Inquest into Celia Marsh’s death raises many issues

In December 2017, on a post Christmas shopping expedition,  42 year-old Celia Marsh died after suffering an anaphylactic reaction. She had just eaten a super-veg rainbow flatbread from Pret a Manger which was subsequently found to contain milk protein to which she was allergic.

The inquest which is on going right now raises a number of concerning issues for those living with allergies, the freefrom food industry and the vegan food industry.

The supply chain

The first of these is the supply chain. How far back can – and should – the final manufacturer or indeed retailer of a freefrom product check the freefrom credentials of that product?

• In this case it would appear that the source of the dairy contamination was the ‘HG1’ tapioca starch used in the CoYo coconut yoghurt in the sandwich.
• CoYo was developed in Australia and the tapioca starch used in the Australian product came from Tate & Lyle in Australia.
• The Australian manufacturer of the product, Henry Gosling, assured the UK manufacturer, Bethany Eaton of Planet Coconut, that the HG1 had been specifically designed for a dairy free yogurt and was made in an allergen free area – and that he had audited all his suppliers. He did not supply Planet Coconut with any further allergen information.
• However, the HG1 used in Planet Coconut’s yogurt did not come from Australia but was supplied by Tate & Lyle from their factory in Mold in North Wales.
• Tate & Lyle in Mold did not claim dairy/milk free status for their HG1 starch and the product supplied to Planet Coconut carried a ‘may contain’ / precautionary allergen warning label as it was made in a factory which also used milk products.
• Testing showed that the yoghurt used in the sandwich did indeed contain between 3.1 and 3.4mg/kg of milk protein.

Assuming that Planet Coconut were aware that the HG1 product they were using was coming from a different factory, even though from the same company:

• Should they have either tested the ingredient themselves or required appropriate assurance from the supplier that the product was allergen free? Since Tate & Lyle Mold were adding precautionery allergen labels to their products they would obviously have been unable to give these assurances.
• And should Pret a Manger, as the final retailer, have also either tested the products or required similar assurances from the manufacturer?

Testing

It is easy to say yes: both Planet Coconut and Pret should test all of their freefrom products to ensure that they are contamination  free. However, how practical or even reliable would such testing be?

• There would be a very significant cost involved if all products were to be regularly tested. Who would carry that cost? Small manufacturers (such as Planet Coconut) already struggle with added costs and freefrom products are already more expensive than non freefrom products. More testing would push the cost up further.
• Continual testing would also involve further delays to supply – another added cost.
• And then how reliable is testing?
  • A test is really only truly reliable for the batch of food that was tested – and indeed for the portion of that batch  that was tested.
  • Depending on the texture and consistency  of the food concerned the allergen may be dispersed throughout the food or may be concentrated in one small part of it. Will the test catch it?
  • And a test only actually relates to the batch tested – what of other batches that come before or after? Obviously you would hope that batches woud be uniform but that is definitely not always the case.

PAL/Precautionary allergen labelling

A more reliable route would appear to be comprehensive risk assessment, manufacturing protocols which eliminate as much risk as is possible and precautionery labelling which accurately reflects the allergen risk carried by that product.

• In this case it would appear that whatever about their risk assessment/manufacturing protocols, Tate & Lyle’s precautionary allergen labelling was both justified and accurate.
• However, this is not always so and until the PAL system is fully regulated it is hard to see how responsible manufacturers can rely on it.
• Which means effectively that, as a manufacturer, if you want to be confident in the allergen status of an ingredient, you need to vet your suppliers’ procedures carefully and not be satisfied with vague assurances that ingredients are allergen free.
• But once again, this is an added cost burden and, for small manufacturers, it may be really difficult to even obtain this information.

Vegan labelling

The issue of vegan labelling has been widely discussed within the allergen community. (For a number of excellent articles on this subject search ‘vegan labelling’ on Alex Gazzola’s Allergy Insight blog.)

• The problem is that for vegans avoiding animal products (which obviously include milk) is all about intention. As long as you did not ‘intend’ to consume milk or eggs, if you do consume a small amount because what you are eating has been contaminated with milk or eggs, that is not an issue. So a vegan label does not need to highlight contamination as a risk.
• But for someone with a milk or egg allergy that is not at all the case. Contamination could be just as dangerous for you as inclusion.
• Unfortunately, all too many of those living with a milk or egg allergy are not aware of this and assume that a ‘vegan’ label means that the product will be safe for them when it might not be at all.

Escalating reactions

Finally, Celia Marsh’s death would also seem to reinforce one of the latest findings of the TRACE study – that the severity of a reaction increases with repeated challenges. In other words, your reactions are likely to get more serious each time one is triggered.

Eight months before her death Celia Marsh had suffered a bad reaction to a food containing marshmallow while at the dental surgery where she worked. The label said it had been made on the same line as a product containing milk. On that occasion she needed 12 shots of adrenalin at the surgery and three in hospital to combat the reaction. On this occasion, tragically, no amount of adrenalin was able to save her.