, there is a growing market for allergen-safe food. Also, as more consumers are interested in the foods they eat, there is a higher demand for accurate ingredient information.  

To help ensure a safe experience for those living with food allergies, it is important to take a thorough approach when managing allergens in your establishment.

This approach should include the following steps:

Step One - Ensure constant care and understanding

It is important that your staff understand the seriousness of food allergies and how they can help minimize the risk for allergic consumers. Focus on the common food allergens identified above to make it easier for your staff to understand what foods to be aware of and how to safely manage the food preparation process. Post pictures of the common allergens to reinforce the need for extra care when preparing a meal for an allergic consumer.   

Step Two - Provide staff with access to complete ingredient information

Identifying and communicating ingredient information requires a careful and organized approach, especially when dealing with food allergens. The information must be made available to allergic consumers before they place their order and given to them in a way that is easy to understand. It is important to remember that all ingredient lists or charts must be kept up to date as they can quickly become outdated due to supplier or cooking changes.

The following methods can be used to provide staff with accurate and complete ingredient information:

• Electronic or manual allergen charts- these can be displayed internally but should not be printed for distribution (see sample below).
   
• Electronic or manual recipe files - these are better suited for establishments with several menu choices.
   
• Employees designated to respond to ingredient inquiries- these employees should have direct access to recipes and cooking/prep staff.

EXAMPLE: Food Allergy and Sensitivity Chart

Other things to consider:

• Cover, seal and label plated meals with the name of the consumer and a full list of ingredients.    
   
• Catering contracts should include a section for “Special Dietary Restrictions” to allow for food allergy requests.

Step 3 - Identify and manage the risks

Know your ingredients:

• Acquire full ingredient lists from suppliers, including all common food allergens
• Check ingredient list on pre-packaged food that will be used in recipes
• Do not substitute ingredients not included in the menu
• Follow the flow of food from receiving to serving and identify where allergen risks may exist so that they can be properly managed

Be aware of cross-contamination and how it can occur:

• Staff contact (e.g. hands or gloves)
• Allergen food to non-allergen food contact
• Cooking and serving utensils
• Preparation surfaces (e.g. counter tops, cutting boards)
• Fryer, grills and slicers

Step 4- Establish a clear policy and plans for staff to follow  
  
Develop a policy that staff can easily understand and follow. It should clearly state:

• What process you have put in place to help protect allergic consumers
• How you will communicate complete and accurate ingredient information to both employees and customers
• What allergen management plans have been developed for both the back of the house (BOH) and the front of the house (FOH) 

Step 5- Inform and train staff

It is important that all staff understand how to respond to questions from consumers with food allergies regarding your establishment’s food preparation. To help with this process consider the following:

• Outline how this process is communicated to the allergic consumer
• Define the roles/responsibilities for staff in both the BOH and FOH
• Train all staff, both full-time and part-time, in all areas of the facility (e.g. wait staff, cleaning crew)  

Step 6 - Effectively communicate with consumers

Provide consumers with the information they need to make an informed choice. Here are some simple and effective methods of responding to a consumer’s inquiry for ingredient information:

• Post or show pre-printed allergen charts for allergic consumers (best suited for a fixed menu establishment)
   
• The chef or manager should discuss safe choices directly with the consumer. If there is any doubt about the accuracy of the ingredient information it must be disclosed to the consumer. In some situations it might be appropriate to decline a consumer request if their choice is not deemed safe for them to eat.

Step 7 - Prepare an emergency plan

Every establishment should have an emergency response process for dealing with allergic reactions. This process should be clearly documented and shared with all staff. The plan should provide instructions for staff to call local emergency services (e.g. 911) as soon as possible so that the consumer receives immediate medical attention. A dedicated staff member should be available at all times to ensure the emergency plan is implemented properly and stay with the allergic consumer until emergency services arrive.

Why this is important: Sabrina’s Story

In 2003, 13-year-old Sabrina Shannon (for whom Sabrina’s Law, the Ontario Legislative Act protecting students at risk of anaphylaxis in public schools, was named) died after eating food served in her school cafeteria. A coroner’s inquiry concluded that a dairy product was likely the cause of Sabrina’s allergic reaction and speculated that the French fries she ate were contaminated with a dairy product transferred by serving tongs. 

This tragedy has highlighted the need for ongoing vigilance and focus on key safety measures, for the restaurant industry including:

• Proper training, food handling and serving practices must be in place to reduce the risk of cross contamination
• Detailed ingredient information should be available for all menu items upon request
• All requests for ingredient information should be dealt with in a courteous, timely and accurate manner by a knowledgeable staff person who has access to this information

Summary

Safely managing food allergies is an ongoing process that requires commitment, vigilance and teamwork. With the growing number of patrons being affected by food allergies, it is essential that foodservice and restaurant operators recognize the importance of providing clear and accurate information about the food they prepare and serve, which will go a long way to building customer confidence and loyalty.

Resources

The following organizations can provide information on food allergen management and training services for your establishment.

Canadian Restaurant and Foodservices Association
316 Bloor Street West
Toronto, Ontario
M5S 1W5
T: (416) 923-8416 or 1-(800)-387-5649
F: (416) 923-1450
Email: info@crfa.ca
Website: www.crfa.ca
CRFA’s National Food Safety Training Program (NFSTP): www.nfstp.ca


Anaphylaxis Canada
2005 Sheppard Avenue East, Suite 800
Toronto, Ontario
M2J 5B4   
T: (416) 785-5666 / 1-866-785-5660
Email: trainingservices@anaphylaxis.ca
Website : www.anaphylaxis.ca

Association québécoise des allergies alimentaires 
6020 Jean-Talon Est
Bureau 315
Montréal, Quebec
H1S 3B1
Tele: 514-990-2575
Email: aqaa@aqaa.qc.ca
Website: www.aqaa.qc.ca

Government Resources

Canadian Food Inspection Agency
The Canadian Food Inspection Agency (CFIA) provides a free priority allergen information booklet, entitled, Common Food Allergies, which provides alternate allergen names, possible sources of allergens in common ingredients and frequently asked questions. They also offer a free “Food Recall and Allergy Alert” subscription service. To download or subscribe, visit the CFIA Website at http://www.inspection.gc.ca/english/fssa/labeti/allerg/allerge.shtml

Health Canada
Health Canada provides information and updates on the current food labelling regulations. They also offer, Food Allergies e-Notice, a free electronic service which provides updates on regulatory and scientific developments in the area of food allergens and intolerances in Canada.
Visit their website for more information: http://hc-sc.gc.ca/fn-an/securit/allerg/fa-aa/index-eng.php

Food Allergy Patient Organizations                   
                               
Allergy Asthma Information Association  
295 West Mall, Suite 118
Toronto, Ontario
M9C 4Z4
Tele: 416-621-4571    
Email: admin@aaia.ca
Website: www.aaia.ca

Anaphylaxis Canada
2005 Sheppard Avenue East, Suite 800
Toronto, Ontario
M2J 5B4
T: (416) 785-5666 / 1-866-785-5660
Email: info@anaphylaxis.ca
Website : www.anaphylaxis.ca

Association Québécoise des allergies alimentaires 
6020 Jean-Talon Est
Bureau 315
Montréal, Quebec
H1S 3B1
Tele: 514-990-2575
Email: aqaa@aqaa.qc.ca
Website: www.aqaa.qc.ca

Celiac Resources

Canadian Celiac Association
5025 Orbitor Drive,
Building 1 — Suite 400
Mississauga, ON L4W 4Y5 Canada
Tele: (905) 507-6208 or 1-(800)-363-7296
Email:  info@celiac.ca
Website: www.celiac.ca

Gluten Free Diet: A Comprehensive Resource Guide: www.glutenfreediet.ca

Pocket Dictionary - Acceptability of Foods & Food Ingredients for the Gluten-Free Diet: www.celiac.ca/store.php