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
Raw
Material
Processing
Aids
Storage
Air Particles in
Manufacturing
Area
Equipment
Cross
contamination
Carelessness
Cleaning
Chain
Supply
Handling
Packaging
People
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 onset
Key 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
Eosinophilic
gastroenteropathies
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
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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.............................................
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...........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
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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.........
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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!!!!)
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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/Steatorrhoea
Vomiting
Anaemia
Cranky
Bloated Belly
Wasting
Childhood 2-16 yrs
Poor growth
Delayed puberty
Anaemia
Osteomalacia
Diarrhoea/Steatorrhoea
Lethargy
Mouth ulcers
Adults
Short stature
Anaemia (especially in pregnancy)
Osteoporosis
Dyspepsia
Weight loss
Mouth Ulcers
Diarrhoea/Steatorrhoea
Infertility
Dermatitis Herpetiformis
Tetany
Hypoproteinaemia
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
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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...........
Dinners on me!
Washing up
/cleaning
solutions
Latex gloves
Food
packaging
Any questions?