Managing allergens in aged care: What chefs need to know
National food allergy rates have increased fourfold over the past 20 years, and the aged care sector needs to brace for an influx of residents with food allergies and intolerances.
We spoke to Ingrid Roche, an Accredited Practising Dietitian with the National Allergy Council about what chefs, cooks and dining staff need to know when it comes to food allergy management.
'We expect that there will be more adults with allergies coming into residential aged care in the coming years,' Ingrid says.
Older studies based on hospital admissions estimate that around 2–3% of Australian adults have a food allergy; however more recent surveys published in peer-reviewed medical literature put that figure at around 5–10% among older adults, with many developing late-onset allergies during adulthood.
In practical terms, based on these recent figures, a 200-bed facility can already expect at least 10 residents with a diagnosed food allergy. In addition to food allergies, chefs are also managing other intolerances and special dietary needs arising from a range of medical conditions such as coeliac disease, and renal conditions, as well as cultural preferences and texture-modification requirements.
The difference between food allergies and intolerances
A food allergy is an immune response that can be triggered by even trace amounts of an allergen and cause either mild reactions such as hives, vomiting or swelling, or life-threatening anaphylaxis involving breathing difficulties and cardiovascular collapse. Coeliac disease is also an immune reaction. While it is not immediately life-threatening, it can cause serious long-term problems, including osteoporosis and an increased risk of
type 1 diabetes.
Chefs and cooks must apply the same rigorous standards when managing both food allergies and coeliac disease during food preparation.
As Ingrid points out, food intolerances, by contrast, are usually digestive and not life-threatening.
‘Somebody who has a food intolerance, for example to lactose, may often feel unwell, or display physical symptoms that affect their wellbeing and quality of life.’
There are two common points of confusion around milk and wheat allergies, and intolerances:
- Lactose-free milk still contains milk protein and is unsafe for anyone with a milk allergy.
- Wheat allergy, which can be immediately life-threatening, is often mistakenly regarded as less serious than coeliac disease.
How allergens and intolerances affect the elderly
Older residents present unique challenges. Ingrid notes that allergies aren't necessarily limited to the 11 mandatory allergens that must be declared in Australia and New Zealand. Reactions to popular fruits and vegetables such as kiwi fruit, tomato, mushroom, onion and garlic are not uncommon, and around 170 foods have been documented in medical literature as possible triggers of allergic reactions.
'One of the most important things for chefs, cooks and dining staff to realise is that a person can be allergic to absolutely any food, not just the ones we hear about all the time.’
Co-factors matter too. NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen, as well as alcohol, illness or a recently introduced medication can lower a resident’s reaction threshold, meaning an accidental exposure can be far more severe than expected. Both clinical and food service staff therefore need to understand residents’ allergies and/or intolerances so reactions can be prevented. All staff should also know what to do in
an allergic emergency.
IDDSI considerations
Texture-modified diets add another layer of complexity.
Ingrid recommends
- All staff who plan, prepare and serve food should be trained in food allergen management.
A well-trained workforce helps keep residents with food allergies safe.
- Using colour coded equipment
Consistently using colour-coded equipment when preparing food allergy meals is one way of reminding staff to focus on preventing allergen cross contamination and checking ingredients. Although there is no industry standard for colour coding, purple is widely used as the ‘allergy colour’.
- Properly cleaning equipment, serving items, crockery and cutlery
All items used to prepare and serve food (including coloured allergy equipment) must be thoroughly cleaned so no trace amounts of any ingredient can be transferred to another meal. Pay particular attention to blenders and mixers.
- Clearly labelling texture-modified foods with all ingredients listed
Because ingredients cannot be identified visually once food has been texture-modified, it is essential to check the ingredient list. This is particularly important when thickeners and energy or protein boosters are added to texture modified meals - they can introduce allergens such as milk and wheat.
Systems, digital tools and shared responsibility
'It's not only the cooks and chefs; allergen safety is everyone's responsibility.'
Keeping residents with food allergies safe requires a systematic approach. Food allergen management should be embedded in the facility’s policies and procedures relating to resident care, activities and food provision. Allergies must be recorded as part of a resident’s admission. This must be communicated to nursing and care staff, to food service teams and any other support personnel involved in preparing or serving food. The kitchen or food service department then needs its own policies and procedures for managing food allergens across menu planning, purchasing, receiving, storage, preparation and service.
Regis Aged Care’s recent digital systems rollout is an example of how technology can help in this area. Provided accurate admission, specialist and nursing data are entered into the system, staff can see each resident’s dietary needs at the touch of a button. Menus can also be updated in real time to present only diet-friendly food options to staff and residents. All of this can support more effective and safe allergy management.
Ingrid recommends kitchens in Australia work closely with dietitians to ensure restricted diets remain nutritionally adequate under the new Aged Care Quality Standards. She also suggests nominating an ‘allergy champion’ at each meal service, and serving allergy meals first to avoid mistakes.
With high staff turnover, reliance on agency workers and staff from different cultural backgrounds who may have limited allergen knowledge, training is non-negotiable.
The National Allergy Council’s All About Allergens training for aged care is available free at foodallergytraining.org.au. The course is designed for all staff working in aged care, not only kitchen staff. The All About Allergens resource hub hosts a suite of resources to help facilities implement best-practice food allergen management, including example policies, audit tools, menu matrices and standard recipe templates.
Disclaimer: The content of this article is created for inspiration purposes only. It is not intended as clinical, medical or nutritional advice.
