Epidemiology and Diagnosis of Allergies

Risk Assessment on Allergens

Case 1

In this case, the boy has hives and faints while running. Regarding the fact that these reactions are observed two hours after lunch but not six hours after eating, the diagnosis of food-dependent exercise-included anaphylaxis (FDEIA) may be given. It is an unusual reaction of the organism when a person begins physical exercises shortly after ingesting food (Al-Nesf & Mobayed 2014). The main signs of FDEIA are hives, trouble breathing, and headache. Runners may also experience vomiting and fainting because of an inappropriate combination of exercises and specific food. Tuna salad, as well as other types of salads, may become a good way for sportsmen to receive a portion of a healthy meal. Still, this type of fish is characterized by multiple allergic reactions, and runners should be careful while adding this dish to their ration. The same symptoms, fainting, and hives are observed in a patient twice under the same condition when he decides to run in two hours after eating.

Case 2

The second case introduces a boy with evident reaction to fresh bananas and spring with such signs as itchy lips, throat, and eyes, sneezing, and runny nose. The integral factor, in this case, is the absence of the same reaction when a banoffee pie is eaten. An allergic reaction to a certain fruit is observed including such symptoms as an itchy throat and runny nose. The situation when not only a particular fruit causes a reaction but seasonal pollen allergies are observe is called oral allergy syndrome (OAS) or pollen-food allergy syndrome (PFS). The peculiar feature of OAS is the relationship between seasonal allergies and food adverse reactions (Price et al. 2015). The reason why the same fruit does not cause the same reaction when it is used in a pie is explained by “prior sensitization to plant inhalant allergens” (Price et al. 2015, p.78). Non-plant food like milk or shrimps cannot cause OAS, but bananas or pineapples provoke profilin sensitivity.

Case 3

The peculiar feature of this case is that both people with the same reactions to the same product may be diagnosed with two conditions. On the one hand, it may be an ordinary food allergy in two adult patients that is explained by the fact that this type of allergy can be unapparent until a certain period and should be treated with antihistamines. However, this coincidence seems to be naïve for two restaurant visitors. Still, it may happen, and this outcome should not be neglected. Therefore, on the other hand, scombroid food poisoning can be diagnosed. It is a type of reaction in this case that may be proved by the ingestion of spoiled fish, and tuna is one of the first fishes on this list (Tortorella et al. 2014). All the syndromes of this condition, including headache, nausea, diarrhea, itchy skin, a red rash, and a restless feeling, are observed in both patients, and antihistamine is defined as a helpful pharmacological intervention.

Case 4

In this case, special attention is paid to two facts: first, a student says about occasional discomfort after meals, and second, he has increased the consumption of dairy products during the last months. Therefore, food intolerance that is usually hard to characterize may be observed and caused by non-proteinaceous food components like lactose (European Food Safety Authority 2014). Lactose intolerance includes such gastrointestinal complaints as nausea, diarrhea, and abdominal pain or cramps. Some of these symptoms are observed in the patient when he takes a large strawberry milkshake. Regarding milk as an evident component of his last meal, it is clear that lactose malabsorption takes place, and new symptoms can be developed, depending on the student’s diet, stimulation sensitivity, and infections. The reduction of the consumption of dairy productions is recommended.

Case 5

Being aware of an allergy to peanuts, a person orders chicken satay. This meal includes peanuts or peanut butter for marinating as one of its ingredients. As a result, peanut allergy is a type of food allergy on a particular product, peanuts, is observed with such symptoms as itching, diarrhea, vomiting, nausea, and abdominal pain (Choi, Ju & Chang 2015). As a rule, epinephrine or adrenaline is used as the first-line treatment to deal with allergy symptoms and stabilize the condition of a patient and remove all life-threatening symptoms. However, in this case, it is wrongly injected and does not help immediately. Therefore, the outcome and the cause of the case may be used to explain this complication as an ordinary food allergy.


The case in question is about a 21-year-old customer who purchased a chicken curry dish at a Chinese restaurant. Despite giving clear instructions for a peanut/nut-free meal, the customer experienced an allergic response and collapsed. Several important definitions are relevant to the present case. First of all, an allergic response is defined as a reaction to a specific allergen that manifests in respiratory, gastrointestinal, or other allergy-related symptoms caused by hypersensitivity (Rajan 2003). Secondly, peanut allergy describes hypersensitivity to particular proteins found in peanuts. Peanut allergy is dangerous, as it is “the leading cause of death due to food-related anaphylaxis in the United States” (Volerman & Cifu 2018). Food handling is also an important term, as it involves the procedures, steps, and processes involved in kitchen operations in the restaurant. For instance, food handling practices include storage, preparation, and serving, and inadequate precautionary measures during these processes could cause contamination of the food with allergens. The present report will seek to describe three prevention strategies that could have been used to prevent the situation described in the case.

Allergy Prevention Training

The first strategy that can help to prevent allergic responses in customers with food allergies is the education of restaurant managers and staff. According to a study by Radke et al. (2016), most restaurant employees have critical gaps in their knowledge of allergic reaction prevention and response. For instance, the researchers note that “more than 10% of managers and staff believed that a person with a food allergy can safely consume a small amount of that allergen” (Radke et al. 2016, p. 1588). Gaps in knowledge could lead to inadequate compliance with food handling rules and principles, thus increasing the risk of contamination. Besides, proper education could help food workers to identify allergy-inducing foods correctly and alert customers when there is a risk of contamination with allergens. In the present case, proper education would have helped food workers to identify the chicken curry dish as unsafe for the customer, thus preventing the person from consuming it and having an allergic response.

Food Handling Protocols

The second recommended option is for the management to implement comprehensive food handling protocols. According to Chang, Sreedharan, and Schneider (2013), one of the main reasons for allergic reactions to peanuts in people with a known peanut allergy is the cross-contamination of food products. Similarly, in the case, cross-contamination of the dish with peanut protein caused an accidental exposure of the customer to the allergen, leading to an allergic response. Preventing cross-contamination requires appropriate food handling practices (Radke et al. 2017). Although some food handling rules are well-known to staff, it would be beneficial to create a clear food handling protocol detailing practices aimed at preventing cross-contamination and accidental exposure to allergens. Applying this recommendation would help to avoid cross-contamination, thus reducing the possibility of an allergic reaction in customers with known allergies.

Food Labelling and Ingredients List

Finally, it is recommended that the restaurant implements a strict policy for labeling foods with popular allergens and provides a list of ingredients for a dish to all customers and workers (Muraro et al. 2014). It should also be taken into account that restaurants often use pre-made foods, such as sauces, which could contain traces of shellfish, eggs, gluten, and nuts. When purchasing products to be used in meal preparation, it is thus critical to review their labels and ingredients. If a product used in preparation may contain traces of specific allergens, the dish should be labeled accordingly. The ingredients list for a dish should include a full description of all products used in the preparation, including pre-made products. Adequate labeling and ingredient listing could help customers and food workers to identify potentially dangerous dishes, thus reducing the risk of accidental exposure to allergens.


All in all, the report indicates some of the critical issues that led to the adverse event specified in the case. It is clear that the restaurant workers were unaware of the full list of ingredients of the dish and did not follow the practices for preventing cross-contamination. If these problems are not addressed, they could lead to similar events in the future. The report provides three main recommendations for the managers, which include providing employee training, implementing a food handling protocol, and labeling dishes and their ingredients correctly. Following these recommendations would help to prevent customers from experiencing allergic reactions in the future, thus improving the quality of service and food safety in the restaurant.

Reference List

Al-Nesf, MA & Mobayed, HMS 2014, ‘Two cases of food-dependent exercise-induced anaphylaxis with different culprit foods’, Annals of Thoracic Medicine, vol. 9, no. 1, pp. 42-44.

Chang, AS, Sreedharan, A & Schneider, KR 2013, ‘Peanut and peanut products: a food safety perspective’, Food Control, vol. 32, no. 1, pp. 296-303.

Choi, Y, Ju, S & Chang, H 2015, ‘Food allergy knowledge, perception of food allergy labeling, and level of dietary practice: a comparison between children with and without food allergy experience’, Nutrition Research and Practice, vol. 9, no. 1, pp. 92-98.

European Food Safety Authority 2014, ‘Scientific opinion on the evaluation of allergenic foods and food ingredients for labelling purposes’, European Food Safety Authority Journal, vol. 12, no. 11, pp. 1-286.

Muraro, A, Hoffmann‐Sommergruber, K, Holzhauser, T, Poulsen, LK, Gowland, MH, Akdis, CA, Mills, ENC, Papadopoulos, N, Roberts, G, Schnadt, S & van Ree, R 2014, ‘EAACI food allergy and anaphylaxis guidelines. Protecting consumers with food allergies: understanding food consumption, meeting regulations and identifying unmet needs’, Allergy, vol. 69, no. 11, pp.1464-1472.

Price, A, Ramachandran, S, Smith, GP, Stevenson, ML, Pomeranz, MK & Cohen, DE 2015, ‘Oral allergy syndrome (pollen-food allergy syndrome)’, Dermatitis, vol. 26, no. 2, pp. 78-88.

Radke, TJ, Brown, LG, Hoover, ER, Faw, BV, Reimann, D, Wong, MR, Nicholas, D, Barkley, J & Ripley, D 2016, ‘Food allergy knowledge and attitudes of restaurant managers and staff: an EHS-Net study’, Journal of Food Protection, vol. 79, no. 9, pp. 1588-1598.

Radke, TJ, Brown, LG, Faw, B, Hedeen, N, Matis, B, Perez, P, Viveiros, B & Ripley, D 2017, ‘Restaurant food allergy practices—six selected sites, United States, 2014’, Morbidity and Mortality Weekly Report, vol. 66, no. 15, pp. 404-407.

Rajan, TV 2003, ‘The Gell–Coombs classification of hypersensitivity reactions: a re-interpretation’, TRENDS in Immunology, vol. 24, no. 7, pp. 376-379.

Tortorella, V, Masciari, P, Pezzi, M, Mola, A, Tiburzo, SP, Zinzi, MC, Scozzafava, A & Verre, M 2014, ‘Histamine poisoning from ingestion of fish or scombroid syndrome’, Case Reports in Emergency Medicine, vol. 2014, no. 482531, pp. 1-4. Web.

Volerman, A & Cifu, AS 2018, ‘Peanut allergy prevention’, JAMA, vol. 319, no. 9, pp. 927-928.