Nutritional Consequences of Cross Contamination

A professional & personal perspective Deborah Griffin MINDI

Senior Paediatric Dietician

Almost anything can be an allergen to someone.

Cross contamination from farm to fork

Cross contamination

Storage

Handling

Raw Material

ProcessingAids

Air Particles inManufacturing

Area

Equipment

Supply

Cleaning

Packaging People

Chain

Carelessness

So what foods.........

Adults (1-2%)• shrimp, lobster, crab,

and other shellfish• peanuts and other tree

nuts• fish• eggs

Children (6-8%)• Cow’s milk• Hen’s egg • Soy Bean• Peanut • Tree nut • Fish • Crustaceans

IgE dependent – Acute onsetKey Symptoms/signs/features Course

Urticaria/angioedema Wheal & flare, ingestion or skin contact. Variable by food

Gastrointestinal rxn Acute onset nausea, emesis, pain.Diarrhoea may follow.

Variable by food

Oral Allergy Syndrome Pruritis, mild oedema confined to oral cavity. Wax/wane

Rhinitis Congestion/rhinirrhoea after ingestion or inhalation. Rarely in isolation.

Variable by food

Asthma Bronchospasm after ingestion or inhalation. Variable by food

Anaphylaxis Multiple organ system reaction that can include cardiovascular collapse.

Variable by food.

Food associated, exercise dependent, anaphylaxis

Food triggers anaphylaxis if followed by exercise (wheat & celery)

Unclear

IgE-associated/cell mediated/delayed onset/chronic

Course

Atopic Dermatis Chronic/relapsing pruritic dermatitis. Common in children with food allergy (35%) – cow’s milk, egg, wheat, soya.

Resolves in child hood

Eosinophilicgastroenteropathies

Symptoms vary in relation to site affected. Oesophageal pain and dysphasia. Ascites, weight loss, oedema and obstruction.

Variable

Cell mediated/delayed onset/Chronic

Key symptoms/signs/features Course

Dietary protein enter colitis

Chronic exposure: emesis, diarrhoea, poor growth, lethargy.Common causes: cow’s milk, soya, grains

Resolves 1-3 years

Dietary protein prostates

Mucous bloody stools. Commonly caused by cow’s milk.

Resolves 1 year

Dietary protein naturopathy

Malabsorption, oedema, emisis, poor growth. Common cause: cow’s milk.

Resolves 1-2 years

Coeliac Disease Malabsorption, diarrhoea PERMANENT

Dermatitis Herpetiformis

Skin lesions PERMANENT

EU Guidelines – Common Allergens• Cereals containing gluten• Crustaceans • Egg• Fish • Peanuts • Milk • Nuts (Hazel nut, brazil nut, almond, walnut, cashew, pecan, pistachio and

macadamia) • Soya • Sesame • Celery • Mustard• Sulphur Dioxide/Sulphites

Directive 2003/89/EC

Consequences of cross contamination

Discomfort – nausea, vomiting, pallor, pain, diarrhoea, asthma, mal-absorption, oedema, nutrient deficiency, poor growth, weight loss, tiredness,anaphylaxis..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................DEATH

Nutritional Consequences

• Nausea and vomiting – decreased dietary intake

• Malabsorption - diarrhoea• Omitting food groups – missing nutrients• Poor growth • Nutrition related diseases – anaemia,

osteoporosis etc. • Self restricted eating habits

Baby Sean

• Bottle fed baby – known milk allergic – on prescription milk free formula

• Mother out shopping – asks for baby bowl with no butter in potatoes

• Baby bowl contains – potato, carrots and gravy • Baby starts spitting out after a few mouthfuls and

becomes unsettled. Rash develops on face. • What’s to blame?

Alice – Known prawn allergy

• Out with friends for a meal in a Chinese restaurant

• Restaurant informed of allergy • Variety of starters ordered – no prawn’s??? • Within minutes of eating – Alice unwell and

having difficulty breathing – administered Adrenaline pen – ambulance to hospital

• Where was the problem? Chef cooked Alice’s starter separately........

Teenage Tom

• Known nut allergic since childhood • Started secondary school • Friday lunch out – chipper/deli • Roll this occasion – ham, cheese, coleslaw • Immediate swelling of lips – difficulty

breathing • Rushed to hospital • Cause of reaction???

CASPER

Casper the friendly ghost.........

• 3 month history of excessive tiredness• Bone and muscle pain • 6 week history of nausea and stomach pain• Made worse by morning scones................• Got to know every bathroom in the hospital • Self restricting diet with a few months – gone off

bread, pasta, cereals.............. • Einstein moment – COELIAC DISEASE (had to

convince the GP!!!!)

• Diagnosis on bloods and biopsy.• Immediate gluten free diet (STRICT) • Packed lunches and breakfast before work!• Feeling better after 1 month – no nausea and

stomach pain • Friends birthday – decided to brave eating out • Informed restaurant on booking – informed waitress

on arrival

• Played safe – ordered tomato and mozzarella starter and steak (garlic stuffed, wrapped in bacon) and salad main, latte rather than dessert.

• Beautifully presented meal, 20 minutes later – stomach cramps and nausea........................

• The cause wasn’t the wine!!! • Any idea’s??

Gluten free

• Intolerance to gluten found in wheat, barely and rye.

• Proteins to blame Gluten, Hordein and Secalin.• Coeliac disease is NOT an allergy!• Due to cross contamination oats not advised, also

some individuals sensitive to Avenin. • Natural gluten free foods. • Gluten free foods – Codex Standard • Changes to codex

Age Group Symptoms

Infancy <2yrs Diarrhoea/SteatorrhoeaVomitingAnaemia Cranky Bloated BellyWasting

Childhood 2-16 yrs Poor growth Delayed pubertyAnaemiaOsteomalaciaDiarrhoea/SteatorrhoeaLethargyMouth ulcers

Adults Short stature Anaemia (especially in pregnancy)Osteoporosis DyspepsiaWeight loss Mouth UlcersDiarrhoea/SteatorrhoeaInfertility Dermatitis Herpetiformis TetanyHypoproteinaemia

Active coeliac disease

• Impairs absorption of nutrients in the upper small intestine

• Mainly iron, folate and calcium • Ongoing inflammation and damage in the

intestine lining increases the need for tissue repair and increasing the risk of several cancers of the intestine

Short term consequences

• Generally uncomfortable for patient • Pain, nausea, vomiting, diarrhoea • Just because it doesn’t cause an issue when

eaten – doesn’t mean it is not causing damage!!

Long term consequences

• Mal-absorption • Nutrient deficiency • Poor Growth • Ill health • Gluten sensitivity in other organs e.g. skin –

dermatitis herpetiformis and rarely the nervous system – gluten ataxia

• Death – cancer

• Individuals educated on what to look for on a label.

• Issue with eating out mainly hence many people restrict eating outside of home – restaurants and deli’s.

• Staff education on ingredients, storage, preparation, cooking, serving! More importantly identification of probable and remote causes of cross contamination. Management plan.

• Language issues – foreign staff.

On being a crumb grouch

• Living with a food allergy/intolerance impacts dramatically on life.

• Once advised easy to achieve in the home. • Difficult when out for a variety of reasons...... • Not just asking about ingredients to be a pain!!• Impact real – and not enjoyable. • For those with anaphylactic allergy – life

threatening.

You don’t need to eat it...........

Latex gloves

Washing up /cleaning solutions

Food packaging

Dinners on me!

Any questions?