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Interpretation of commercial food ingredient labels by parents of food-allergic children
Abstract
To avoid allergic reactions, food-allergic consumers depend on the ingredient labels of commercial products. Complex ingredient terminology (eg, casein and whey for milk) and label ambiguities (eg, natural flavor and may contain peanut ) might compromise the ability of patients/parents to determine the safety of particular products.
The purpose of this investigation was to determine the accuracy of label reading among parents of food-allergic children.
Parents of children on restricted diets attending our referral center were asked to review a group of 23 food labels taken from widely available commercial products. For each label, each parent/parent pair was asked to indicate whether the product was safe for the allergic child and, if it was not, which foods restricted from the child's diet were in the product.
There were 91 participants. Peanut was the most commonly restricted food (82 children), followed by milk, egg, soy, and wheat (60, 45, 27 and 16 children, respectively). Identification of milk and soy was the most problematic: only 4 (7%) of 60 parents correctly identified all 14 labels that indicated milk, and only 6 (22%) of 27 parents correctly identified soy protein in 7 products. Peanut was correctly identified in 5 products by 44 (54%) of the 82 parents restricting peanut. Wheat (10 labels) and egg (7 labels) were correctly identified by most parents (14/16 and 42/45, respectively). Correct label identification was associated with prior instruction by a dietitian.
With current labeling practices, most parents are unable to identify common allergenic food ingredients. These results strongly support the need for improved labeling with plain-English terminology and allergen warnings as well as the need for diligent education of patients about reading labels.
... In this case, the owner received a list (due to the picky eating pattern of the patient) with adequate diets to start the elimination diet to properly exclude a food hypersensitivity. Joshi et al. (2002) showed that only 54% of parents who have children with a peanut allergy correctly identify the allergen in the label. This percentage decreases in the case of a milk allergy (7%) (Joshi et al. 2002). ...
... Joshi et al. (2002) showed that only 54% of parents who have children with a peanut allergy correctly identify the allergen in the label. This percentage decreases in the case of a milk allergy (7%) (Joshi et al. 2002). The important fact is that those who scored almost perfect (9/10) received advice from the Food Allergy and Anaphylaxis Network (Joshi et al. 2002). ...
... This percentage decreases in the case of a milk allergy (7%) (Joshi et al. 2002). The important fact is that those who scored almost perfect (9/10) received advice from the Food Allergy and Anaphylaxis Network (Joshi et al. 2002). To our knowledge, no similar official veterinary organisation exists. ...
A 2-year-11-month-old female spayed cat was at the Small Animal Teaching Hospital of Ghent University presenting with hyperactivity, scratching and licking all over her body and an abnormal urination behaviour. Nothing remarkable was found on the dermatology and neurological examination. Based on the owner’s history and video material, the presence of feline hyperaesthesia syndrome (FHS) was hypothesised. A symptomatic treatment with gabapentin was established for a month without any significant improvement. An elimination diet with hydrolysed protein sources was started and, as a result, the dose of gabapentin was reduced after three days and completely stopped after one week. With the exception of two non-intentional exposures to non-hypoallergenic diets and the challenge with new protein sources by the owner, the cat has been free of symptoms, with the exception of a slight reaction in the lumbar area (significantly reduced in comparison before starting the diet), and without the use of medication. In conclusion, an elimination diet should be considered as part of the diagnostic plan for FHS and should not be delegated to the last step if the patient’s condition allows it.
... A identificação de alimentos que contenham ou não leite de vaca depende da relação de ingredientes descritos nos rótulos das embalagens 10 . Os erros na identificação do produto podem ocorrer pela rotulagem errônea 11 ou por interpretação inadequada pelo consumidor 10 12 Na identificação de alimentos permitidos e não permitidos na dieta isenta de leite de vaca e derivados, verificou-se que há uma tendência dos indivíduos, tanto do grupo de estudo como do controle, em acertar a identificação de produtos que contenham leite de vaca na composição (Tabela 2). ...
... A identificação de alimentos que contenham ou não leite de vaca depende da relação de ingredientes descritos nos rótulos das embalagens 10 . Os erros na identificação do produto podem ocorrer pela rotulagem errônea 11 ou por interpretação inadequada pelo consumidor 10 12 Na identificação de alimentos permitidos e não permitidos na dieta isenta de leite de vaca e derivados, verificou-se que há uma tendência dos indivíduos, tanto do grupo de estudo como do controle, em acertar a identificação de produtos que contenham leite de vaca na composição (Tabela 2). Esta identificação afasta o perigo de contato com o alérgeno; no entanto, por outro lado, a classificação de alimentos permitidos como sendo proibidos torna a dieta ainda mais restritiva. ...
... produtos industrializados10,11,15 . O governo dos EUA propôs alteração na regulamentação da rotulagem dos produtos alimentícios, tornando obrigatória a nitidez dos rótulos das embalagens e a identificação dos ingredientes com maior potencial alergênico. ...
OBJECTIVE:
To investigate how well the parents of children on cow's milk free diets perform at recognizing whether or not expressions describe and foods contain cow's milk proteins.
METHODS:
Interviews were conducted with 24 parents of children on cow's milk and by-products exclusion diets and 23 parents of children with no need for any type of exclusion diet. They were asked if they recognized 12 expressions relating to cow's milk. They were then asked to classify 10 commercial food products in terms of whether or not they contained cow's milk proteins.
RESULTS:
Terms that included the word milk were more often recognized by both groups of parents. The parents of children on exclusion diets recognized the terms cow's milk protein, traces of milk and milk formulation or preparation most frequently (p < 0.05). Less than 25.0% of those interviewed recognized casein, caseinate, lactalbumin and lactoglobulin. Both groups correctly identified more of the commercial products containing cow's milk than those free from milk. The median number of products containing cow's milk (total = 5) correctly identified by the parents of children on exclusion diets (4.0) was greater than for the control group (3.0; p = 0.005). Reading at least one label was associated with a greater chance of correctly identifying more than five of the 10 products (odds ratio = 8.0).
CONCLUSIONS:
Despite having received guidance, the parents of children on exclusion diets were not fully prepared to manage these diets, indicating a need for improvements to the instruction provided when indicating exclusion diets.
... purchasing (Joshi et al, 2002). Less than 20% had perfect product recognition for milk allergen and this was as a result of the numerous names utilized for milk identification such as casein or whey (Joshi et al, 2002). ...
... purchasing (Joshi et al, 2002). Less than 20% had perfect product recognition for milk allergen and this was as a result of the numerous names utilized for milk identification such as casein or whey (Joshi et al, 2002). A cross sectional study carried out by Barnett et al, 2011 showed that in the recent past, customers were using food labels (allergy box), previous experiences and confidence in manufacturers to make choices on the type of food to purchase though there were requests as observed in this study to have more identifiable specific allergen labelling since some manufacturers are already doing that. ...
Milk ranks as the second most common allergen, following peanuts. Recent studies from Spain and theUSA reports an annual frequency of accidental allergic reactions (AAR) ranging from 34% to 40%. AAR severity is influenced by food allergens and the presence of atopic diseases such as asthma, eczema, hay-fever, and recurrent wheezing. This study aimed to determine the frequency of accidental allergic reactions in children with cow’s milk protein allergy between September 2011 to September 2012. The study design employed is missing. A structured questionnaire was used and the guardians of the patients were guided in answering by the research assistants (Students). The questionnaire was conducted on 62 patients (35 males, 27 females) with a median age of 67 months. The inquiries were about the number and locations of accidental reactions, their severity, other food allergies, and risk factors such as asthma, hay-fever, recurrent wheezing, and eczema. Symptoms were classified as mild, moderate, or severe, and previous and current skin prick test results were recorded. Between 2011 and 2012, the frequency of AAR was found to be 57% (inclusive of adults). Among the children, 37 (60%) experienced 51 accidental reactions in the past year, with 43% classified as mild, 19% as moderate, and 38% as severe. The majority of reactions (60%) occurred at home, and treatment primarily involved the use of Chlorphenamine [Piriton©] (79%). Three anaphylactic reactions occurred and were identified leading to hospitalization and administration of epinephrine. Oral exposure was the primary route (89%), with milk-containing products being the most common allergen sources (51%). The main cause of AAR was attributed to mislabeling and misreading of labels, especially in newly implemented recipes and non-packaged cereal products like homemade croissants sold in cafes and restaurants. Other causes included high levels of peanut traces and hazelnuts in cookies and chocolates. In conclusion, accidental allergic reactions are prevalent in children and are often caused by contamination, mislabeling, recipe changes by companies, misinterpretation by caregivers, and direct milk intake. Risk factors for AAR severity include hay fever, peanut allergy, multiple atopic diseases, and wheal size.
... Consequentemente, as comparações são difíceis porque diferentes metodologias foram usadas. Várias características do rótulo foram classificadas como problemas graves ou muito graves por cerca de 40% dos entrevistados com AA. 19,20 Joshi et al. 19 estudaram a precisão com que os pais de crianças com AA podiam identificar alimentos alergênicos nos rótulos dos alimentos. Eles descobriram que muitos pais podem cometer erros ao ler os rótulos dos alimentos. ...
... Consequentemente, as comparações são difíceis porque diferentes metodologias foram usadas. Várias características do rótulo foram classificadas como problemas graves ou muito graves por cerca de 40% dos entrevistados com AA. 19,20 Joshi et al. 19 estudaram a precisão com que os pais de crianças com AA podiam identificar alimentos alergênicos nos rótulos dos alimentos. Eles descobriram que muitos pais podem cometer erros ao ler os rótulos dos alimentos. ...
Objective
The aim of this study was to evaluate allergenic labeling components of packaged foods for “What is the quality of food labels?” and “What is the group of Brazilian Food Pyramid that ‘May contain’ is predominant?.”
Methods
The photographs of 916 products were obtained, of which 518 were analyzed. Data from each label were evaluated according to Brazilian Food Pyramid Groups (i.e., Cereals, Fruits, & Vegetables; Soybean & products; Milk & dairy products; Meat & eggs; Fats & oils; and Sugars & sweets). Ten items were analyzed in each label, namely, the presence of a list of ingredients, alert phrase for allergy sufferers, grouping of the alert phrase, phrase location, uppercase phrase, the phrase in bold, the color of alert phrase contrasting to the background, adequate font size, do not claim the absence for any allergen with the ingredients, and others factors that make it difficult to read. For the second question, a structured questionnaire was completed, and products were classified into two categories, namely, “Contain” and “May contain.”
Results
The quality of the label was appropriate, and 69% of packaged foods had at least one allergen. The information “May contain” were higher in cow’s milk (Cereals and Meat & eggs), soy (Soybean & products), and egg protein (Cereals). Soybean & products were the highest insecurity group.
Conclusions
Brazilian health professionals can count on good-quality labeling of packaged products. Consequently, they could promote patients’ and parents/caregivers’ education to consult the labels and manage the risks in processed foods about precautionary allergen labeling. Soybean & products were the most significant insecurity for food choices between Brazilian Pyramid Groups.
Keywords:
Allergens; Food hypersensitivity; Industrialized foods; Food labeling
... Consequently, comparisons are difficult because different methodologies have been used. Several characteristics of the label were classified as severe or very serious problems by about 40% of respondents with FA. 19,20 Joshi et al. 19 studied the accuracy with which parents of children with FAs could identify allergenic foods on food labels. They found that many parents could make mistakes when reading food labels. ...
... Consequently, comparisons are difficult because different methodologies have been used. Several characteristics of the label were classified as severe or very serious problems by about 40% of respondents with FA. 19,20 Joshi et al. 19 studied the accuracy with which parents of children with FAs could identify allergenic foods on food labels. They found that many parents could make mistakes when reading food labels. ...
Objective:
The aim of this study was to evaluate allergenic labeling components of packaged foods for "What is the quality of food labels?" and "What is the group of Brazilian Food Pyramid that 'May contain' is predominant?."
Methods:
The photographs of 916 products were obtained, of which 518 were analyzed. Data from each label were evaluated according to Brazilian Food Pyramid Groups (i.e., Cereals, Fruits, & Vegetables; Soybean & products; Milk & dairy products; Meat & eggs; Fats & oils; and Sugars & sweets). Ten items were analyzed in each label, namely, the presence of a list of ingredients, alert phrase for allergy sufferers, grouping of the alert phrase, phrase location, uppercase phrase, the phrase in bold, the color of alert phrase contrasting to the background, adequate font size, do not claim the absence for any allergen with the ingredients, and others factors that make it difficult to read. For the second question, a structured questionnaire was completed, and products were classified into two categories, namely, "Contain" and "May contain."
Results:
The quality of the label was appropriate, and 69% of packaged foods had at least one allergen. The information "May contain" were higher in cow's milk (Cereals and Meat & eggs), soy (Soybean & products), and egg protein (Cereals). Soybean & products were the highest insecurity group.
Conclusions:
Brazilian health professionals can count on good-quality labeling of packaged products. Consequently, they could promote patients' and parents/caregivers' education to consult the labels and manage the risks in processed foods about precautionary allergen labeling. Soybean & products were the most significant insecurity for food choices between Brazilian Pyramid Groups.
... This is an integral aspect of preventing accidental exposure to the allergen, as a large percentage of participants in studies conducted in different countries (Mauritius, Netherlands, and United States) agreed that the use of complex terminology posed to be an obstacle for food allergic individuals when choosing suitable foods. 8,20,33 The participants also agreed that the use of a striking symbol to indicate the presence of an allergen is important to ease the process for the food allergic customer (93.5%). Similar results were reported by Hassan et al and Soogali et al, 15,33 where 97.1% and 87.6% of the participants, respectively, believed that the use of a striking symbol was needed to indicate the presence of an allergen. ...
Background:
Food allergy is a life-threatening medical condition of public health concern. The aim of our study was to characterize food allergies, in terms of sources, symptoms, severity, and history, as well as to assess the knowledge, practices, and attitudes towards food allergens and allergies, in addition to food allergen labeling, in Lebanon.
Methods:
For this, 1100 participants filled over the phone a comprehensive valid questionnaire composed of 41 questions.
Results:
Fruits were reported as top food allergens (29.6%), while itching and rash were the most reported symptoms (9.6% and 8.0%, respectively). In terms of knowledge, participants scored on average 67.9 ± 16.2%. Participants who identified as females, below 35 years, highly educated, and from health backgrounds had a significantly higher score (p < 0.05), while area of residence did not have any significant effect (p > 0.05). Participants who are medically diagnosed with allergies and those with health background were found to check the ingredients list and read nutritional claims significantly more frequently than those from a non-health background and who are non-medically diagnosed, respectively, while females were found to check ingredients list and read nutritional claims significantly more frequently (p < 0.05). The majority reported that ingredients are easy to understand (63.2%) and simple to read (61.3%), while allergic individuals agreed that the font size of the ingredients list is not big enough (56.8%) and that E-code numbers are not understood (68.7%). The majority considered it "important" to have the label writings larger and bolded (85.7%), to use simple language (95.5%), to place allergen warning (82.2%), and to use a striking allergen symbol (93.5%).
Conclusions:
Our results emphasize the need for national awareness campaigns to improve knowledge and practices, and to lobby policymakers for appropriate management of food allergies and allergens in Lebanon.
... • The language utilized in the label is so complex or ambiguous that the patient cannot recognize the allergen (Joshi et al., 2002). • The use of precautionary labeling such as "may contain" leads the affected person to risk eating the product ). ...
Cover design molecule: Model of the major peanut allergen, Ara h 1, produced with the MPACK suite. (C. H. Schein and coworkers, 2006.) Address editorial correspondence to ASM
... It is obviously in the best interest of the patient to educate them on identification of the allergen, so it can be avoided [16]. Correct label identification has been shown to be associated with prior instruction by a dietitian [31]. According to a survey in the UK however, dietitians seem to be more cautious in recommending eating foods with precautionary labelling than allergists [32]. ...
... In doing so, we bridge our theoretical understanding of how parents make Elbel et al. (2011) found no evidence that labelling influenced parental food choice for children. Perhaps this stems from the possibility that parents of food allergic children often were unable to correctly identify common allergenic food ingredients (Joshi et al., 2002). Further, food advertising to children shows unhealthy eating behaviours with positive outcomes (Harris et al., 2009). ...
We investigated the effects of parent’s gender, education, and attitudes towards childhood obesity on parents’ unhealthy food choices for their children and how these effects might be moderated by child and/or parent food allergy. A random sampling procedure returned 206 valid responses of parents who had children aged between 6 and 12 years old. A structural equation modelling approach was employed. Contrary to monitoring, our findings revealed that pressure to eat positively predicted parents’ unhealthy food choices for their children. Furthermore, mothers were more likely to make unhealthy food choices for their children than fathers, unless the child had food allergy. In that case, i.e., having a food-allergic child, mothers were less likely to make unhealthy food choices than fathers. In addition, higher educated parents were less likely to make unhealthy food choices for their children than lower educated. Finally, parents’ food allergy did not moderate our hypothesised path model. Future scholarly work can address the role marketing initiatives play in assisting parents to prevent childhood obesity. Our study guides health care professionals and government health departments to pay more attention to parent’s education levels while making efforts to improve the effectiveness of their nutrition and health promotion programmes.
KEYWORDS:
Social marketing; parenting; food choice; food allergy; obesity
... Outro estudo investigou a precisão da leitura de rótulos por pais de crianças alérgicas e verificou que a maioria dos entrevistados foi incapaz de reconhecer ingredientes alérgenos nos produtos, especialmente no leite de vaca e soja. 22 É importante mencionar que os estudos nacionais que abordaram a verificação da rotulagem de alergênicos referente à nova resolução ainda são escassos. Até o momento, o estudo realizado por Freitas & Piletti 15 investigou a rotulagem de 15 produtos lácteos de diferentes marcas sob os critérios da RDC n.º 26/2015. ...
Objective: To analyze labeling adequacy of allergenic foods in accordance with Resolution no. 26, of July 2, 2015. Methodology: The agreement of allergen declarations was evaluated on 221 labels of processed foods commercialized in three distinct supermarket chains. The products were subdivided into ten food groups (breads and cereals; fish and crustaceans; eggs and derivatives; oily seeds; milk and derivatives; soybeans and derivatives; pastas; sweets, cakes and biscuits; meats and processed meats and alcoholic beverages) and were categorized as "inadequate" when they failed to meet any criteria set forth in the resolution. In order to detail the inadequacies, the following classifications were adopted: incorrect location of the declaration on the label, incomplete declaration and/or inadequate formatting and nonexistent declaration. Results: The evaluated food labels showed that 31.7% (n=70) were identified as inadequate. Of these inadequacies, it was observed that 48.6% were classified as "Nonexistent Declaration". It was also observed that the inadequacies were found in the ten food groups. Conclusion: National regulatory labeling norms have innovated regarding the protection of allergic consumers, however, there are still several irregularities in their compliance. Investigations of this nature are relevant to public health and must be carried out to demand supervision and implementation of the current legislation.
DOI: 10.12957/demetra.2018.32906
... The most prevalent advice for preventing serious allergic reactions is to read "every label, every time" (Food Allergy Research & Education [FARE], 2015, p. 6). While thoroughly reading food labels can be effective, even educated and cautious consumers make mistakes (Joshi, Mofidi, & Sicherer, 2002). ...
Allergen information on food labels is not standardized, making allergen avoidance difficult for consumers. This study investigated the speed and accuracy of allergen identification on commercial packaging across different types of warning labels. The results identified packaging label characteristics significantly correlated with faster and more accurate identification of allergens. Standardizing warning and safe-to-consume labels may reduce risk of accidental allergen exposure for consumers managing food allergies.
... To protect allergic consumers from accidental consumption of allergenic foods, various regulatory bodies, especially in developed countries, have developed allergen labeling regulations and guidelines (Gendel, 2012). Likewise, studies are regularly carried out to assess adequacy of the regulations (Anandan & Sheikh, 2005;Derr, 2006;Gendel, 2012;Taylor & Hefle, 2006), compliance with such regulations by manufacturers (Pieretti, Chung, Pacenza, Slotkin, & Sicherer, 2009;Van Hengel, 2007), and the impact of the food allergen labeling practices on allergic consumers (Joshi, Mofidi, & Sicherer, 2002;Simons et al., 2005). Unfortunately, there has been sporadic research focusing on food allergies in developing countries (Obeng, Hartgers, Boakye, & Yazdanbakhsh, 2008). ...
... To protect allergic consumers from accidental consumption of allergenic foods, various regulatory bodies, especially in developed countries, have developed allergen labeling regulations and guidelines (Gendel, 2012). Likewise, studies are regularly carried out to assess adequacy of the regulations (Anandan & Sheikh, 2005;Derr, 2006;Gendel, 2012;Taylor & Hefle, 2006), compliance with such regulations by manufacturers (Pieretti, Chung, Pacenza, Slotkin, & Sicherer, 2009;Van Hengel, 2007), and the impact of the food allergen labeling practices on allergic consumers (Joshi, Mofidi, & Sicherer, 2002;Simons et al., 2005). Unfortunately, there has been sporadic research focusing on food allergies in developing countries (Obeng, Hartgers, Boakye, & Yazdanbakhsh, 2008). ...
Food allergen labeling is an important tool in minimizing the risk of exposure to foods allergens and the resultant adverse effects for individuals with food allergies. Unlike in the industrialized countries, there have been very few studies that have scrutinized food allergen labels and analyzed the robustness of food allergen regulation in developing countries. In the present study, food allergen labeling of 105 supermarket food products in Malawi were evaluated. Furthermore, Malawi's allergen labeling regulation was compared with Codex general standard on labeling, and regulations in force in the E.U, U.S, and Republic of South Africa. About 54.3% of the surveyed products carried the special allergen declaration in addition to the declaration on the list of ingredients, 23.8% used special emphasis (bolding, italic, contrasting color and enlarged font) when declaring allergens on the ingredient list, and 28.6% used precautionary allergen labeling (PAL). Notably, none of the surveyed locally manufactured products had any of these features. However, all the surveyed products complied with the allergen labeling requirements stipulated in Malawi General Standard for Labeling of Prepacked Foods implying that the Malawi standard is not protective enough. Moreover, Malawi's allergen labeling regulation was found to be the least demanding. Although this study is based on data from Malawi, trends and implications for standards development may be applicable to other developing countries especially those in Sub-Saharan Africa.
... individuals to identify the presence of clinically important food allergens in their packed products [10], and (b) patients training to follow correct label reading practices to recognize and avoid everything they are allergic to. Teleologically, the identification of the traces that may exist in processed food is of major importance and for that reason the detection techniques that will be applied should be highly sensitive. ...
Food allergy is a public health concern especially after recognizing its constantly increased prevalence and severity. Despite careful reading of food ingredient statements, food allergic individuals may experience reactions caused by “hidden”, “masked”, or “contaminated” proteins that are known major allergens. Many techniques have been developed to detect even small traces of food allergens, for clinical or laboratory purposes. Enzyme-linked immunosorbent assay (ELISA) is one of the best validated and most routinely used immunoassay in allergy research, in allergy diagnosis in allergy-related quality control in various industries. Although as a technique it has been implemented for the last 45 years, the evolution in biochemistry allowed the development of ultrasensitive ELISA variations that are capable of measuring quantities in the scale of picograms, rendering ELISA attractive, robust, and very famous.
... Clear food labelling regarding allergens is essential to help allergic patients manage their allergy, although precautionary labelling can lead to unnecessary restrictions. A study by Joshi et al. (35) showed that in a group of parents avoiding peanuts, only 54% were able to correctly identify their presence on a label. This was worse for those with a milk allergy, where <10% correctly assessed the labels. ...
Food allergy affects 6% of children but there is no cure, and strict avoidance of index allergens along with immediate access to rescue medication is the current best management. With specialist care, morbidity from food allergy in children is generally low, and mortality is very rare. However, there is strong evidence that food allergy and food hypersensitivity has an impact on psychological distress and on the quality of life (QoL) of children and adolescents, as well as their families. Until recently, the measurement of QoL in allergic children has proved difficult because of the lack of investigative tools available. New instruments for assessing QoL in food allergic children have recently been developed and validated, which should provide further insights into the problems these children encounter and will enable us to measure the effects of interventions in patients. This review examines the published impact of food allergy on affected children, adolescents and their families. It considers influences such as gender, age, disease severity, co-existing allergies and external influences, and examines how these may impact on allergy-related QoL and psychological distress including anxiety and depression. Implications of the impact are considered alongside avenues for future research
... Another important issue is that allergens may be described in numerous different ways on the food product labels (34,44). This is particularly relevant if we take in account that studies have reported that food allergic consumers are unable to correctly identify and recognize products which contained food allergens (45,46). Thereby, for example, label ingredients that an individual should be aware in case of a milk allergy include casein, whey, ghee, curd, lactalbumin, lactoglobulin, lactulose, lactose (12,34). ...
Food allergies are a growing problem and currently the primary treatment of food allergy is avoidance of culprit foods. However, given the lack of information and education and also the ubiquitous nature of allergens, accidental exposures to food allergens are not uncommon. The fear of potential fatal reactions and the need of a proper avoidance leads in most of the cases to the limitation of leisure and social activities. This review aims to be a practical approach on education and accidental exposure prevention regarding activities like shopping, eating out, and travelling. The recommendations are focused especially on proper reading of food labels and the management of the disease, namely in restaurants and airplanes, concerning cross-contact and communication with other stakeholders. The implementation of effective tools is essential to manage food allergy outside home, avoid serious allergic reactions and minimize the disease's impact on individuals' quality of life.
... Successful avoidance of food allergens depends on appropriate education and an individual's ability to identify the foods that caused the reactions, ability to read food labels, ability to prevent allergen contamination through cross-contact (5). Patients also need instruction on obtaining safe meals in restaurants, school cafeterias, and other public eating venues (6). ...
Objective: Te aim of this study was to evaluate the knowledge of dietitians and dietetic students about food allergy in order to develop suggestions for educational activities. Materials and Methods: Dietitians and dietetics students were surveyed via a questionnaire aimed to document their knowledge about food allergy management. Results: Of the 150 questionnaires distributed, 122 valid questionnaires were returned. Te response rate was 81.3%. Of all the respondents, 51.4% were working in a hospital. About sixty percent of respondents rated themselves 'moderate' for identifying some clinical manifestations of FA, developing elimination diets, providing avoidance education, managing the dietary needs of children with cows' milk allergy (CMA). Only 72.1% of respondents answered the questions about foods that can cause anaphylaxis correctly. About forty percent of respondents did not recognize that food allergens could be transmitted by means of tools used for service such as knives and spoons and thought that smoke of the cooking food does not cause allergy. About sixty percent of respondents also thought that touching the food never causes allergic reactions. Of all the respondents, only about 18.9% suggested amino acid based formulas for children with CMA, 23% suggested fully hydrolized formulas and 39.3% thought that lactose free formulas can be given to patients with CMA. Conclusion: Tis study revealed that there are some gaps in the knowledge of dietitians about food allergy. Dietitians should be given training on this subject and there should be a re-evaluation of health policies with a wider global perspective.
... The quality, safety, and nutritional content of packed foods have not been thoroughly researched for certain newly packed foods. The desire for higher quality and safer food with a longer shelf-life led to increased interest in the interaction between foods and food packaging (Joshi et al., 2002). Color is an important quality feature of catsup sauces that affected during storage time by environmental conditions and packaging attributes significantly. ...
... Previous studies have identified the shortcomings of food labels, including lack of uniform allergen names and incomplete ingredient lists (43). Some terms on labels were complex, ambiguous, and/or out of date (22). Legislatures and manufacturers may need to work hand in hand to ensure that food allergens are more easily identified on food labels. ...
This study investigated the attitudes and behaviors of consumers with food allergies toward dining out. Four focus groups with 17 individuals with food allergies were conducted to learn about their dining experiences. All sessions were audio-recorded, transcribed verbatim, and organized for extracting key concepts. Eight participants experienced allergic reactions after dining out at the restaurants, and many had unpleasant experiences when dining out. Participants perceived cross-contact, hidden ingredients, and miscommunication as potential causes of food allergic reactions. Participants identified lack of training, awareness, and knowledge about food allergy, and other operational restrictions such as lack of resources, as barriers to providing allergen-free food in restaurants. Buffet, ethnic, and specialty restaurants were seen as high-risk dining places due to potential risks of cross-contacts and hidden allergens in sauces.The participants took various precautions such as asking for clarifications of ingredients and seeking restaurants that are familiar to them. Consumers with food allergies experienced many difficulties in restaurants due to restaurant employees' lack of knowledge and training regarding food allergy.Through qualitative research, this study provides an in-depth understanding of the difficulties faced by consumers with food allergies, and addresses future training needs for restaurateurs to accommodate their clients with food allergies.
... In addition, natural flavors could refer to peanuts, tree nuts, milk, or any other food. Patients commonly make mistakes and are unable correctly to identify the food allergens in store-bought foods; in a recent study, only 7% of parents of children with milk allergy were able correctly to identify products that contained milk, and 22% of parents of children with soy allergy were able correctly to identify products that contained soy [66] . Another impediment faced by food-allergic patients is undisclosed contamination with trace amounts of food resulting from sharing of equipment. ...
... En 2002, Joshi et al. montraient que 7 % des consommateurs allergiques au lait identifiaient correctement l'allergène sur l'étiquetage, 54 % pour les allergiques à l'arachide et 22 % pour le soja [27] et soulignaient l'importance d'améliorer la terminologie, la significativité de l'étiquetage et l'apprentissage à la lecture des étiquettes. ...
L’allergie alimentaire est un problème de santé publique de prévalence croissante. L’alimentation moderne se caractérise par l’augmentation de la consommation d’aliments complexes et la mondialisation. Les consommateurs allergiques sont dépendants de l’accessibilité, la précision et la qualité de l’information concernant les aliments qu’ils achètent. Les nouvelles règles européennes en matière d’information du consommateur allergique sont présentées. L’obligation d’information s’applique à 14 ingrédients allergéniques (céréales contenant du gluten, crustacés, œufs, poissons, arachide, soja, lait, fruits à coques, sésame, céleri, moutarde, sulfites, lupin et mollusques) et à leurs produits dérivés que ce soit sur les produits pré-emballés, vendus en vrac ou délivrés en restauration. La liste des allergènes à étiquetage obligatoire doit être périodiquement actualisée sur la base des informations scientifiques et cliniques liées à l’émergence de nouveaux allergènes. La maîtrise du risque repose sur la méthode HACCP appliquée au risque allergique. Elle justifie la détermination des seuils de réactivité allergénique pour évaluer la plus petite dose réactogène et la dose sans effet et développer des méthodes analytiques pour détecter l’allergène dans les aliments. L’attention est attirée sur l’absence d’harmonisation de la réglementation internationale sur l’étiquetage des allergènes, le sentiment d’insécurité du consommateur allergique lié à l’incertitude de l’étiquetage. La nécessité d’une réflexion éthique pour une information juste, équitable et permettant l’autonomie des consommateurs allergiques est soulignée. L’avènement de l’information numérique est prometteuse et s’inscrit dans la conception de sites alliant toutes les parties prenantes : association de patients allergiques, professionnels de santé et de l’alimentation, décideurs et législateurs.
... Owing to the confusion caused by such jargoned terminology, parents of children with allergies in a US study (Joshi et al., 2002(Joshi et al., : 1021 failed to identify food allergens correctly as indicated on the label. ...
This article provides a review of ethical food labelling from a consumer perspective and makes recommendations to the food industry and regulators regarding ethical food labelling in order to satisfy consumers’ food-labelling needs. Various studies have found that many consumers have negative perceptions regarding food labelling. However, research on consumers’ perspectives regarding ethical food labelling has been accorded little attention. This article addresses this topic through a review of the relevant literature of mostly quantitative research, but also includes qualitative and mixed method studies. The article examines such aspects as the trustworthiness of claims on food labels, intelligibility of label information, listing of food additives on labels, and labelling of genetically modified foods. As negative perspectives on food labelling are likely to affect consumers’ decision making regarding the purchasing of food products, the food industry must realise their responsibility to provide ethical food labels. The food industry and regulators should aim to provide risk communication and intelligible information through ethical food labels and consumer education programmes on food labelling. Consumers need to be aware of their right to know what they are purchasing through ethical food labels and take a stand in this regard.
... In light of the apparent limitations of food allergy-related empowerment and knowledge 6 as vehicles through which to improve parental FAQOL, interventions aiming to mitigate parental fears and anxieties regarding potential allergen exposure in the child's school, 23 childcare provider, 24 and broader social environment would appear to hold promise (eFig 3). Recent policy efforts along these lines include policies encouraging the placement of undesignated epinephrine auto-injectors in public schools 25 and efforts to improve food labels that might be difficult to interpret 26 and are frequent sources of anxiety for caregivers. 27 Group interventions aimed explicitly at decreasing parental burden and building mutually supportive social networks among parents of children with food allergy also appear to hold promise for improving parental FAQOL. ...
... FA management can be a complex process that entails lifestyle changes and poses multiple challenges for the family system. Parents often have difficulties correctly identifying causal foods in products (Joshi, Mofidi, & Sicherer, 2002) and may use inadequate strategies to guide their children's food avoidance in activities outside of the home (Kapoor et al., 2004). Furthermore, parents often lack the skills to recognize symptoms of anaphylaxis, may not have medication readily available, and lack the knowledge or confidence to treat exposures appropriately (Arkwright & Farragher, 2006). ...
Objective Develop a measure that evaluates effective pediatric food allergy (FA) management, child and parent FA anxiety, and integration
of FA into family life. Methods A semistructured family interview was developed to evaluate FA management using a pilot sample (n = 27). Rating scales evaluated eight dimensions of FA management (FAMComposite), child anxiety, parent anxiety, and overall
balanced integration (BI). Families of children with IgE-mediated food allergies (n = 60, child age: 6–12) were recruited for interview and rating scale validation. Results FAMComposite was correlated with physician ratings for families’ food avoidance and reaction response readiness. FA anxiety
was correlated with general anxiety measures for children, but not parents. Parents’ FA anxiety was correlated with expectations
of negative outcomes from FA. Low BI was associated with poor quality of life and negative impact on family functioning. Conclusions Preliminary analyses support Food Allergy Management and Adaptation Scale validity as a measure of family adaptation to pediatric
FA.
O presente trabalho teve como objetivo realizar uma revisão da literatura acerca das alergias alimentares na infância. Foram utilizados os bancos de dados Lilacs, Scielo e PubMed para o levantamento bibliográfico. A alergia alimentar consiste na reação adversa do organismo decorrente da resposta imunológica a certos alimentos. Tem-se observado um aumento na prevalência dessa doença, que apresenta diversas manifestações clínicas, sendo elas cutâneas, gastrointestinais e respiratórias. Vários fatores podem estar associados ao surgimento da alergia alimentar, como uma resposta anormal a algum ingrediente proteico dos alimentos ingeridos, processos imunológicos, herança genética ou anormalidades metabólicas. Os principais alimentos alergênicos são: leite de vaca, ovos, peixes, crustáceos, amendoim, trigo, soja e nozes. A alergia alimentar deve ser tratada com eliminação dos alimentos alergênicos, podendo ser utilizadas fórmulas hipoalergênicas, no caso de lactentes, para o fornecimento de uma dieta adequada.
Objective: Gluten-free packaged snack products are generally low in protein and fiber, and high in sugar and fat. Considering the nutritional requirements of celiac patients; it is aimed to produce healthy bar with Izabella grapes, arrowroot flour, buckwheat popped, date syrup, bee pollen and grape seeds.
Materials and Methods: Fifteen samples were produced from mustrad from Isabella grapes (100 g), date syrup (10%, 20%, 30%) and arrowroot flour (5 g, 7.5 g, 10 g) by using Box Behnken optimization method and sensory analysis was performed in the samples. The formula of the inner core of the bar was acquired according to the overall acceptance score. Buckwheat popped (5 g, 7.5 g, 10 g), grape seed (5 g, 7.5 g, 10 g) and pollen (1 g, 2 g, 3 g) that the quantities of which were determined by using the Box Behnken optimization method, and sensory analysis was applied.
Results: It was determined that the samples with 5 g arrowroot flour got the highest scores in all parameters. On the overall acceptability parameter; arrowroot flour (p=0.016), time (p=0.019), buckwheat popped (p=0.026) and grape seed (p=0.022) were found to be effective separately. 100 g of the bar; It contains 31 g carbohydrates, 2 g protein, 1.2 g fat, 7.5 g fiber, 43.4 mg calcium, 21.4 mg magnesium, 0.4 mg zinc and 0.8 mg iron and gluten content < 5 ppm determined.
Conclusion: Produced product; it is a healthy product for individuals with celiac, with its feature of meeting 30% of the daily fiber, 6% of both calcium and magnesium needs, 4% of protein needs according to the reference intake values.
Introduction: Food allergies have been recognized as significant health issue in last two decades. Prevalence is from 3-38 % of self-reported cases, i.e. 1-7% of those that have been diagnosed as allergies. Numerous projects have been undertaken during last years in order to determine prevalence of food allergies, most frequent allergen types, cause of allergies, link with other health problems, methods of diagnosing, risk control management in food industry, adjustment of legislation in accordance to the needs of allergic persons etc. While some countries have done a lot when it comes to this issue, others even do not have yet data on food allergies in their area, and this is the situation in BiH too. RESEARCH GOALS: Establish food allergy prevalence from survey in Sarajevo Canton. Establish frequency of some other allergies in subjects. Material and methods: This is a cross-sectional study on allergies and it was conducted during March and April, 2017 amongst Sarajevo Canton population of both genders and all age groups by random sampling method. Specifically designed survey questionnaire consisting of 16 questions was filled in by 480 subjects. The research was conducted retrospectively. Results: Results of the survey conducted in Sarajevo Canton are: 51% of persons reporting to have some type of allergy, while 20% of that is reported food allergy cases, i.e. 11.67% of diagnosed food allergy cases, in relation to the total number of 480 subjects (100%) who participated in the survey. The most frequently reported allergens are: milk and dairy products, cereals, eggs, peanut, nuts, fish (including mollusks and crustaceans) and eggs. Conclusion: As per obtained results of food allergy prevalence in our research in total surveyed sample of 480 subjects, there are 96 (20%) of subjects, which indicates that the problem of allergies in Sarajevo Canton is significant, with frequency in values characteristic for other regions of Europe and the world. Legislation is harmonized at a regular basis with the EU Acquis communautaire, but there is lack of easily accessible information, that people with allergies could use to facilitate the process of diagnosing, preventing contact with allergens and coping with them in everyday life.
Background
The aim of our study was to assess the knowledge, practices, and attitudes towards food allergens and allergies among diagnosed food allergic individuals in Lebanon.
Methods
Seventy diagnosed participants were recruited after reaching out to all the allergists of the country. They completed in person or over the phone a comprehensive valid questionnaire composed of 49 questions.
Results
Wheat was reported as top food allergen (15.7%), while itchy skin and rash were the most reported symptoms (71.4% and 68.6%, respectively). Only 34 (48.6%) of participants indicated they carry medications, 58 (70.7%) were diagnosed using blood test, and 22 (31.4%) stated that they are very knowledgeable on the topic. In terms of knowledge, participants scored on average 84.2 ± 11.5%. In terms of best practices, participants scored on average 47.8 ± 28.3%. Having a health related educational background increased significantly (p < 0.05) both knowledge and best practices scores, while age and gender did not have an effect.
Conclusions
Our results highlight the importance of organizing ongoing educational initiatives and emphasize the need to lobby policy makers to making allergen-warning labels obligatory in the country.
This study explored factors that influence the accuracy of caregivers’ appraisals of the foods their children with food allergy should avoid. Seventy-two caregivers of children with food allergy completed measures of caregiver educational attainment, food allergy knowledge, food allergy worry, and a questionnaire assessing whether or not their child should avoid specific foods (the Foods to Avoid Test). Unnecessary avoidance was indicated when a caregiver reported their child should avoid a food item, even though that item was safe for their child based on their food allergy (i.e., false positive). Lack of appropriate avoidance was represented by caregivers reporting a food did not need to be avoided when it should be avoided based on the child’s food allergy (i.e., false negative). Caregivers with lower educational attainment and less food allergy knowledge and whose children were more recently diagnosed had more false-negative appraisal errors. In contrast, false-positive appraisal errors were most strongly related to parental worry about food allergy. The findings suggest that screening for food allergy general knowledge and food avoidance appraisals may help identify gaps in caregivers’ knowledge and ultimately prevent accidental exposures and/or unnecessary avoidance.
The incidence of food allergy is increasing globally and whilst there is consensus that dietitians should be involved in its management, the roles that dietitians should fulfil differ between different guidelines and the description of tasks remains unclear. Currently, no Swiss guideline exists to assist dietitians in counselling children with food allergies. There is a need for recommendations that will guide dietitians through the counselling process. The aim of this project was to create a practice guideline for dietary counselling of children with food allergy. Practice guidelines were developed following the Academy of Nutrition and Dietetics stepwise approach. The process consisted of six steps: (1) Determine the scope of the guideline. (2) Conduct a systematic review. (3) Draft the guideline recommendations using the Nutrition Care Process (NCP) as a framework. (4) Finalise the guideline during a face-to-face meeting. (5) Conduct internal and external review and revise accordingly. (6) Publish guideline. The process resulted in 25 recommendations for dietary counselling. Most recommendations are based on expert opinion only, due to the lack of studies in this field and showed similar levels of consensus between the expert group and external review by allergists. However, there were nine recommendations where the consensus differed. This guideline provides a comprehensive guide to dietary counselling for food allergy by dietitians in Switzerland. It will inform best practice and improve patient-centred care and encourage a consistent approach, but it will need to be reviewed and updated as more robust evidence is produced.
The study examined the influence of two dimensions of intolerance of uncertainty (i.e., desire for predictability and uncertainty paralysis) on protective parenting behaviors in mothers of children with food allergy. Sixty-six mothers of 3- to 6-year-old children with food allergy completed the Intolerance of Uncertainty Scale (IUS) and measures of two types of protective parenting – restrictive protectiveness and intrusive/nurturant protectiveness. Restrictive protectiveness was significantly related to both the desire for predictability and uncertainty paralysis dimensions of the IUS among mothers of children over the age of 5 years. Intrusive/nurturant protectiveness was significantly related only to the desire for predictability dimension of the IUS among mothers of children under the age of 4.5 years. The results demonstrate the two dimensions of intolerance of uncertainty predict the type of protective parenting behaviors used by mothers of children with food allergy and that age moderates this association. Taken together, the findings suggest that intolerance of uncertainty may be a risk factor for overly protective parenting in children with food allergy and other health conditions.
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy that typically affects infants and young children. Currently, diagnostic tests for FPIES do not exist, and diagnosis is contingent on differential diagnoses based on clinical history and food challenges. The limited tools for FPIES diagnosis, compounded by the lack of data providing guidance for individualized avoidance diets, contribute to impaired quality of life among caregivers. Nutritional, social, and emotional burdens accompany FPIES as well lack of FPIES awareness among providers, lack of diagnosis and treatment guidelines, and lack of collaborative care among providers and integrative care teams. Few studies have been conducted to systematically assess quality of life among families caring for a child with FPIES. Future research and management support is necessary to elucidate the impact of FPIES on families’ quality of life and better identify their needs and concerns.
There remains a paucity of research in food allergies in Sub-saharan Africa. It is the aim of this study to determine the self-reported prevalence of food allergies and consumers’ perceptions towards food allergen labelling in Mauritius. A survey was conducted in four supermarkets in the Municipalities of Vacoas-Phoenix, Quatre-Bornes and Moka during the period of September to November 2017. The questionnaire was designed based on previous studies and administered using a face-to-face interview approach to increase completion rate. Descriptive analysis and one-way ANOVA between subjects design were conducted. Shellfish was reported as the most common causative agent followed by fish, egg and peanut. Respondents were satisfied with the current font size and general information provided in food labels. Respondents agreed that it could be problematic to identify suitable foods for individuals suffering from food allergies or intolerances. Variations of PAL statements and generic terms provided in food labels, and location of allergy warnings were cause for concern. More than 80% of the respondents felt that allergens in ingredient list should be emphasised (e.g. bold font) and plain English or French language should be used to describe allergenic ingredients. The findings in this study provide practical insights on food allergen labelling issues for policy makers and stakeholders in the food supply chain. Determining the prevalence of food allergies in the country will inform policy makers to consider adding shellfish and other major allergenic ingredients to the list of ingredients requiring mandatory allergen warning label in Mauritius.
A heredity component in the pathogenesis of atopic disease has been shown in Chap. 4, and an increased prevalence of atopic disease in Chap. 5, so such diseases represent a very contemporary problem: even a cursory glance at the literature clearly demonstrates the growing prevalence of atopic disorders. In the past two decades, a number of factors have contributed to this increase: urbanization that has brought in pollen-carrying ornamental plants and has generated extensive pollution, excessive smoking that seems to have made inroads everywhere, increased exposure to allergens, and poor ventilation of modern homes, which are outfitted with everything that favors Der p proliferation. These figures alone demonstrate that atopic diseases must not be underestimated, regardless of their manifestations. This is not only because a mild clinical picture can quickly become complicated, but also because in cases that are serious from the outset, only an accurate and timely diagnosis -and a rapid therapeutic conclusion — can effectively resolve this contingency.
The first description of an event similar to anaphylaxis was made at least 4,600 years ago [179]; however, only in 1765 was a fatal case reported in Europe (Chap. 17). In 1905, the first cases (one lethal) of food anaphylaxis were reported [72, 174], the subject of a book appeared in 1919 [111], and since 1926 [214] such cases have continued with an impressive frequency. The term “anaphylaxis” (from the Greek “αναϕυλαξις”, away from protection) was coined by Portier and Richet in 1902 during a Mediterranean voyage [156] to define the paradoxical effect of an experimental protocol. While attempting to immunize dogs to the venom of the sea anemone, after the first nonlethal tolerated dose, they unwillingly sensitized the animals with the second dose injected after 2 weeks, either equal to or less than the previous dose, and noted that the dogs exhibited severe manifestations, even lethal. Therefore the first injection sensitizes the animal, provoking synthesis of IgE antibodies; after a latent period for sensitization, re-exposure to the inciting allergen triggers within a few minutes the very severe clinical manifestations called anaphylactic shock, the reverse result of the prophylaxis envisaged by the scientists [156].
This chapter examines how anaphylaxis shapes the geographies of adolescence. Anaphylaxis is a severe and life-threatening allergic reaction, commonly triggered by food. Research suggests that adolescents who experience anaphylaxis are at higher risk of death than other age groups. The chapter reviews previous studies and presents qualitative data about how being at risk of anaphylaxis affects teenagers’ bodies, their experiences of everyday spaces, and their patterns of travel. This analysis contributes to work on children’s geographies of food and of risk.
Anaphylaxis emerges as a spatially disruptive force, confounding conventional expectations about bodies, spaces, risk, and safety. The chapter explores how anaphylaxis and food intersect to produce spatialized risks, experienced most acutely by those with severe allergies and their close family and friends but also with wider societal effects. Within this context, anaphylaxis management can be understood as a form of biopower which shifts responsibility away from food producers and onto consumers. Where this is effective, it results in an intensification of self-surveillance and self-regulation. However, this relation to self can also allow for a loosening of power, creating opportunities for adolescents to adapt, rework, or resist different aspects of “good” allergy management, fashioning their own ways of living with risk and uncertainty.
Egg is an ubiquitous allergen found in many food products. Current food allergy guidelines recognize the importance of consultation with a registered dietitian to ensure nutritional adequacy. However, there is a lack of evidence on its impact on the implementation of allergen avoidance strategies. Taking advantage of a well-characterized cohort of influenza vaccination in egg-allergic children (n=397), we tested the hypothesis that real-life professional dietary advice was associated with a decrease in accidental reactions to egg in allergic children with retrospective questionnaires. Lack of consultation with a dietitian was associated with a 1.89-fold increase in the risk of accidental reactions to egg (confidence interval: 1.47–2.42). The only other independent variable that predicted reactions was having had a history of acute reaction to egg prior diagnosis (relative risk=2.02; confidence interval: 1.64–3.00). These findings support the usefulness of referral to a food allergy-specialized dietitian at time of diagnosis in order to prevent future accidental reactions to egg.
Purpose
Allergy information on food labels is crucial to individuals with food allergies. The purpose of this paper is to investigate what information consumers are concerned with as well as improving the allergen information on the product labels.
Design/methodology/approach
A questionnaire was developed based on previous studies and was administered to citizens in South Korea. Descriptive analysis and analysis of variance were conducted to find significances of important information when purchasing and improvement needed on the labels in relation to allergy knowledge.
Findings
The results indicated that respondents were concerned about allergy information and general information regarding the basic value of food and also food safety. In addition, this study found knowledge of food allergies is not related to consideration of allergy information on labels.
Originality/value
This study measured consumers’ perceptions of the current food allergy labeling when purchasing food products. This study concluded improvements were needed in order to deliver allergy information in a clear manner. Such as font size, shape, and color should be implemented together in order to communicate effectively with allergic consumers.
This chapter examines how anaphylaxis shapes the geographies of adolescence. Anaphylaxis is a severe and life-threatening allergic reaction, commonly triggered by food. Research suggests that adolescents who experience anaphylaxis are at higher risk of death than other age groups. The chapter reviews previous studies and presents qualitative data about how being at risk of anaphylaxis affects teenagers’ bodies, their experiences of everyday spaces, and their patterns of travel. This analysis contributes to work on children’s geographies of food and of risk.
Anaphylaxis emerges as a spatially disruptive force, confounding conventional expectations about bodies, spaces, risk, and safety. The chapter explores how anaphylaxis and food intersect to produce spatialized risks, experienced most acutely by those with severe allergies and their close family and friends but also with wider societal effects. Within this context, anaphylaxis management can be understood as a form of biopower which shifts responsibility away from food producers and onto consumers. Where this is effective, it results in an intensification of self-surveillance and self-regulation. However, this relation to self can also allow for a loosening of power, creating opportunities for adolescents to adapt, rework, or resist different aspects of “good” allergy management, fashioning their own ways of living with risk and uncertainty.
Education is key to effective food allergy management. This chapter provides an overview of the cornerstones of food allergy management and avoidance strategies for patients with food allergies. Approximately 4% of adults and nearly 8% of children in the United States are affected by food allergy, with teens and young adults at high risk for anaphylactic reactions due to risk-taking behavior. Food-allergic individuals must avoid their allergen by practicing vigilant label reading, taking precautions in restaurants, and while traveling. Food allergy is a source of stress for families and affects the quality of life. This chapter also presents an overview of school food allergy management practices.
The needs of food-allergic and intolerant consumers are an increasingly important consideration for food manufacturers. This chapter first examines the definition of food allergy and food intolerance in children and adolescents, the prevalence of these conditions, and their impact on health and quality of life. The role of food in the development and management of food allergies and intolerances is also discussed. The chapter also considers the implications of food allergies and intolerances in children for the food industry, healthcare professionals and policy makers, including future trends in the prevalence and nature of food allergies and intolerances.
Die Diagnose einer Nahrungsmittelallergie hat für Patienten in der Regel eine große Bedeutung. Sie führt zum einen zu einer Einschränkung in der Lebensführung durch die notwendigen Diäten. Zum anderen aber ist sie in vielen Fällen mit einem ständigen Bedrohungsszenario verbunden, da plötzliche allergische Reaktionen bis hin zu einer lebensgefährlichen Anaphylaxie drohen. Es ist für die Patienten essenziell, im Umgang mit Notfallsituationen geschult zu sein und die richtigen Entscheidungen über den Einsatz der Notfallmedikamente zu treffen. Bei guter Aufklärung treten schwere allergische Reaktionen aber nur selten auf. Die resultierende Angst führt zu einer signifikanten Beeinträchtigung der Lebensqualität.
In den letzten Jahren sind viele Untersuchungen zur Lebensqualität von Patienten mit Nahrungsmittelallergie und Anaphylaxie durchgeführt worden. Sie helfen, das Verhalten der Patienten in ihrem Alltag zu verstehen. Sie ermöglichen vor allem, durch eine gezielte und bewusste Beratung die Einschränkung der Lebensqualität zu reduzieren und Meidungsverhalten und Compliance hinsichtlich der notwendigen Notfallmaßnahmen zu verbessern.
In diesem Artikel werden die vorhandenen Daten zusammengefasst und Empfehlungen formuliert, die helfen können, die Betreuung von Patienten mit Nahrungsmittelallergie hinsichtlich ihrer Lebensqualität und der Compliance zu verbessern.
Zitierweise: Lange L. Quality of life in the setting of anaphylaxis and food allergy. Allergo J Int 2014; 23:252–60 DOI: 10.1007/s40629-014-0029-x
Elimination diets and oral food challenges are two key approaches to food allergy diagnosis. Diagnostic elimination diets are undertaken to provide presumptive evidence of food-responsive symptoms. In particular, this approach may be applied to disorders with chronic symptoms, such as atopic dermatitis or eosinophilic esophagitis. Diets may be devised based upon test results, elimination of common triggers, or the use of nonallergenic formulas. The medically supervised oral food challenge, in particular when double-blinded and placebo-controlled, is the most definitive modality available to diagnose a food-related illness. The oral food challenge may be undertaken to identify or exclude a food trigger, or for research purposes. The decision to undertake an oral food challenge requires consideration of the reaction risks derived from the history and ancillary tests, and potential benefits (nutritional, social). Performance of an oral food challenge requires preparation and consideration concerning dosing, whether to include masking, when to stop a challenge and treat a reaction, and how to instruct patients about introducing or avoiding a food following a challenge.
The definitive treatment of food allergy is strict elimination of the offending food from the diet. Symptomatic reactivity to food allergens is generally very specific, and patients rarely react to more than one food in a botanical or animal species. If elimination diets are prescribed, care must be taken to ensure that they are palatable and nutritionally adequate. Patients must have a good knowledge of food containing the allergen and must be taught to scrutinize the labels of all packaged food carefully. Formula-fed infants with cow's milk allergy should be fed an elemental or extensively hydrolysed hypoallergenic formula. Soy formulas are inappropriate alternatives as a significant number of infants who are allergic to cow's milk are also allergic to soy. Most children outgrow their food hypersensitivity. As such, rechallenge testing for food allergy should be performed; the interval between rechallenges should be dictated by the specific food allergen in question, the age of the child, and the degree of difficulty in avoiding the food in question Emergency treatment of food-induced anaphylaxis should follow the basic life support ABC principles, with the simultaneous intramuscular injection of adrenaline. A fast-acting H1 antihistamine should be considered for the child with progressive or generalized urticaria or disturbing pruritus. Pharmacological therapies such as mast cell stabilizers have very little role to play in the treatment of gastrointestinal manifestations of food allergy. In high-risk infants, exclusive breastfeeding with introduction of solid foods not earlier than 6 months of age may delay or possibly prevent the onset of food allergy in some children. Avoidance of allergenic foods by lactating mothers is often recommended. When breastfeeding is not possible, the use of a partially or extensively hydrolysed hypoallergenic formula is desirable. Prophylactic medications have not been shown to be consistently effective in the prevention of life-threatening reactions to food. Their use may mask a less severe reaction to a culprit food, knowledge of which might prevent a more severe reaction to that food in the future.
Reports of fatal or near-fatal anaphylactic reactions to foods in children and adolescents are rare. We identified six children and adolescents who died of anaphylactic reactions to foods and seven others who nearly died and required intubation. All the cases but one occurred in one of three metropolitan areas over a period of 14 months. Our investigations included a review of emergency medical care reports, medical records, and depositions by witnesses to the events, as well as interviews with parents (and some patients).
Of the 13 children and adolescents (age range, 2 to 17 years), 12 had asthma that was well controlled. All had known food allergies, but had unknowingly ingested the foods responsible for the reactions. The reactions were to peanuts (four patients), nuts (six patients), eggs (one patient), and milk (two patients), all of which were contained in foods such as candy, cookies, and pastry. The six patients who died had symptoms within 3 to 30 minutes of the ingestion of the allergen, but only two received epinephrine in the first hour. All the patients who survived had symptoms within 5 minutes of allergen ingestion, and all but one received epinephrine within 30 minutes. The course of anaphylaxis was rapidly progressive and uniphasic in seven patients; biphasic, with a relatively symptom-free interval in three; and protracted in three, requiring intubation for 3 to 21 days.
Dangerous anaphylactic reactions to food occur in children and adolescents. The failure to recognize the severity of these reactions and to administer epinephrine promptly increases the risk of a fatal outcome.
Fatal food-induced anaphylaxis is rarely reported. In 16 months, we identified seven such cases involving five males and two females, aged 11 to 43 years. All victims were atopic with multiple prior anaphylactic episodes after ingestion of the incriminated food (peanut, four; pecan, one; crab, one; fish, one). In six cases the allergenic food was ingested away from home. Factors contributing to the severity of individual reactions included denial of symptoms, concomitant intake of alcohol, reliance on oral antihistamines alone to treat symptoms, and adrenal suppression by chronic glucocorticoid therapy for coexisting asthma. In no case was epinephrine administered immediately after onset of symptoms. Premortem or postmortem serum samples were available from six victims; in each case elevated levels of IgE antibodies to the incriminated food were demonstrated. Food-sensitive individuals must self-administer epinephrine promptly at the first sign of systemic reaction. Emergency care providers should be aware of cricothyrotomy as a life-saving procedure.
To examine the natural history of adverse reactions to foods, 480 children were followed prospectively from birth to their third birthdays. Foods thought to be causing symptoms were evaluated by elimination of suspected foods, open challenges, and double-blind food challenges. Foods producing symptoms were reintroduced into the diet at 1- to 3-month intervals until the symptoms no longer occurred. Of the 480 children completing the study, 28% were thought to have symptoms produced during food ingestion, but in only 8% were these reactions reproduced (excluding fruit and fruit juices). During the first year of life 80% of the initial complaints occurred. The most striking finding was the brief duration during which reactions could be reproduced. The majority of foods were replaced in the diet within 9 months of their incrimination. A long list of foods was reported to produce many symptoms, but only a few foods reproducibly evoked gastrointestinal and skin symptoms, with respiratory symptoms being infrequent. Of great interest was that 75 children were reported to react to fruit or fruit juice, and 56 of these children had reproducible symptoms. This study has found that most food reactions occur during the first year of life, but rechallenge at regular intervals has shown that the food can be reintroduced into the diet by the third year without risk. Almost all reactions that were reproduced appear to be non-immunoglobulin E mediated.
We have previously demonstrated that peanut oil is not allergenic to peanut-sensitive individuals. Seven soybean-sensitive patients were enrolled in a double-blind crossover study to determine whether ingestion of soybean oil can induce adverse reactions in such patients. All subjects had histories of systemic allergic reactions (urticaria, angioedema, wheezing, dyspnea, and/or vomiting) after soybean ingestion and had positive puncture skin tests with a 1:20 w/v glycerinated-saline whole soybean extract. Sera from six of the seven subjects were tested by RAST assay for the presence of specific IgE antibodies to soybean allergens. All patients had elevated levels of serum IgE antibodies to the crude soybean extract; binding values ranged from 2.3 to 28.1 times that of a negative control serum. Before the oral challenges, all patients demonstrated negative puncture skin tests to three commercially available soybean oils and to olive oil (control). On four separate days, patients were challenged with the individual soybean oils and olive oil in random sequence. At 30-minute intervals, under constant observation, patients ingested 2, 5, and 8 ml of one of the soybean oils or olive oil contained in 1 ml capsules. No untoward reactions were observed with either the commercially available soybean oils or olive oil. Soybean oil ingestion does not appear to pose a risk to soybean-sensitive individuals.
Soy lecithin and soy oil are usually produced from the hexane extract of soybean. Some of the soybean proteins are included in the extract and are therefore present in small amounts in both soy lecithin and soy oil. The antigenicity of the proteins present in defatted soybean has been studied with respect to soybean allergy, but the antigenicity of those found in the extract is yet to be investigated.
The antigenicity of soy lecithin and soy oil proteins with regard to soybean allergy were investigated.
The proteins present in soy lecithin and soy oil were determined according to already established method and analysed by SDS-PAGE. The IgE- and IgG4-binding abilities of the soy lecithin proteins were investigated by immunoblotting with sera from 30 soybean-sensitive patients, including seven with a positive challenge test. Immunoblotting of soy oil proteins was performed with the sera from some of these patients.
In 100 g of sample, the soy lecithin and soy oil contained 2.8 mg and 1.4-4.0 microg of proteins, respectively. The results of SDS-PAGE demonstrated the presence of only three proteins, with molecular weights of about 58-67 kDa in soy oil, and suggested that soy lecithin also contains these proteins. The soy lecithin also contained many proteins besides these. In the soy lecithin, the detection rate of only one protein, with a molecular weight of 31 kDa, by the serum IgE of patients was significantly different compared with controls (detection rate: 40%). The proteins with molecular weights of 58-67 kDa rarely bound to serum IgE. Only one of the patients who presented a positive challenge test had IgE antibodies to soy lecithin proteins. IgG4-binding proteins were found only rarely in soy lecithin. Neither the IgE nor the IgG4 present in the patients' sera reacted to any soy oil protein.
Proteins present in soy lecithin and soy oil have little antigenicity with regard to soybean allergy.
Up to 8% of children less than 3 years of age and approximately 2% of the adult population experience food-induced allergic disorders. A limited number of foods are responsible for the vast majority of food-induced allergic reactions: milk, egg, peanuts, fish, and tree nuts in children and peanuts, tree nuts, fish, and shellfish in adults. Food-induced allergic reactions are responsible for a variety of symptoms involving the skin, gastrointestinal tract, and respiratory tract and may be caused by IgE-mediated and non-IgE-mediated mechanisms. In part 1 of this series, immunopathogenic mechanisms and clinical disorders of food allergy are described.
Fatal anaphylactic reactions to foods are continuing to occur, and better characterization might lead to better prevention. The objective of this report is to document the ongoing deaths and characterize these fatalities. We analyzed 32 fatal cases reported to a national registry, which was established by the American Academy of Allergy, Asthma, and Immunology, with the assistance of the Food Allergy and Anaphylaxis Network, and for which adequate data could be collected. Data were collected from multiple sources including a structured questionnaire, which was used to determine the cause of death and associated factors. The 32 individuals could be divided into 2 groups. Group 1 had sufficient data to identify peanut as the responsible food in 14 (67%) and tree nuts in 7 (33%) of cases. In group 2 subjects, 6 (55%) of the fatalities were probably due to peanut, 3 (27%) to tree nuts, and the other 2 cases were probably due to milk and fish (1 [9%] each). The sexes were equally affected; most victims were adolescents or young adults, and all but 1 subject were known to have food allergy before the fatal event. In those subjects for whom data were available, all but 1 was known to have asthma, and most of these individuals did not have epinephrine available at the time of their fatal reaction. Fatalities due to ingestion of allergenic foods in susceptible individuals remain a major health problem. In this series, peanuts and tree nuts accounted for more than 90% of the fatalities. Improved education of the profession, allergic individuals, and the public will be necessary to stop these tragedies.
A voluntary registry of individuals with peanut and/or tree nut allergy was established in 1997 to learn more about these food allergies.
The purpose of this study was to elucidate a variety of features of peanut and tree nut allergy among the first 5149 registry participants.
The registry was established through use of a structured questionnaire distributed to all members of the Food Allergy and Anaphylaxis Network and to patients by allergists. Parental surrogates completed the forms for children under the age of 18 years.
Registrants were primarily children (89% of registrants were younger than 18 years of age; the median age was 5 years), reflecting the membership of the Network. Isolated peanut allergy was reported by 3482 registrants (68%), isolated tree nut allergy by 464 (9%), and allergy to both foods by 1203 (23%). Registrants were more likely to have been born in October, November, or December (odds ratio, 1.2; 95% CI, 1.18-1.23; P <.0001). The median age of reaction to peanut was 14 months, and the median age of reaction to tree nuts was 36 months; these represented the first known exposure for 74% and 68% of registrants, respectively. One half of the reactions involved more than 1 organ system, and more than 75% required treatment, frequently from medical personnel. Registrants with asthma were more likely than those without asthma to have severe reactions (33% vs 21%; P <.0001). In comparison with initial reactions, subsequent reactions due to accidental ingestion were more severe, more common outside the home, and more likely to be treated with epinephrine.
Allergic reactions to peanut and tree nut are frequently severe, often occur on the first known exposure, and can become more severe over time.
US Food and Drug Administration, Center for Food Safety and Applied Nutrition, Office of Scientific Analysis and Support
- Food
- Partnership
Food allergen partnership. US Food and Drug Administration, Center for Food Safety and Applied Nutrition, Office of Scientific Analysis and Support. 2001. (www.cfsan.fda.gov/~dms/alrgpart.html).