TAChis Policy will address the procedures to be taken to ensure the provision of adequate and nutritious diets to those service users with food allergies or intolerances, or where certain foodstuffs have been forbidden for reasons of clinical diet, religion or culture.
A: DEFINITIONS & BACKGROUND INFORMATION:
1. An ALLERGY is a specific response by the body’s immune system to a substance (eaten, touched or Inhaled) which it mistakenly identifies as harmful.
Contact with this substance triggers the release of histamine, a chemical released by the cells of the body’s immune system. This causes contraction of the muscles around the air passages (an attack of breathlessness or asthma), local swelling, skin irritation and if serious enough, a drop in blood pressure.
2. The most severe allergic reaction is ANAPHYLACTIC SHOCK or ANAPHYLAXIS. The body becomes flooded with histamine causing immediate swelling of the air passages, mouth and throat, a rapid drop in blood pressure, and loss of consciousness. Anaphylaxis is life-threatening but can be treated through the speedy administration of adrenaline / epinephrine to counteract the release of histamine (see Safeguarding Policy No: 3723 - Anaphylaxis).
3. Elderly and malnourished persons and children can have particularly vulnerable immune systems compared to normal healthy adults and are therefore more susceptible to allergic reactions.
The Organization has a legal obligation to provide information about allergenic ingredients used in foodstuffs and meals prepared for the service user. The EU Food Information for Consumers Regulation No. 1169/2011, and the Food Information Regulations 2014 lists 14 major allergens which must be declared. These 14 allergens are recognized as the most common and potent sources of food allergies:
Cereals containing gluten – namely wheat (including specific varieties such as spelt and Khorasan), rye, barley, oats and their hybridized strains, and products thereof
Crustaceans – for example lobster, prawns, crabs and crayfish, and products thereof
Eggs – including those from hen, duck, goose and ostrich etc, and products thereof
Fish – and products thereof
Peanuts - and products thereof
Soybeans / soya - and products thereof
Milk – including that from cows, goats, sheep etc, lactose, and products thereof
Nuts – need to declare the presence of almond, hazelnut, walnut, cashew, pecan, Brazil nut, pistachio nut and macadamia nut (Queensland nut), and products thereof
Celery – including celery leaves, seeds and celeriac, and products thereof
Mustard - and products thereof
Sesame seeds - and products thereof
Sulphur dioxide and sulphites (where added and is above 10mg/kg in the finished product – often found in wine and dried fruit
Lupin - and products thereof
Molluscs – for example clams, oysters, scallops, snails and squid, and products thereof
5. It is also possible for persons to suffer adverse reactions to certain foods which have not sparked an immune system response. These responses are normally classed as INTOLERANCES or SENSITIVITIES and have a very wide range of causes, symptoms and degrees of severity. However, they nearly always manifest as part of some other condition or illness.
1. The preliminary Assessment of Need of a prospective service user will identify details of any special dietary needs that the person may have. This will address:
food allergies, intolerances and sensitivities;
foods prohibited for clinical reasons, e.g. as a result of a special diet etc;
foods forbidden by reasons of religion or culture (ref Form No: 3-401 for a complete summary).
This information is noted in the service user’s records and passed to domiciliary care staff involved in the preparation of meals and snacks for the service user for their records.
2. Within the food hygiene and meal preparation environment, staff receive special training in food allergies. An essential part of this training requires staff to be knowledgeable of the ingredients in purchased ready-to-eat foods, and to retain a list of ingredients of all dishes prepared by domiciliary care staff from raw ingredients.
3. The Domiciliary Care Services Manager will ensure that a service user’s special dietary requirements are passed to the appropriate staff. If required, staff will discuss specific dietary needs with the service user / advocate / responsible person from a knowledge of food ingredients, ref. Section A.3 of this Policy, to ensure that an acceptable diet is provided. Staff will retain a list of service users with special dietary needs.
4. Staff First Aid training will include the diagnosis and treatment of adverse reactions to foods, including anaphylactic shock. Where a service user possesses an Epi-pen this will be kept with the service user’s medication in an appropriate secure location. If anaphylactic shock is suspected, and there is no Epi-pen available, an ambulance will be summoned IMMEDIATELY. The emergency services must be advised that anaphylaxis is suspected so that adrenaline is available. Policy No: 3723 refers.
Form No: 3-002 Baseline Assessment of Needs for Daily Living
Form No: 3-401 Service User Diet, Ethnicity & Religion - Master Matrix
Form No: 3-416 Food Allergies & Intolerances - Summary Chart
Form No: 3-417 Food Dishes - Allergen Content
Form No: 3-418 Food Allergens - Catering Recipe Cards