Earlier this month the Food Standards Agency held one of its annual food allergy/hypersensitvity (FHS) symposiums. We were in the middle of the FreeFrom Food Awards judging so I couldn’t be there in person but fortunately they offered on line access to all of the talks and subsequent reflections. So here is a brief run down on what was discussed.
Overviews from the chairs
Professor Robin May, the FSA’s chief Scientific Adviser highlighted the FSA’s research which informs their understanding of behaviours of consumers, the prevalence of food hypersensitivity and its impact. Professor May pinpointed several emerging areas that are of concern to the allergic community:
- Recyclable packaging.
This is often created from food waste, which could potentially cause risks for consumers with food hypersensitivity (FHS), particularly if it isn’t clear what it is made from.
These could ultimately be life threatening so a full understanding of what food packaging is derived from is critical to reduce risk and protect the health of allergic people. - Alternative plant and insect based proteins and lab grown meats
Many of these foods have not previously been widely eaten or are being used in a more concentrated form.
Understanding what risk, if any, they may present for people with FHS is critical to ensuring they can be marketed safely. - Globalisation of food and GM foods
Many foods are now being exported around the world to countries where they have not previously been eaten and could pose new risks to the local population.
It is also important to continue to evaluate genetically modified and genetically engineered crops to understand the consequences and any unintended risks.
Professor May emphasised that the FSA’s work in these areas is only of use if it can be clearly and concisely communicated to consumers without either overloading them or providing them with inaccurate information. This communication is a vital part of the FSA’s work.
FSA Director of Policy, Rebecca Sudworth, outlined the recent collaborative research and communications campaigns that the FSA have initiated:
- Speak up for Allergies
This encouraged young people to tell their friends about their food allergies, and encouraged those friends to provide both moral and practical support in keeping the alleric person safe.
It also advised food businesses by providing a simple allergen checklist to ensure their staff have good, up-to-date knowledge of allergies, and could embed effective allergen management in their day-to-day processes. - Free On Line training for food businesses and local authorities
- Consultation on Precautionary Allergen (PAL)/’may contain’ labelling
The aim is to gather views on how PAL could be made to work better for food businesses and consumers, keeping the latter safe without limiting their food choice. - Reporting reactions and near misses
A 4 month pilot study of a reporting tool which would allow consumers with an allergy, intolerance or coeliac disease to report any reaction or ‘near miss’ they had with foods. - Food Allergy Safety Scheme
The FSA are also exploring options for improving safety and trust for people with FHS when they purchase food outside of the home – from restaurants, cafes and takeaways.
The Day’s Speakers
Professor Fox outlined the differences between Immediate (IgE) and Delayed (non IgE) reactions.
- Immediate (IgE)
Quick onset, easy to diagnose, validated tests, small risk of dangerous reactions, can be lifelong, major impact on quality of life - Delayed (non IgE)
Delayed onset, hard to diagnose, often related to eczema, reflux etc, no validated tests, no risk of dangerous reactions, often outgrown, less impact on quality of life.
UK position over last 20 years
- Although there have been substantial increases in hospital admissions with food anaphylaxis the data does not suggest that there has been an increase in the incidence of food allergy.
- No change in rate of fatal anaphylaxis but the anaphylaxis case fatality rate has decreased.
- Hard to say whether the data suggests an increase in prevalence of food allergy or just an increasing concern and awareness about food allergy?
Change in management of IgE food allergy over last 15 years
- Rather than early avoidance of allergens an early ‘active’ introduction of allergens to a child’s diet is encouraged to ‘induce tolerance before allergy develops’.
- Greater awareness of society’s role in managing allergy – in schools, the labelling of food in retail outlets, information provision when eating out.
- Increasing use of oral desensitisation treatments although these are still in their early days and bring complexities of their own.
- Management is a balancing act between avoiding allergens and promoting the acquisition of tolerance.
Dr Knibb looked at the psychological burden of living with food hypersensitivity.
Why is it a burden?
The individual is generally well and in good health when avoiding the foods they react to, but is continually at risk of symptoms after eating, symptoms which can be severe or life-threatening. So managing food hypersensitivity requires constant vigilance to avoid an accidental reaction. This can have a significant effect on the individual with food hypersensitivity and their family in terms of:
- Depression and anxiety
- Stress and Post Traumatic Stress
- Quality of life.
It would appear that a sensitivity to foods that are widely used in cooking and in food manufacture (milk or egg) causes more anxiety than a sensitivity to a single allergenic food such as peanuts.
Because there is relatively little data on the impact on Quality of Life in instances of food hypersensitivity or food intolerance Rebecca’s team have been:
- Evaluating the impact of food hypersensitivity on daily lives and quality of life.
- Producing monetary valuations by assessing how much someone would be willing to pay to remove the anxiety and day-to-day impact of being food sensitive.
They found that Quality of Life for all food hypersensitives was significantly impacted by:
- The need to read food labels when shopping
- The need to check with any eateries before going there as to whether it would be safe.
- The anxiety over whether the information available, especially when eating out, could be trusted.
Dilys Harris, Senior Trading Standards Officer
Caerphilly County Borough Council
Dilys outlined the role of Trading Standards in the management of food hypersensivity in terms of guidance and enforcement, the emphasis being on prevention rather than cure.
She then described the award winning Allergen Resource Pack for food businesses that her group had put together. This included:
- A professionally made allergen awareness video and –
- Real life films of two cases – ‘A day in the life of Chloe’ and ‘Megan’s story’.
- Both dubbed in Welsh, Bengali, Cantonese, Kurdish, Mandarin, Punjabi, Turkish, Urdu, Bulgarian, Hungarian, Polish, Romanian
- Key message hand outs and allergy/intolerance posters – all available in the above languages.
Ashleigh Moore from Greggs
Ashleigh shared the allergen training that all Greggs’ staff undergo with especial attention focused on Natasha’s Law covering the labelling of all foods pre packed for direct sale – particularly relevant for a business such as Greggs so much of whose business is takeaway snacks.
Maggie Young and Sarah Baker from the Anaphylaxis Campaign – a new Model Policy for Schools
Why is this needed?
- Around 5-8% of children in the UK live with a food allergy
- Most school classrooms will have at least one allergic pupil
- 17% of fatal food anaphylaxis reaction in school-age children happen while they are at school
- 20% of anaphylactic reactions in schools are in children with no prior history of food allergy
- Following the deaths of two children in school as a result of anaphylaxis coroners have flagged the key issues including lack of staff training
- 32% of children surveyed reported bullying due to food allergy at least once
Working with BSACI, Allergy UK and the Medical Conditions in Schools Alliance and supported by the Department for Education, the Campaign are developing a policy model which will include:
- Spare pens in schools website
- Allergy action plans
- Cross contamination
- Recognise Anaphylaxis – ABC – Training
- Risk assessment
Working with caterers, parents and carers they are developing a range of resources and an allergy management checklist:
- Anaphylaxis Emergency response plan
- Has your school purchased spare pens?
- Does each child have a completed and signed Allergy Action Plan?
- Have all school staff been trained in allergy and anaphylaxis?
- Does the school plan include where and how to store AAIs?
- Is there a schedule to check the expiry dates on spare AAIs and each child’s AAI?
- Does the policy cover catering for children with allergies?
- Does the policy include pupil allergy awareness?
- Has the school completed an Allergy Risk Assessment?
- Does the policy include risk assessment of extra curricula activities?
- Does your policy cover safeguarding children with allergies, including bullying?
For more information contact the Anaphylaxis Campaign.
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