Food Allergy Research & Education and Food Allergy Canada announce findings of first global survey on food allergen thresholds

Consumers in 16 countries, including the UK, provide insights into views on allergen thresholds and purchasing habits

Results of the first-ever international survey on perceptions of food allergen thresholds and consumer habits surrounding precautionary labeling were published online in Allergy, the journal of the European Academy of Allergy and Clinical Immunology (EAACI). The study, spearheaded by Food Allergy Research & Education (FARE), Food Allergy Canada (formerly Anaphylaxis Canada), and others, were presented at the EAACI Congress in Vienna, Austria this week.

This study is the first to examine differences in the international food allergy community’s perceptions about thresholds (the lowest amount of a food allergen that can elicit a reaction) and precautionary labeling from the perspective of consumers in 16 countries. Results show that in most countries, the vast majority of individuals managing food allergies would still not buy foods that contained an allergen, even if the amount were reliably determined to not cause an allergic reaction per validated allergen thresholds.

Neither the U.S. nor Canada has established allergen thresholds. Precautionary labeling – often seen as a “may contain” statement – warns consumers about the potential for a food product to contain trace amounts of an allergen due to shared equipment lines or other manufacturing practices. This type of labeling, which is voluntary, is widely used across the manufacturing industry.

“Families and adults managing food allergies face a number of challenges in their daily lives, not the least of which is finding safe foods to eat, and relying on accurate ingredient labels,” said James R. Baker, Jr., MD, CEO and chief medical officer of FARE. “This is an important topic among stakeholders in the community, and FARE has led efforts to ensure that the consumer’s perspective on this issue is heard and understood.”

FARE has recommended to the U.S. Food and Drug Administration (FDA) that it not establish a threshold for any food allergen unless the FDA is in possession of reliable scientific data that clearly identifies a quantity of the allergen that is so small that it will not cause an allergic reaction in even the most sensitive individuals, and also a reliable analytical method for determining compliance with the threshold that can be easily used by food companies and the FDA.

FARE and Food Allergy Canada facilitated the distribution of the consumer survey to 14 other countries: Australia, Chile, France, Germany, Ireland, Israel, Italy, Japan, Mexico, New Zealand, South Africa, Spain, the Netherlands and the United Kingdom. Surveys were conducted between February 2013 and April 2014. Nearly 10,000 people managing food allergies participated in the survey, which was translated into eight languages and posed hypothetical questions about thresholds.

“We will continue to work together with other countries to enhance our educational efforts to ensure that consumers are making informed choices,” said Laurie Harada, executive director of Food Allergy Canada.

“Many families surveyed did not understand that precautionary allergen labeling statements do not correspond with the likelihood of a potential allergen in a food and that these labels are voluntary and at the manufacturer’s discretion,” said Ruchi Gupta, M.D., MPH, study co-author, of Northwestern University’s Feinberg School of Medicine. “Similarly, it was difficult for families to understand the meaning of thresholds and how they may potentially make an impact. It’s clear that we need more consistency and transparency in labeling that correspond to a demonstrable level of risk in consuming these foods and allergen amounts that may occur through cross-contact.”

Among the study findings:

• Less than 20 percent of participants in 11 of 16 countries reported they would be willing to purchase foods containing their allergen if the amount would be incapable of causing an allergic reaction. Respondents in Italy were least willing (14 percent) and in Japan were most willing (44 percent).
• An average of 3 percent of participants across the board reported they would purchase a food containing their allergen if it was capable of only triggering a mild
• Consumers seemed to assess risk based on the wording of the precautionary warning –
  • About 16 percent of participants reported they would be willing to purchase foods with the “may contain allergens” label (respondents in South Africa reported the highest rate – 53 percent – and Spain reported the lowest rate – 6 percent).
  • When asked whether they would buy a food labeled “may contain traces of allergen,” the weighted average rate of affirmative responses was slightly higher (25 percent).
  • When asked whether they would buy a food with the label “manufactured in a facility that also processes allergen,” the weighted average rate of affirmative responses was the highest – 41
• Peanut was the most common allergen reported in nine of 16

The authors note that previous studies analyzing the content of allergens in products with precautionary labeling have shown there is little correlation between the amount of allergen present in a food product and the type of precautionary statement that is used. A study published in 2010 in the Journal of Allergy and Clinical Immunology analyzed a number of U.S. products with precautionary labels for milk, peanut and egg. Ten percent of these products contained milk, 4.5 percent contained peanut and 1.8 percent contained egg, respectively.

More work continues to be done in the area of food allergen thresholds. In the meantime, consumers throughout the world report confusion about precautionary statements. FARE has previously documented that U.S consumers continue to take risks when buying such products.

The study published this month advocates for the inclusion of consumers in discussions around standardisation of precautionary statements and validated allergen thresholds.

“Through its Patient Organisation Committee, EAACI has long advocated to ensure the patient voice is present and heard,” said Antonella Muraro, president of EAACI. “We were very pleased when leaders of patient organisations developed and completed this global survey to help inform research on a complicated but important issue and look forward to supporting future collaborations on this and other advocacy priorities.”