Nutritional Consequences of Cross Contamination
A professional & personal perspective Deborah Griffin MINDI
Senior Paediatric Dietician
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 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!