What is an allergy safe adult care facility?

Food allergy affects about 3 to 4 adults out of every 100. While care facilities cannot be expected to be completely free of the foods that cause allergic reactions, facilities should make efforts to create and maintain a safe environment for adults with food allergy. Creating an allergy safe facility involves:

• Following policies and procedures that reduce the risk of accidental exposures to foods that cause allergic reactions among the residents in care
• Having a care plan in place for each resident with a food allergy that includes a copy of their Anaphylaxis Emergency Plan. The plan explains what to do in case of an allergic reaction. To get a blank copy of an Anaphylaxis Emergency Plan, visit the Canadian Society of Allergy and Clinical Immunology https://csaci.ca/patient-school-resources/
• Regular staff training to ensure everyone has the knowledge and skills to respond to and care for a resident who is having an allergic reaction

What is an allergic reaction?

An allergic reaction is when a person’s immune system treats a protein (an allergen) in a food as harmful. Allergic reactions to foods can be mild or severe. Food allergy needs to be taken seriously. It involves avoiding the food that causes allergic reactions and responding appropriately to an accidental exposure. A severe allergic reaction is called anaphylaxis (an-nah-fil-axe-is). It often happens quickly and can cause death if left untreated.

What are the symptoms of a severe allergic reaction?

Symptoms of a severe allergic reaction can start within minutes of eating the food that triggers reactions. They will usually occur within 2 hours. While rare, symptoms can take up to a few hours to develop.

Symptoms can vary from person to person. The same person may experience some differences in their symptoms each time they have an allergic reaction. The most dangerous symptoms include difficultly breathing or a drop in blood pressure. Symptoms of anaphylaxsis can include any of the following:

• Breathing: coughing, wheezing, shortness of breath, chest pain or tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (such as runny, itchy nose, watery eyes and sneezing), trouble swallowing
• Heart: signs of a drop in blood pressure like weak pulse, feeling faint, dizzy or lightheaded, passing out
• Skin: hives, swelling (tongue, lips or face), itching, warmth, redness, rash, pale or blue-coloured skin
• Stomach: nausea, vomiting, abdominal pain or diarrhea
• Other: anxiety, headache, metallic taste or uterine cramps

If a person with a food allergy is concerned they are having a reaction, treat this as a priority. Do not ignore early symptoms.

How is a severe allergic reaction treated?

When a reaction begins, it is important to respond right away. Do not wait. Give the prescribed medication called epinephrine (eh-puh-NEH-fren) right away. Epinephrine will not cause harm to the resident if it is given unnecessarily.

Epinephrine comes in a pre-loaded syringe called an auto-injector. Epinephrine helps reverse the symptoms of an allergic reaction and can save the person’s life.

Steps for treating a severe allergic reaction

The above section has been adapted from: Anaphylaxis in Schools and Other Settings, Copyright 2005-2016 Canadian Society of Allergy and Clinical Immunology.

What can be done to create an allergy safe facility?

Care plans and auto-injectors

• Create a care plan for every resident with food allergy. Include a copy of the resident’s Anaphylaxis Emergency Plan. Ensure their meal plan is free of their food allergens
• Store each resident’s epinephrine auto-injectors in a secure unlocked place that is easy for all staff to access
• If it is safe to do so, have the resident carry their auto-injector(s) in a fanny pack or other carrier
• Ensure their auto-injector is available whenever food is available
• Replace each auto-injector before the expiry date
• Consider having residents with food allergy wear MedicAlert® identification

Buying, preparing and serving food

• Tell food suppliers about the food allergies at your facility
• Make sure staff who buy, store, prepare and serve food:
  • Have a complete list of foods that cause allergic reactions among residents and know how to recognize food allergens on product labels. For more information on allergen labelling, visit the Canadian Food Inspection Agency https://inspection.canada.ca/food-labels/labelling/consumers/food-allergies/eng/1332442914456/1332442980290
  • Read the ingredients list each time they buy a food or receive a food delivery. Ingredients in packaged foods can change without notice. Do not assume that a food served before is safe
  • Ensure all foods prepared and stored on site are clearly labelled with a list of ingredients. This includes leftovers, foods made from scratch and any foods brought in by families or staff
  • Prevent cross-contamination. Wash hands, utensils and food preparation surfaces well between preparing different foods
• Do not take risks. If you are not certain a food is safe for a resident with a food allergy, offer something else
• Be aware of the needs of residents with food allergy whenever food is offered, not just at regular meal and snack times. Celebrations, demonstrations and craft activities can involve food. Visitors can bring food in unexpectedly

Meal and snack times

• Make sure all residents and staff wash their hands with soap and water before and after eating. This helps prevent food from getting on objects, clothing or other surfaces. Hand sanitizers or just water are not as effective
• Supervise meals and snacks if residents need help to follow instructions
• Clean all tables and other eating surfaces well before and after eating

When eating out

• For social gatherings like picnics, pack separate meals for residents with food allergy
• Call restaurants a head of time to see if meals can be prepared without the resident’s allergens. Restaurant staff may not have the training to deal with food allergy. If in doubt, choose another restaurant
• Take Anaphylaxis Emergency Plans and epinephrine auto-injectors on all trips

What is oral allergy syndrome?

Many people with tree or grass pollen allergies also develop food allergy to certain raw fruits and vegetables. This is called Oral Allergy Syndrome (OAS) or pollen food allergy syndrome. OAS can lead to itching and mild swelling of the lips and in the mouth and throat. It is uncommon for OAS related reactions to become severe. Adults with OAS can often eat the fruits or vegetables if they are cooked. If in doubt, include the resident’s health care provider when developing the resident’s care plan.

For more information

If you have questions about food allergies, call 8-1-1 to speak with a registered dietitian.

For more information about understanding and managing anaphylaxis, visit:

• Food Allergy Canada https://foodallergycanada.ca
• Anaphylaxis in Schools and Other Settings https://csaci.ca/wp-content/uploads/2017/11/Anaphylaxis-in-Schools-Other-Settings-3rd-Edition-Revised_a.pdf (PDF 1.68 MB)
• Allergy/Asthma Information Association https://asthma.ca/get-help/allergies-and-asthma/