The vital importance of good information when living with allergy

The conviction this week of Indian takeaway owner, Mohammed Zaman, for Paul Wilson’s shocking and totally needless death in January 2014 has once again brought anaphylaxis onto the front pages.

As I am sure you will all have read, Paul Wilson, who was peanut allergic, died because Zaman had substituted cheap ground groundnuts (peanuts) for the more expensive ground almonds in his food. (This is the Guardian’s report, and also their photo, but there were many more.) Moreover, because Zaman was allegedly heavily in debt, he had employed cheap, illegal workers who had no training in allergy. Despite having requested a nut free meal and having ‘no nuts’ written all over his order, Paul Wilson’s chicken tikka masala did contain peanuts and he died from anaphylactic shock.  Weeks earlier, another nut allergic customer had been hospitalised after eating at one of Mr Zaman’s restaurants.

This was obviously a case of gross negligence and Mr Zaman has rightly been sentenced to six years in prison for manslaughter and food safety offences both for substituting peanut for almond and for failing to train his staff in the management of allergy. But you have to go back a step and ask how well Paul Wilson himself had been trained in the management of his allergy. As reported, he knew he was nut allergic and was ‘very, very  careful always to avoid nuts when ordering his food’. But how well had he been ‘trained’ by his GP or his allergist?

Those of us who work or live with serious allergies would see warning lights flashing very brightly if anyone suggested eating either in an Indian restaurant or at a take-away.

Nuts are widely used in Indian cooking and most dishes served in Indian restaurants are slow-cooked composite dishes in which it would be very difficult to tell whether or not any nuts had been used. There is, of course, no reason why an Indian restaurant cannot cook a nut free meal but when you combine the nature of the cuisine with the facts that many of the staff will not have English as their mother tongue and that food allergy is still a relatively uncommon condition in India, the potential for mistakes or contamination is very high. So most nut allergics that I know would not be prepared to take that risk.

Takeaways are well known for having a high turn over of marginally trained staff and recent FSA surveys have certainly suggested that allergy awareness among takeaways is abysmal. So when you combine that with the risks already inherent in eating Indian food if you have a nut or peanut allergy, having an Indian takeaway is always going to be a very high risk option.

But, did Paul Wilson know that? If he was not a cook, why would he have known anything about the composition of an Indian meal over and above the fact that he enjoyed Indian food? If he did not know much about the catering trade, how was he to know how well or badly trained the staff in any restaurant or takeaway were likely to be? That is the kind of information you would have hoped that he would have got from his GP along with his prescription for his Epipen – but did his GP know? (Indeed, I am not even sure that he carried an Epipen as one report I read suggested that he had tried to make himself sick when he realised that he had eaten peanuts by mistake. In which case, why did he not have an Epipen and why had he not been trained in how to use it?)

Sadly, this kind of back up information is not widely available, unless you go to specialist sources such as the excellent Anaphalaxis Campaign. It is certainly not available from your average GP, most of whom (not their fault, they have never been trained themselves) cannot even tell their patients how to operate an Epipen. More alarmingly, there are still a number of new small freefrom manufacturers who set off to make allergen free food with the best possible intentions but without the requisite knowledge and allergen awareness.

For one reason or another, some of them come our way and we do out best to alert them to the possible hazards inherent in ‘freefrom’ food preparation. The most obvious of these is, of course, excluding the relevant allergen from the recipe and that is not usually an issue. What is more difficult for them to get their heads around is the potential for contamination if the allergen is allowed anywhere into the facility. They also need to understand – and avoid – the confusion surrounding ‘may contain’ or precautionary allergen labelling.

As you know, this is a subject close to our hearts and we are still working on an accreditation scheme which will enable allergic consumers to really trust such warnings when they appear on foods. In other words, that the manufacturer has to be sufficiently diligent in their processes only to use a ‘may contain’ warning if therein a genuine risk.

But it is essential that manufacturers, even the smallest and newest, do understand the contamination issue from the allergic consumer’s point of view. If you are seriously allergic (or you have a child who is seriously allergic) a speck of dust or a tiny droplet of milk can kill you or your child. It is true that the chances of being killed by an allergic reaction are far lower than being killed in a road accident – but, they are chances that you can control, whereas you cannot control the road accident. So, if you can control them, why wouldn’t you? Especially as an allergic parent on whom the responsibility of keeping your child alive weighs very heavily.

Therefore, in the main, serious allergics do not take risks – and eating anything from a manufacturer which carries a ‘may contain’ warning, even if that warning only applies to a small element in that product (such as mini egg fillings to chocolate eggs) constitutes a risk, so they will not take it. The better manufacturers understand this and its implications for their processes, the better for both allergic consumers and for the freefrom food industry.