Managing food allergies in aged care facilities

Food allergies are an increasing issue. With the rise in food allergy over the past 20 years, aged care residential services can expect to see more residents with food allergy in the future. As part of their duty of care, aged care facilities must have policies and procedures in place to identify and support residents with food allergy. National Allergy Council CEO Dr SANDRA VALE provides insight into standards, challenges, policies and procedures, and training, and sets out the key principles to apply — and common mistakes to avoid — in managing food allergies in aged care facilities.

Australia has one of the highest rates of food allergy in the world with 1 in 10 babies,^1,2 1 in 20 school aged children^3,4 and 1–2 in 50 adults⁵ having a food allergy. Some people with food allergies are at risk of anaphylaxis, a severe, life-threatening allergic reaction. There is currently no cure for food allergies and management requires strict avoidance of the food(s). Managing residents with food allergy, and other allergies, aligns with strengthened Aged Care Quality Standards.

Aged Care Quality Standards

• Standard 1, The Individual, and Standard 3, Care and Services, ensure that residents are treated with respect and dignity by all staff in the disclosure of their food allergy and that food allergy is planned across all aspects of their care and support services.
• Standard 2, The Organisation, ensures that the workforce is trained and possesses the necessary skills to manage food allergies appropriate to their role.
• Standard 5, Clinical Care, ensures that allergies to medication, food and environmental allergens are included in residents’ clinical assessment and documented. Allergy risks and preventive measures must be planned and documented.
• Standard 6, Food and Nutrition, ensures that residents with food allergies are catered for appropriately with safe and suitable food and fluids that meet their nutritional needs. This must include training, processes and procedures for all staff who are involved in planning, making and serving food to residents.

Challenges, policies and procedures

Managing food allergies in the aged care sector has unique challenges. Residents with dementia may not remember that they have food allergy and may find it difficult to understand if they are given a different meal from others or feel they are being excluded from meal choices. There is a high turnover of staff; staff are from culturally diverse backgrounds and so there is a high demand for appropriate and frequent training. Staff often have multiple care and support roles so need to be trained across a range of food allergy skills.

Policies and procedures ensure that staff understand their roles and responsibilities; and how tasks should be performed, particularly when it applies to safety issues. Food allergies are a clinical and food safety issue. The National Allergy Council has developed a sample food allergy policy for residential care that can be downloaded and used by aged care facilities. If your facility already has a policy, the sample policy can be used as a checklist to ensure your policy is comprehensive. A food allergy policy is your governance document that procedures and policies will spring from, so it fits under Standard 3.

Food allergen management training

We all know the value of training. Food allergen management training helps food service staff to understand:

• the importance of good communication between food service staff about a patient’s food allergies;
• how to read labels and select appropriate ingredients for patients with food allergies;
• how to prepare meals and drinks to avoid cross contamination with the food the patient is allergic to; and
• how to make sure the right food and drinks are given to the person with food allergies.
   

Care staff should also complete food allergen management training. Care staff often provide food from the pantries or out of hours for residents who have missed meals or desire a snack out of hours. Care staff also must understand the importance of knowing which patients and residents have food allergy and communicate that to the kitchen or food service staff. If care staff serve food, they need to know the process for making sure the right person is given the right food or drink.

Key principles to support resident safety for food allergy

There are some important key principles to support resident safety for food allergy.

Train all staff in food allergy

Everyone involved in caring for residents with food allergy, food service and meal delivery should complete food allergen management training relevant to their role. They should also know the healthcare organisation’s policies and procedures about food allergy.

Document food allergies on admission

Residents’ food allergies must be documented on admission to the facility. This information must then be transferred to food services when their diet requirements are submitted. Food allergies must be transferred to clinical, care and support staff and between clinical staff on shift change.

Make meals for those with food allergies stand out

Meals for patients and residents with food allergies should stand out from other meals. This makes it easy for staff to identify that it is an allergy meal. Different services will use different strategies, but it can simply be the use of a different coloured tray or plate with the allergy highlighted, or a coloured flag.

Serve residents with food allergies first

In dining areas, serve residents with food allergy first so they are more likely to receive the correct meal.

Ensure staff who know residents with food allergies serve their food

Make sure that only staff who know the residents serve meals to residents with food allergy, to prevent mistakes being made.

Check items on food trays

If residents are given meals on trays or in their rooms, check the items on the meal tray are correct. All foods for the resident with food allergy should be checked, to make sure they are not being given a food they are allergic to. If it is a ticketed system, check that the items on the meal ticket match what is on the tray.

Heed precautionary allergen labelling statement

Do not give patients or residents with food allergies a packaged food that has a precautionary allergen labelling statement (for example, ‘may contain’ statement) for the food they are allergic to. For example, if a product has a ‘may contain’ statement for milk, the manufacturer is telling you that the product is not safe for a person with milk allergy.

Check you are giving the right meal to the right patient

In hospital, a three-point identification check should be done with another staff member to check the right meal is being given to the patient. In residential care this might be a verbal identity check with the resident or another staff member that it is the correct resident.

Give meals to the resident with food allergy

Do not leave meals for residents if they are not at the table, or not in their room or bed. Leaving a meal when the resident is not there increases the risk of giving them the wrong meal.

Supervise bulk meal deliveries, buffets and self-service

Ideally, residents with food allergies should be given an individual meal to reduce the risk of cross contamination. If this is not an option, meal-time supervision by staff who understand food allergen management and how to reduce the risk of cross contamination is essential.

Create a food allergen menu matrix

For food and drinks kept in and outside the main kitchen, including pantries and other kitchen areas, create a food allergen menu matrix. A food allergen menu matrix means that staff can easily check what allergens are in each of the food and drink items available in those areas. The food allergen menu matrix must be kept up to date. The National Allergy Council has developed a food allergen menu matrix template which can be downloaded and used by residential facilities. It is available at www.foodallergytraining.org.au/resources/allergen-menu-matrix.

Common mistakes to avoid

There are common mistakes made by people providing meals and drinks to residents with food allergy that should be avoided.

Giving people with milk (dairy) allergy lactose-free products

Lactose is a sugar in milk and dairy products; however, people who are allergic to milk (dairy) are allergic to the protein in milk and dairy products. Lactose free products still contain milk (dairy) proteins and must not be given to people who are allergic to milk (dairy).

Assuming vegan foods are safe for people with milk or egg allergy

While foods labelled ‘vegan’ should not contain milk or eggs, they often have a ‘may contain’ statement for milk and egg, which means they should not be given to a person with a milk or egg allergy. Vegan foods often contain nuts, which are a common food allergen, so check products carefully for the person’s allergen.

Making a meal that is free of the food allergen and then adding a garnish that does contain the allergen

Check ingredients carefully, including decorations and sauces for meals and if in doubt, don’t add it.

^Resources

^{The National Allergy Council has developed the free ‘All about Allergens for Residential Care’ online training and a range of supporting resources to help aged care providers implement strategies to prevent allergic reactions to food. The courses and resources are available free of charge from the All about Allergens training site (www.foodallergytraining.org.au) and All about Allergens Resource Hub (www.foodallergytraining.org.au/resources).}

^{The training and resources were developed in consultation with our working group members from the aged care sector. Over 4000 residential care workers have completed our courses, which will be available later in 2025 to host on local organisations’ LMS under a licensing agreement. For further information contact us at info@nationalallergy.org.au. You can also subscribe to the National Allergy. Council newsletter for all the latest project updates at www.nationalallergycouncil.org.au/news#sub.}

^References

^{1. Hua X, Dalziel K, Brettig T, et al. Out-of-hospital health care costs of childhood food allergy in Australia: a population-based longitudinal study. Pediatr Allergy Immunol. 2022;33(11):e13883. doi:10.1111/pai.13883}

^{2. Osborne NJ, Koplin JJ, Martin PE, et al. The HealthNuts population-based study of paediatric food allergy: validity, safety and acceptability. Clin Exp Allergy. 2010;40(10):1516–1522. doi:10.1111/j.1365-2222.2010.03562.x}

^{3. Peters RL, Soriano VX, Allen KJ, et al. The prevalence of IgE-mediated food allergy and other allergic diseases in the first 10 years: the population-based, longitudinal HealthNuts study. J Allergy Clin Immunol Pract. 2024;12(7):1819–1830.e3. doi:10.1016/j.jaip.2024.03.015}

^{4. Sasaki M, Koplin JJ, Dharmage SC, et al. Prevalence of clinic-defined food allergy in early adolescence: the SchoolNuts study. J Allergy Clin Immunol. 2018;141(1):391–398.e4. doi:10.1016/j.jaci.2017.05.041}

^{5. Tang MLK, Mullins RJ. Food allergy: is prevalence increasing? Intern Med J. 2017;47(3):256–261. doi:10.1111/imj.13362}

Dr Sandra Vale is CEO of the National Allergy Council.

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