One major plus of being in Europe for food allergics was that all labelling regulation came from Brussels so applied Europe wide. But a major minus was that for new regulation to become mandatory it has to pass through EFSA (The European Food safety Authority). Excellent though EFSA may be, they are not speedy, Indeed, a geriatric snail would put them to shame. So departing from the EU may have liberated the FSA and is allowing them to forge ahead.
Certainly, surveys and consultations have come hot on each other’s heels recently and, last week, they held their first symposium on food allergy. And a very good symposium it was too. There is a full report on the FoodsMatter website but below are a few of the highlights.
Keynote speech – Heather Hancock, chair of the FSA
Taking note of the fact that of the 10 or so deaths each year from food anaphylaxis, the majority of were in the 16 – 24 year old age group, the agency will focus their efforts on this group. Teenagers and early 20s, with or without food allergies, are known to take more risks and to be especially anxious to blend with the crowd. Continually questioning what they should eat and remembering to carry and use medication if they think they need it, does not sit well with them. Nor is it easy to remain vigilant when part of an even moderately drunken party – or, before you kiss or are kissed, to ask the person you are fancying when they last ate peanuts….
Research suggests that the way to get through to this age group is to be direct – so the agency wants to use ‘braver, bolder and more direct messaging’ which emphasises the consequences of getting it wrong. This includes ‘normalising’ the conversation about food allergy – encouraging allergy sufferers to speak out, to share with each other, their friends and, especially, with the outlets serving them.
The agency also want to make the reporting of allergic incidents easier and more efficient – coordinating with Trading Standards, Environmental Health and, in the case of a fatality, coroners.
Incidence and traces
Dr Paul Turner who leads the FSA’s research programme gave us some figures:
- Worldwide approximately 6% suffer from food allergy.
- 90% of their allergic reactions are to the top 14 allergens
- Hospital admissions for anaphylaxis between 1995 and 2015 rose by 8% in Australia and 5% in Britain.
- However, anaphylaxis is not binary – it can range from quite minor reactions to life threatening. The problem is the unpredictability of the reactions.
- The likelihood of dying from anaphylaxis remains less than 1 in 1,000 and it has been dropping over the last 20 years.
- The most frequent cause of anaphylaxis is not peanuts but milk – while 21% of children are allergic to milk that drops to less than 8% in adults.
Paul also pointed out that, as far as we know, no reactions have ever been triggered by ‘traces’. The perception that they are causes unnecessary anxiety amongst allergy sufferers and their families.
Therefore Precautionary Allergen Labelling (PAL) or May Contain warnings should only be used when there is a genuine risk of cross contamination or of an allergen being mistakenly included in a product. They should not be used if good manufacturing processes have been used and there is no genuine risk.
Alexa and Sydney
Alexa Baracaia described some of her experiences with her son Sydney, now 8 years old, who has multiple life threatening allergies.
Although looking after a small child with life threatening allergies is always challenging, the most difficult is eating out.
- Information is frequently inadequate and all to often incorrect.
- It can take an inordinate amount of time and effort to get the right information. It took 32 emails to arrange one family celebration meal that Sydney would be able to eat safely.
- Staff are often poorly trained if trained at all.
- Staff attitudes to those with allergies are frequently intolerant, lacking in understanding and on occasions both rude and unkind.
Unfortunately, while the recent publicity surrounding the deaths of Natasha Ednan Laperouse and Owen Carey has raised the awareness of food allergy with the general public, it has seriously put ‘the frighteners’ on the food service industry. Far from engaging with their allergic customers to try and improve the situation, all too many outlets are retreating behind precautionary warnings that they cannot guarantee that any foods will be safe.
Welcome exceptions to this tendency that Alexa singled out were Nandos’ and Pizza Express. Also Leon who, after initially adding warnings to their menus, engaged with Alexa and have altered their procedures so that they are now happy to serve allergic customers.
Her plea to food service outlets:
‘Please think about how you and your staff talk to allergy sufferers. Allergy sufferers know that it will not always be possible to cater for them but they want to be talked to kindly – not dismissed as a nuisance or idiots.’
Carla Jones, CEO of Allergy UK also covered the challenges of living with food allergy and the need for more training. She suggested that formal training on food allergies should be included as part of the food hygiene rating.
She also pointed out that some local training schemes already include allergy in their hygiene training. However they found that they needed to do the allergy training first as if it were left till second a significant number of students would leave after the hygiene was finished and did not stay for the allergy segment. Which suggests that there is definitely space for raising awareness about allergy among catering students.
Barnsley referral scheme
Christine Heeley, a Trading Standards Officer from Barnsley where peanut allergic Dylan Hall died in 2015 as a result of eating a Chicken Korma with nuts, described the positive initiative that came out of the inquest into Dylan’s death.
Barnsley TS were asked to investigate the case. While they were doing so they were approached by a consultant at the hospital to alert them that there had recently been similar case in the same restaurant of a 15 year old who had suffered an anaphylactic shock but who had survived. As a result, together with Dr James Griffiths, a clinician at Barnsley Hospital, Barnsley TS have developed a referral form to ensure that any allergy incidents that come to the attention of clinicians are automatically referred to the local authority to investigate.
If this sort of cooperation could be rolled out countrywide it would create a much more joined up service for allergy sufferers. It would also hugely help in gathering much needed data on the incidence of allergic reactions in food service outlets and how they are dealt with.
Christina also pointed out that the potential for confusion with e-orders was considerable. Moreover, there was no way for an outlets servicing e-orders to know whether the exclusion of particular ingredient was because of preference or allergy. She suggested that E-orders should include some sort of allergy alert.
Safety first at Pizza Express
Rupi Zani from Pizza Express described Pizza Express’ ‘safety first’ approach to catering for food allergics. From their original decision only to use gluten-free flour (at 5 times the cost of ‘normal’ flour) to roll out their pizza bases so as to keep coeliacs safe to their recent decision that, as from spring this year, all of their vegan offerings will be totally milk and egg free and suitable for milk and egg allergic people. (See below for vegan milk/egg free confusion.)
Looking at the issue of 16-24 year olds she also suggested that allergy information should be available from a trusted source (the FSA?) via an app which included a wider range of information than just allergy so as to make it more inclusive.
Tech company Kafoodle talked up the virtues of technology for providing easy access to massive amounts of information, for gathering data and enabling transparency and a clear audit trail but… They pointed out that 90% of small business have a very low level of IT literacy and as yet only see food as ‘food’ – not as data which could help their businesses.
FDF’s Allergen Steering Group on the vegan market
Dr Jayne Hipkiss and Dr Stella Cochrane, chair and deputy chair of the FDF’s Allergen Steering Group, looked at the confusion surrounding vegan food as far as allergy is concerned.
- The vegan market is estimated to be $12.7 billion in US this year.
- Demand for vegan food grew by 987% between 2002 and 2017, but – there is a great lack of regulatory consistency covering vegan foods.
- There is no legal definition of vegan food. The FSA define it as food which is ‘not contaminated with non vegan foods’.
- The Vegan Society and the European Vegetarian Union both state that vegan food may not be suitable for allergics.
- European Vegetarian Union says that animal products (including dairy/milk) in a vegan product must not exceed 1% – but that would be a triggering dose for an allergic.
- Definitions are urgently needed for both vegetarian and vegan.
- Labelling needs to be harmonised but that harmonisation should be based around the needs of allergic consumers.