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 ’91Over 27,000 membersMission 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

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 peanutsTree nut allergy affects 1.5 million

AmericansMost 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 reactionJust one little bite can hurtEpinephrine 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

50

5560

6570

7580

8590

Score

General health

Emotional stress

Family activities

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 Labelsby Parents of Food Allergic Children

0 20 40 60 80 100

Egg

Wheat

Peanut

Soy

Milk

Percent Perfect Score

Joshi, Mofidi, Sicherer JACI 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 BehaviorFAAN 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 keyOutreach 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