Imagine a busy school lunchroom. Suddenly, a child collapses. One possible cause: a food allergy. Imagine a busy food court on a college campus. A co-ed suddenly begins vomiting. The cause: a reaction to a food allergy.

Imagine a busy corporate dining room. An executive about to leave for an important presentation finishes off his dessert, unaware that it had nuts in the crust. Suddenly, because he is allergic to them, he finds himself breaking out in hives. All these scenarios are possible and could easily happen in your operation. As many as 2.5% of the U.S. population, or 6.8 million Americans, have true food allergies. When exposed to the wrong foods even in ordinary circumstances, these individuals can have serious—sometimes even deadly—reactions.

A greater public awareness of the extent of this problem has made it increasingly important for FSDs to understand which foods cause allergic reactions, what symptoms to look for and, most importantly, how to handle a food allergy incident.

“Understanding food allergies and knowing how to prevent and treat an incident can mean the difference between life and death,” says Anne Muñoz-Furlong, founder/CEO of The Food Allergy & Anaphylaxis Network, a Fairfax, Virginia- based advocacy group.

“Today we’re seeing a lot more foodservice professionals looking to educate themselves about these problems and for ways to minimize the chance of having food allergy incidents in their cafeterias,” she adds. “But there’s still a lot of work to be done.”

The few but mighty

While there’s no definitive data on the prevalence of food allergies, experts say that the largest affected group is children. “We’re definitely seeing an increase in the number of students who report with this problem,” says Carol Kehrer, director of Champ’s Cafe at Charlotte County Public Schools, Punta Gorda, FL. “At one of our Head Start schools last year, half the 140 students enrolled listed some kind of food allergy.” FSDs in healthcare and higher education report similar increases.

“We used to have one or two patients on allergy diets at any given time. Now we have 15 or more,” says Mary Keysor, director of food and nutrition services at Maine Medical Center, Portland. “I am finding more challenges in the retail side of my business as well, as more customers want access to recipe and ingredient lists.”

Muñoz-Furlong says a few theories exist as to why food allergies seem to be more prevalent today.

• There is greater awareness of the problem and quicker diagnoses because of increased media coverage. Symptoms attributed to other causes in the past may actually have been food allergy reactions.

• Changing diets mean that more proteins are being introduced to children at younger ages, sometimes before their immune systems are prepared to handle them; experts say this may result in food allergies; and

• Cleaner environments have eliminated many of the bacteria our immune systems used to battle, so the systems may instead be turning on certain ingested foods.

The eight main culprits

Essentially, a food allergy is an abnormal response by the body’s immune system to a food protein. When the dangerous food is eaten, the body releases histamine and other chemicals to “attack” the food, causing anaphylaxis (a severe reaction). Symptoms generally occur within a period that ranges from a few minutes to up to two hours.

These can include a tingling sensation in the mouth, a swelling of the tongue and the throat, difficulty breathing, an outbreak of hives (large reddish “wheals” that appear suddenly on skin areas), vomiting, abdominal cramps, diarrhea, a drop in blood pressure, loss of consciousness and (in the most severe cases) sudden death.

Food allergies are the leading cause of anaphylaxis outside a hospital setting. Experts estimate that up to 200 deaths per year can be attributed to them. Currently, there is no cure.

It is important to note that true food allergies are different from simply having an “intolerance” to certain foods. For example, a lactose intolerance is not the same thing a food allergy. Food intolerance is an adverse food-induced reaction that does not involve the immune system.

Fortunately, only eight common foods account for 90% of all allergic reactions. Unfortunately, these foods (or by-products of them) appear in a wide variety of menu items, and pre-packed foods, and are common ingredients. They are: milk, eggs, wheat, soy, peanuts, tree nuts, fish and shellfish.

Any person of any age can be allergic to these foods, but Muñoz-Furlong says that infants and younger children are more likely to be allergic to milk and soy; older children to eggs, wheat and peanuts; and adults to fish and shellfish.

Many children grow out of their allergies as they mature (especially those with allergies to milk, soy, eggs and wheat), although some have to continue to monitor what they eat for the rest of their lives. In any case, every foodservice director should familiarize him or herself with the symptoms of food allergies and about what to do in case of an incident.