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March/April 2023 XII MAGAZINE but was a packaged product - the incident has brought attention to an issue that needs to be handled with great care by those serving food. ‘In Italy,’ explains Dr. Paola Minale , scientific head of ALA (Associazione Ligure Allergici) and representative for Liguria of AAIITO, Associazione Allergologi ed Immunologi Italiani Territoriali ed Ospedalieri (Association of Italian Territorial and Hospital Allergologists and Immunologists), ‘about 3% of the adult population suffers from some kind of food allergy. In children, the proportion rises to 6-8%: fortunately, allergic diseases are evolutionary, so those who are allergic in the first years of life can later become tolerant, particularly to milk and eggs. In a city like Genoa, 100 children go to school with a vial of adrenalin in their backpack, which is no small thing. A segment of the population that is very much at risk is that of adolescents who don’t want to show their friends their problem, so as not to appear different from the group. They often take risks even voluntarily, do not carry the adrenalin with them and do not tell the caterers that they are allergic and escape parental control’. WHAT ARE ALLERGIES ‘Allergy,’ explains the allergist, ‘is an incorrect response of the immune system, which recognises proteins that are harmless in themselves as harmful, triggering an inflammatory response that can involve the entire body. The reaction can range from mild to severe, up to anaphylactic shock. Symptoms may involve the skin (itching, erythema, urticaria...), the intestine (nausea, diarrhoea, abdominal cramps), the respiratory system (acute asthmatic crises or oedema of the glottis) or even the circulatory system in the most severe cases. A loss of consciousness may occur, which may evolve into cardiac arrest and lead to death. The process may stop in the early stages or reach extreme consequences, but it develops within a limited time from the ingestion of the allergen, approximately 30 minutes. This is why it is important that those working in administration know how to recognise the symptoms and are able to intervene’. HOW TO INTERVENE The first form of intervention is certainly to call 112 as soon as even mild symptoms occur, to alert the emergency services and ask for instructions on how to proceed. It may be necessary, in fact, to administer the vial of adrenalin that allergic patients carry with them. ‘Alerting help,’ Paola Minale points out, ‘is also a way of legally demonstrating that you took care of the person who was sick right away. I would like to see a vial of adrenalin in every public place, for cases where patients do not have it with them or if one vial is not enough. It could be a way to save a life. Being trained on how to handle these emergencies is essential to intervene correctly’. COMMUNICATING: A LIFE- SAVING OBLIGATION Regulation (EU) 1169/2011 on the provision of food information to consumers - requires clear and fair communication of ingredients that may cause allergies. This applies not only to packaged food, but also to dishes on the menu, whether printed or digital. There should be no need to ask, but the information should be clearly available. ‘The only way not to create problems for an allergic person,’ Paola Minale points out, ‘is for them to know exactly what is in a dish and to be able to choose accordingly. Abroad, almost all restaurant reservation apps ask you to indicate any allergies in advance, so that the kitchen can organise itself. In Italy this is still not very widespread’. A restaurateur should therefore pay attention to the ingredients he uses; if packaged, he should know the label inside out. ‘I am not saying that you should have a menu only for allergy sufferers,’ Minale argues, ‘but that you should also have simple, minimally elaborate dishes on the menu, without sauces or toppings, that an allergy sufferer can choose with confidence. If a parent can do it for a child or school catering, why can’t a professional chef do it?”. Modern cooking techniques, such as vacuum cooking, also prevent accidental contamination. ‘Although,’ he concludes, ‘in my professional experience I have never detected strong reactions to food merely contaminated with an allergen. In every serious case the allergen was present in the food’. __________________________________ BOX Foods for special categories Allergies and intolerances are not the same thing, and foods that are suitable for the intolerant are not necessarily good for the allergic. Intolerance to lactose, a sugar, has nothing to do with milk protein allergy. Lactose-free’ foods cannot be served to milk-allergic patrons, where the proteins might be present. Foods for coeliacs are free of gluten, which is only one of the proteins in flour. Wheat protein allergy sufferers are sensitive to all proteins. Speaking instead of ethical regimes, the recent news case makes it clear that it is not enough to indicate that a food is vegan to serve it to a person allergic to some animal protein. As much as veg foods follow precise protocols, one must read the list of ingredients carefully to ensure that they do not contain allergens, even in trace amounts. __________________________________ BOX What are the allergens? Annex II of EU Reg. 1169/11 lists the 14 allergens that must always be reported: gluten, crustaceans, eggs, fish, peanuts, soya, milk, nuts, celery, mustard, sesame, sulphur dioxide, lupins, molluscs. The most common food allergies are to nuts, milk and fish. __________________________________