# Presentation: 496558

## Food-Allergic Consumer’s Perspective on Ingredient Labeling 

- Anne Munoz-Furlong
- FAAN

## Objectives

- Profile of the food-allergic consumer
- Discuss food allergy labeling information
- Provide consumer’s perspective on threshold levels

## FAAN

- Non-profit organization, established in ’91
- Over 27,000 members
- Mission is:
-    To increase public awareness, to provide advocacy and education, and to advance research on behalf of all those affected by food allergy and anaphylaxis.

## Profile of Food-Allergic Consumer

- Affects approximately 4% of U.S. population or 11 million Americans
- Fish and shellfish allergy   2.3% or
- 	6.5 million
- Peanut and tree nut allergy  1.1% or 3 million people

**Notes:**
Children are the largest group of the population affected by food allergies. Many of them outgrow their allergies with the exception of peanut and tree nut allergy, which is considered life long. 

Using current US Census Bureau statistics, we speculate that there are an estimated 6 to 7 million Americans who have true food allergies. 

A study to determine the prevalence of peanut and tree nut allergy in the US, published in the Journal of Allergy & Clinical Immunology, April 1999, by Sicherer, et al, showed that 1.14% of the population is believed to be allergic to peanuts and tree nuts.

## Fish and Shellfish Allergy

- Shellfish allergy:
- 2% of the population
- Shrimp, crab, lobster, clam
- Fish allergy:
- .4% of the population
- Salmon, tuna, catfish, cod

## Tree Nut Allergy

- Tree nuts are not related to peanuts
- Tree nut allergy affects 1.5 million Americans
- Most common causes of tree nut allergy:
- Walnut, cashew, almond, pecan

## What does it mean to have food allergies?

- Vigilant label reading for foods, bath products, pet foods, medications--everything
- Trace amounts can cause a reaction
- Just one little bite can hurt
- Epinephrine is the only medication to stop a severe reaction

## Profile of Food-Allergic Consumer

- There is no cure, strict avoidance is key
- Food allergies impact
- Decisions about
- Food shopping
- Cooking
- Dining out
- Socializing
- Schools and child care
- Travel
- Vacation
- Family relationships

## Food Allergy Impact on Quality of Life

- Families with a food-allergic child scored lower than the general population on scales of general health, emotional health and family activities
- Reduction in score for general health influenced by associated chronic disorders (i.e. asthma, eczema)
- Families with children with > 2 food allergies scored lower for 9/12 scales compared to those with 1-2 allergies

## Impact on Quality of Life

**Sicherer, Noone, Munoz-Furlong *****Ann Allergy Asthma Immunol***** 2001**

## Label reading

## Reading Food Ingredient Statements

- Food-allergic consumers must live in a black and white world: if you are allergic, you don’t eat the product
- If the allergen is listed on the label or the product says, “Contains *allergen”, *they avoid it
- They expect ingredient labels to be consistent and reliable
- The same product with different information causes confusion, frustration, and concern

## Reading Food Ingredient Statements

- Challenge:
- Patients are told to strictly avoid the allergen—zero tolerance
- They are not aware of the scientific names for these foods
- It’s more than just the patient’s family who is reading labels on their behalf
- Allergens appear in unexpected places

## Common Foods In Unexpected Places

| Egg | Tree Nut |        Milk | Peanuts
 | Fish |
| --- | --- | --- | --- | --- |
| Tartar sauce
Sorbet 
Pizza
Mustard
Barbecue flavor potato crisps
Shampoo

 | Walnut in pasta, pie crusts, frozen lasagna, blue cheese dressing
Pistachio, pine nuts, or walnuts in pesto sauce 
Almond in soap
 | Chicken flavor rice mix
Barbecue flavor potato crisps
Hamburger
Coffee whiteners
Non-dairy products 
Hot dogs
French fries
Bath soap | Turkey Stew
Veg. w/hot oil
Sweet Potato puree
Pesto sauce
Egg rolls
Enchilada sauce
Brown gravy
Basting sauce
Barbeque sauce | Caesar Salad dressing
Worcestershire sauce
Imitation shellfish

Soy & Wheat
Roast Beef
Canned tuna

 |

## Interpretation of Food Labelsby Parents of Food Allergic Children

- Joshi, Mofidi, Sicherer J*ACI* 2002** **

## Allergen Advisory Statements

- Problem
- No guidelines or standards for use
- Can’t educate consumers about what they mean
- Proliferation of “may contain” precautionary allergen labeling has further restricted their diet
- Northern Virginia grocery store
- Products from cookies, crackers, candy, and bakery
- 28 different versions of “may contain” type statements

## Allergen Advisory Statements

- Current Environment
- Some physicians advise their patients to ignore precautionary labeling
- Some companies tell consumers the statement is on the package only for legal purposes
- Advisory statements for peanut only
- Consumers confused and frustrated
- Risk taking behavior, particularly teens

##  Consumer BehaviorFAAN Labeling Study

- Would _Never_ purchase a product that says:
- Contains *Allergen **	**	**	**	*99%
- May contain *Allergen**	**	**	**	*95%
- May Contain Traces of *Allergen **	**	*91%
- Manuf. on Shared Equipment ... 		91%
- Manuf. on a Line ... 				91%
- Manuf. in a Facility ... Uses 			76%
- Packaged in a Facility ... 			74%

## Thresholds from the Consumer’s Perspective

- Physician advice--strict avoidance or a reaction may occur
- Consumers believe:
- threshold levels will put their child at risk
- threshold levels are the industry’s way to avoid appropriate cleaning and labeling

## Thresholds from the Consumer’s Perspective: Catch 22

- Labeling for all allergen levels may lead to:
- further restricted diets
- increased frustration and risk taking
- undermine the integrity of the ingredient label
- potentially more allergic reactions and
- an increase in doctor or hospital visits

## Thresholds from the Consumer’s Perspective: Catch 22

- Example:
- 	One FAAN member of a soy-allergic child who had safely eaten soy lecithin in the past, gave a packaged product to the child.
- 	Afterward, she read the label “Contains Soy”, and screamed “it now contains soy!”
- 	Child had itching, hives , rash, feeling of impending doom. Mom administered medication –reaction or panic attack?
*We should not subject consumers to this type of stress*

## Thresholds from the Consumer’s Perspective

- Education is key
- Outreach needed for:
- physicians and registered dietitians
- patients and their families
- food industry

## Summary

- Consumers want as many food choices as safely possible
- Consumers need:
- to understand the information on the ingredient statement
- to **trust** that the information is complete and reliable
- minimal number of precautionary/Allergen Advisory statements used and guidance from industry regarding their meaning

## Conclusion

**Current labeling and manufacturing practices present enormous challenges to food-allergic individuals**

## The bottom line is

-    We must protect the integrity of the ingredient information because the food-allergic consumer depends on this information to avoid an allergic reaction and to maintain their health and safety