CHAPTER 18 | Food Allergy and Adverse Food Reactions in Older Adults 273


out according to FDA regulations. Most recently, allergen labeling of sesame has been required under the Food Allergy Safety, Treatment, Education and Research (FASTER) Act of 2021, as the ninth major food allergen requiring labeling in the United States, effective January 1, 2023. FALCPA-regulated allergens can be called out in one of three ways on packaged food labels:


• in the ingredient list using the allergen’s common name—for example, “peanuts”;


• in the ingredient list in parentheses, when the ingredient is a less common form of the allergen— for example, “albumin (egg)” or “whey (milk)”; or


• as a separate statement using the word “Contains” followed by the name of the major food allergen immediately following—for example, “Contains milk, wheat.”


Because there are many varieties of tree nuts, fin fish, and crustacean shellfish, the specific type contained in the product must be further identified. For exam- ple, the label may contain phrases such as: “Contains tree nuts: almond,” “Contains fish: salmon,” or “Con- tains shellfish: shrimp.”27 The FALCPA labeling requirements apply to


dietary supplements, infant formula, and medical foods (including enteral formulas). The requirements do not apply to other FDA-regulated products such as cosmetics, personal care items, and over-the-counter or prescription drugs.27 Several foods are excluded from the FALCPA


food allergen labeling requirements because of the absence of food allergen protein. These foods include highly refined oils, such as refined, bleached, and deodorized soy and peanut oil (and other oils), and two types of soy lecithin whose manufacturers have petitioned the FDA that their manufacturing prac- tices eliminates all soy protein and therefore does not require food allergen labeling. The FALCPA does not include mollusks and shellfish (eg, clam, oyster) as a major food allergen. Foods inspected by the US Department of Agriculture (meat and poultry prod- ucts) are labeled for food allergens consistent with FDA FALCPA requirements. Food packages may also have precautionary aller-


gen labeling statements, such as “may contain…” or “processed in a facility that also processes.” These


are voluntary, are not regulated by the FDA, and can vary from manufacturer to manufacturer. Some individuals may be directed to avoid foods with these statements out of an abundance of caution. Although many products do not contain the allergens listed in precautionary labels, up to 8% of consumers with food allergies have had reactions to foods that were labeled this way.28


Consumers and their caregivers


should read a product label every time, as a manu- facturer can change a product’s formulation without warning. The product label is the best place to obtain accurate information.


Cooking and Food Preparation Tips


The first step in preparing healthy meals for older adults with food allergies is to make sure each ingre- dient is safe. As noted earlier, encourage individuals to read the label every time to get the most up-to-date information. When preparing meals for older adults with food allergies, it is important to follow these steps:


• Start with a clean workspace and equipment. If the counter is dirty, the rest of the meal may be compromised.


• Check items to ensure that no cross-contact occurred in transport (eg, broken or torn packag- ing or spillage).


• If preparing food for someone else, confirm their food allergies before meal preparation.


• Use separate pans and utensils in food prepara- tion and service to avoid cross-contact with food allergens.


• Avoid shared equipment that is difficult to clean (eg, fryers or blenders). For example, fish fried in a commercial kitchen fryer can carry fish protein that can then be attached to the surface of french fries prepared in the same oil. Cleaning all peanut or other food allergen residue from a blender is challenging, given multiple parts to clean.


• Work with simple recipes that do not require a long list of complicated ingredients or reading multiple food labels.


If food allergen-friendly meals are a daily practice, a separate storage area for specific ingredients will help avoid cross-contact.


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