Food Safety For People Who Are Immunosuppressed

The immune system helps protect you from infection. When your immune system is weakened, it may not be able to rid the body of the bacteria found in some foods. By not eating the foods and drinks listed in the “Not Allowed” section, you are better able to prevent illnesses that may be caused by organisms in foods. The foods and drinks in the “Food Allowed” sections are safe when properly prepared. Talk with your doctor about how long you need to follow these guidelines.

Food Groups Foods Allowed Foods Not Allow
Dairy
  • All pasteurized, grade “A” milk and milk products
  • Commercially packaged cheese and cheese products made with pasteurized milk (e.g., mild and medium cheddar, mozzarella, parmesan, Swiss, etc.)
  • Pasteurized yogurt
  • Dry, refrigerated, and frozen pasteurized whipped topping
  • Ice cream, frozen yogurt, sherbet, ice cream bars, homemade milkshakes
  • Commercial nutritional supplements, liquid and powered
  • Commercial eggnog
 
  • Unpasteurized or raw milk, cheese, yogurt, and other milk products
  • Cheeses from delicatessens
  • Cheeses with molds (e.g., blue Stilton, Roquefort, gorgonzola)
  • Sharp cheddar, brie, camembert, feta cheese, farmer’s cheese
 
Meat and Meat Substitutes
  • All well-cooked or canned meats (beef, pork, lamb, poultry, fish, shellfish, game, ham, bacon, sausage, hot dogs)
  • Well-cooked eggs (white cooked firm with thickened yolk is acceptable)
  • Well-cooked pasteurized egg substitutes
  • Commercially-packaged salami, bologna, and other luncheon meats
  • Canned and commercially-packaged hard smoked fish, refrigerated after opening
  • Cooked tofu (must be cut into 1-inch cubes, or smaller, and boiled a minimum of 5 minutes in water or broth before eating or using in recipes
 
  • Raw or undercooked meat, poultry, fish, game, tofu
  • Raw or undercooked eggs and egg substitutes
  • Meats and cold cuts from delicatessens or grocery store deli
  • Hard cured salami in natural wrap
  • Cold smoked salmon (fish); lox
  • Pickled fish
  • Tempe (tempeh) products (fermented food made by the controlled fermentation of cooked soy beans with a Rhizopus mold)
 
Entrees, Soups
  • All cooked entrees and soups
 
  • Fresh, unpasteurized foods using soybean paste
 
Fruit and Nuts
  • Canned and frozen fruit and fruit juices
  • Well-washed raw fruits
  • Dried fruits
  • Canned or bottled roasted nuts
  • Nuts in baked products
  • Commercially packaged peanut butter
 
  • Unwashed raw fruits
  • Roasted nuts in the shell
  • Unpasteurized fruit and vegetable juices
 
Vegetables
  • All cooked frozen, canned, or fresh vegetables and potatoes
  • Well-washed raw vegetables
  • Fresh, well-washed herbs and dried herbs and spices (added to raw or cooked foods)
  • Commercial salsas stored on grocers shelf, not refrigerated until after opening
 
  • Unwashed raw vegetables or herbs
  • All sprouts (alfalfa, radish, broccoli, mung bean, all others)
  • Salads from delicatessens or salad bars
  • Commercial salsas stored in refrigerated case
 
Bread, Grain and Cereal Products
  • All breads, bagels, rolls, muffins, pancakes, sweet rolls, waffles, French toast (Patients themselves should not make (mix, knead) any bread product containing yeast)
  • Potato chips, corn chips, tortilla chips, pretzels, popcorn
  • All cereals, cooked and ready-to-eat
 
  • Raw grain products
 
Beverages
  • Tap water and ice made from tap water (If using a water service other than city water service, it is recommended using distilled or bottled water. Water may also be boiled for one minute and stored in a clean covered container in the refrigerator for no more than three days)
  • Commercially bottled distilled, spring, and natural water
  • All canned, bottled, powdered beverages
  • Instant and brewed herbal teas using commercially-packaged tea bags
  • Nutritional supplements, liquid and powdered
 
  • Well water (unless tested yearly and found to be free of coliforms)
  • Cold-brewed (sun tea) made with warm or cold water
  • Non-pasteurized commercial fruit, vegetable juices and milk products
 
Desserts
  • Refrigerated commercial and homemade cakes, pies, pastries, and pudding
  • Refrigerated, cream-filled pastries
  • Homemade and commercial cookies
  • “Shelf-stable”* cream-filled cupcakes, fruit pies, and canned pudding (any items not eaten must be wrapped and refrigerated after opening)
  • Ices, Popsicle-like products
  • *“Shelf stable” refers to unopened canned, bottled, or packaged food products that can be stored before opening at room temperature
 
  • Unrefrigerated, cream-filled pastry products (not “shelf-stable”*)
 
Fats
  • Oil, shortening
  • Refrigerated lard, margarine, butter
  • Commercial, shelf-stable mayonnaise and salad dressings (including cheese-based salad dressings; refrigerated after opening)
  • Cooked gravy and sauces
 
  • Fresh salad dressings containing aged cheese (e.g., blue Roquefort) or raw eggs, stored in refrigerated case
 
Other
  • Salt, granulated sugar, brown sugar
  • Jam, jelly, syrups; refrigerated after opening
  • Commercial (heat-treated) honey
  • Catsup, mustard, BBQ sauce, soy sauce, other condiments (refrigerated after opening)
  • Pickles, pickle relish, olives (refrigerated after opening)
  • Candy, gum
 
  • Raw or non-heat treated honey; honey in the comb
  • Herbal and nutrient supplement preparations unless okay with your doctor
  • Brewers yeast, if eaten uncooked
 

Please talk with your doctor if you have any questions or concerns about these diet guidelines.

Note: Adapted from the following: Fred Hutchinson Nutritional Guidelines for Immunosuppressed Patients Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center; High Risk Neutropenic Diet University of Arkansas for Medical Sciences; Diet For Immunosuppressed Patients University of Mississippi Medical Center; Diet Guidelines For Immunosuppressed Patients Vanderbilt University Medical Center; and Patient and Family Educator For Food Safety, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Center.

Tips for Handling Foods For the People who are Immunosuppressed

  • Always wash hands with warm soapy water before and after handling foods.
  • Keep kitchen surfaces such as appliances, countertops, cutting boards and utensils clean with hot, soapy water. To wash food preparation areas (including cutting boards and all utensils) that have come into contact with raw meat, use 1 part bleach to 8 parts water (example: 1 oz. bleach to a cup of water).;
  • Use two cutting boards: one strictly to cut meat, poultry and seafood; the other for ready – to – eat foods, like breads and vegetables. Use paper towels for drying. If using kitchen towels, wash daily. Replace sponges at least weekly and wash daily with bleach solution or place them in dishwasher and run through a complete cleaning cycle using the heat cycle. 
  • When preparing foods, the hands should be kept away from the hair, mouth and nose. If possible, jewelry (especially rings) should be removed, because they can hold germs.
  • Dishes and silverware should be washed in hot soapy water, rinsed and air-dried, or washed and dried in the dishwasher on the heat cycle.
  • Clean the inside of refrigerator regularly with soap and water to control mold. 
  • Check the expiration dates of all foods and discard if expired. Throw out all foods after 72 hours (3 days) in the refrigerator that have been opened, used, or leftover.
  • Keep the refrigerator temperature between 34 F. degrees and 40 F. degrees. Freezer temperature should be below 5 degrees F. Keep cold foods cold (<40 F. degrees) and hot foods hot (>140 F. degrees); Defrost meat, turkey, and chicken in the refrigerator.
  • Never use canned foods if the can is swollen, dented, or rusted.
  • Avoid foods from self-serve, bulk containers.
  • Avoid salad bars, delis, and buffets.
  • At the supermarket, pick up perishables last and take them home right away.