Last month Caroline Benjamin of the Food Allergy Aware Training Consultancy (FATC) and the solicitors Blake Morgan staged a hugely successful and interesting mock trial – ‘a fictional scenario involving the prosecution of a food business involved in the supply of produce containing allergens which had not been correctly identified’.
Unfortunately it fell on the day of the presentation of this year’s FreeFrom Food Awards so I couldn’t actually take part but I did pull together some interesting statistics for Caroline to use. It seemed a shame not to give them a slightly wider airing, so here they are.
USA – from a 2016 study for the Centre for Disease Control (CDC):
- 15 million people suffer from allergies
- 30,000 emergency room visits
- 2,000 hospitalizations
- 150 deaths each year in the United States
- Over 50% of fatal food reactions caused by a food from a food service outlet
- In 78% of those incidents someone in the establishment knew that the food contained the allergen as an ingredient.
UK – figures from studies by Paul Turner and Hazel Gowland in 2007 and 2014 and further work by Paul Turner and his colleagues at Imperial College in 2015:
- 2% young children suffer from a potentially fatal food allergy
- This figure drops to 3.7% for adults
Perspective– Death from anaphylaxis to food comes, in the likelihood scores between ‘death due to murder’ and ‘death due to fire’ – at 1 in 100,000. So while the incidence of anaphylaxis is quite common death from anaphylaxis is very rare
The researchers’ estimate of the foods implicated in fatalities:
- 44% (57% in adults) are caused by some sort of nut – peanuts, treenuts or unidentified nuts.
- 16% (22% for adults) are caused by peanuts
- 15% (23% for adults) are caused by unidentified nuts
- 13% (12% for adults) are caused by tree nuts
- 26% (24% for adults) are caused by unidentified foods
- 21% (3% for adults) are cause by milk – It is always assumed that peanuts are the most dangerous allergen and cause the most fatalities but this this is not true – milk causes the most problems followed by treenuts
- 10% (9% in adults) by fish
- 0% ( 1% in adults) by egg
Where do such fatalities happen, when they happen?
- 27% happen with pre packed foods – as yet there is no confirmed case of fatal anaphylaxis to a ‘trace’ / contamination /may contain although that does not mean that these have not occurred.
- It is possible that of 26% of deaths caused by ‘unidentified’ foods and a proportion – maybe even a high proportion, were caused by contaminated foods rather than the allergen being included in the dish as an ingredient.
- All registered fatalities as yet have been as a result of the food containing the allergen but it being wrongly labelled, being there by mistake, the consumer not realising that it was there.
- 59% happen in food service outlets
Drilling down into with happens in food service outlets – there is very little detailed analysis of the UK scene but these two studies come from the Environmental Health Specialists Network for the CDC (Center for Disease Control). Their findings:
- Only 44% of managers,
- 40% of food workers
- and (alarmingly) 33% of the servers interviewed had receive allergy training.
- Only 22% of menus mentioned allergens.
- Of those 22%, 55% was a note for the customer to inform the outlet of their allergies
- Outlets with some sort of ‘allergen plan’ were likely to have a higher food allergy knowledge score than those without.
- Female workers had higher scores than male workers
- Food workers with at least 2 years experience had higher scores
- Food workers in higher priced restaurants ( $10-$20 per head) had a better allergen knowledge than those where average price was under $10
- Servers in outlets where there was a specific person to answer allergy related question had better allergen knowledge
- Servers in full service restaurants had higher scores tha those in quick serve restaurants
- Servers in outlets serving more than 300 meal a day had better knowledge than those serving less than 300.
- Many restaurant workers did not identify eggs as an allergen and wrong identified strawberries as one.
- Many also believed that allergics could eat a small amount of their allergen without harm.
Interesting further information comes from the 2016 Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division
A review of a number of studies suggested that although respondents reported high levels of comfort in providing “safe” meals, their comfort was probably not justified. Importantly, respondents did not show high understanding of food allergy when faced with knowledge-based questions. For example,
- 24 percent thought that small ingestions of the food were acceptable,
- 35 percent thought heat destroys most allergens,
- 34 percent thought giving water is an appropriate response to a consumer having an allergic reaction,
- 54 percent thought a buffet “kept clean” was safe for an allergic patron, and
- 25 percent thought removing a nut from a finished meal was safe.