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Rx For Responding To Food Allergies
Reported by Donna Boss
Food allergies have always been a concern to the staff at Harvard University Dining Services (HUDS) in Cambridge, Mass. Each manager and staff member at the residential houses is introduced to students who have self-identified themselves as having allergies and helps them avoid foods that are dangerous to their health. Which is why an incident last summer surprised everyone on staff and resulted in a review of policies and procedures, including an emphasis on communications.
A student living in a residential house was known by the manager and dining staff to be allergic to nuts. The student ate dinner as
usual, and within moments began to have a severe allergic reaction. She was assisted by managers and staff, who immediately called for emergency medical assistance.
The house manager wanted to determine the cause of the reaction, so she placed small samples of food into refrigerated storage for further examination. Inspection of the foods revealed that the topping on an apple crisp served for dinner contained finely chopped nuts. Normally, nuts were not part of the recipe's ingredients.
After speaking with staff that prepared the apple crisp, the manager discovered that a leftover batch of topping that had been recently prepared for a catered event was used to prepare the dessert. The preparers did not communicate this to the dining
hall staff and the apple crisp was assumed to be the same as has always been served. Therefore, no special identification tag was placed alongside that item and the student who became ill was not informed (as she normally would have been) by staff that
the item contained nuts.
"So what happened and how could we have prevented this situation?" asked Rosemary McGahey, director, Residential Dining at HUDS. "Better communication!"
Following are excerpts from a presentation McGahey made to foodservice colleagues who were meeting at Harvard in April.
"This incident was quite a scare for everyone involved and it sent us a very strong message: We needed immediately to improve
our internal awareness and communication as these relate to food allergies.
"As a result of this situation, as well as the growing numbers of students with food allergies, we continued to step up our effort to become appropriately informed and equipped to assist in managing the special dietary needs of our students on an individual basis.
"Given the seriousness of food allergies and the rapidly increasing number of people with food allergies, we at HUDS have long known that education and collaboration are essential elements in order to ensure healthy eating for our food-allergic guests.
"HUDS has an open kitchen approach to meeting the special dietary needs of our food allergic students. Students are strongly encouraged to identify themselves as food allergic. Our executive chef and UHS dietitian arrange for an individual meeting with each student to determine the specific actions required on our part.Subsequently, the student is given a full tour of our kitchen facilities and is introduced to our managers and key staff members. Often a parent or roommate is part of this process.
"Our relationships with our food allergic students almost alway blossoms into a partnership that provides close individual attention to their dietary needs. For example, two students, a brother and sister, living in a residential house have multiple
life-threatening food allergies, which include milk, eggs, dairy,
nuts, modified food starch and certain oils. Prior to these students' arrival last year as freshmen, our chef met with their mother, who is a doctor, to carefully plan their menus and discuss preparation and storage requirements. We purchased separate cooking equipment including a special grill, individual fryers and a bread maker to meet their needs. Additionally,cooking and serving utensils used for preparing these students'foods were clearly labeled and kept separate from other utensils.
"In September 2001, the siblings moved into separate houses.
The entire process of introduction and training was repeated with
the managers and staff at these houses to ensure that the students could continue to eat well and stay healthy.
"After the incident with the apple crisp topping, our recipe compliance policy was modified to include in its purpose statement our intent to minimize risk as it relates to food allergies. Food allergies is now a required topic at all of our pre-meal meetings with staff. All of our staff is informed of potential allergens and provided with suggestions for substitutions.
Additionally, all newly developed recipes contain a "flag" in the recipe.
"Cross contamination awareness signs can be found at many of our self-service food stations. They create awareness of and stress the importance of using provided utensils and caution against "sharing" of utensils."
Current Allergies
"The most common allergies we see at HUDS involve nuts. Most of our houses have at least one student who is allergic to nuts. Additionally, we have a handful of students allergic to either shellfish or poultry. These cases are fairly easily managed through strict food avoidance and eliminating possible risks of cross contamination.
"Recently, we have seen a slight rise in the number of students with gluten allergies/intolerances.
Here again, food avoidance is key, but we also supplement these diets with specially purchased and prepared breads, grains and pastas.
"Currently, we have four students with Celiac Disease. While similar to a gluten allergy, Celiac Disease is much more serious. It is a chronic disorder affecting the small intestine and is found in individuals who are genetically susceptible. Damage to the small intestine is caused by an immunologically toxic reaction to gluten. Because food cannot be properly absorbed, serious health problems may occur.
"Our chef and dietitian work very closely with these students and our staff to develop menus based on strict food avoidance, as well as sound purchase and preparation of allowed foods. In addition, the mother of a student with Celiac Disease recently sent us the student's favorite cookie recipe. Our staff
prepared the cookies and presented them to the student for his birthday. He was so surprised and thrilled that he sent a personal note of thanks to our staff."
Training and Development
"Three of the key ingredients for any foodservice provider to achieve success with food allergies agreed education, cooperation and teamwork. During our March Workshop 2001, Colleen McSpirit, president of Parents of Children with Food Allergies, conducted a food allergy session, which was mandatory for
staff to attend. She is a parent of a young son with multiple life-threatening food allergies. Colleen provided our managers and staff with many facts about food allergies and anaphylaxis. These sessions were highly acclaimed, prompting recommendations for more!
"Moving forward into the current school year, Colleen's materials were reviewed and discussed during our September kick-off meetings. We discussed the importance of precision and communication, as well as the roles we all play in the successful management of food allergies.
"In October 2001, our training coordinator provided all of our units with a book, 'Consumers Dictionary of Food Additives'. With a growing number of people allergic or sensitive to food additives, it is very important for us to broaden our knowledge about this topic. This book has been helpful in identifying the 'hidden' ingredients commonly found in foods, particularly processed foods. It continues to be a great resource for us.
"This past January, in a follow up session, Colleen once again presented to our managers. She reviewed materials from the previous workshop and provided us with a number of additional informational resources to use as we continue to learn about food allergies. Colleen also spoke about additives and the many common hidden ingredients found in popular foods. Because many of these additives can barely be pronounced, our rule of thumb for all students with food allergies is to 'keep it simple, less is best'!
"This past March we welcomed Colleen back to present another session for Workshop 2002. Little did we know that she would start her session with a pop quiz to test us on how well we knew the information that had been presented and discussed in prior sessions. I'm happy to report that we all passed with flying colors. The fact that most answered the quiz questions correctly speaks to the
commitment to continued learning and individual collaboration with our students.
"At this session Colleen showed us a videotape produced by the National Education Foundation for use by all foodservice providers. It stressed the importance of being knowledgeable and using precision when working with food allergic customers. Most important, the video stressed, 'IF YOU
DON"T KNOW, SAY SO!!!!' This has been a long standing practice of ours here at HUDS.
"We were introduced to the Feingold Program and diet at this session, as well. The program addressed the issues of ADD/ADHD, but also aimed to provide symptom relief to those with food additive sensitivities. The session ended with a discussion on latex, commonly found in gloves used in food preparation and service. Most us of probably know someone with a skin sensitivity to latex but the actual allergy (when ingested) is still fairly uncommon. Because of the skin sensitivity, we have already stopped using latex gloves and now use only vinyl in our units.
Where Are We Going?
"This summer we intend to do a global recipe identification process for all recipes containing the top eight allergens. We will work with our marketing department to produce a larger scale campaign to promote self-identification, as well as an awareness campaign, for the general population. Our kick-off meetings in September will include viewing the most recent video, reviewing previous materials and setting expectations regarding communication.
"Additionally, we hope for Colleen to join the management team once again at our fall kick-off to provide us with any and all important information as we move forward. We will continue collaborating
with Colleen and University Health Services to provide us with the most up to date nutritional and allergy-related information so we can continue to support our students with special dietary needs.
"Our chef will continue working with our food allergic students on menu development and training for our staff. Most important, our managers and staff will continue to build the - individual relationships. As mentioned earlier, teamwork is a key ingredient for successful food allergy management. With our
team of chefs, managers, cooks and front-of-house staff, as well as the unlimited number of outside resources, we hope to continue providing safe, healthy and nutritious food to our food allergic students."
Please send along your advice and/or stories of discovery for identifying food allergies and preventing incidents to [email]Bossdl@aol.com[/email].
