1. Food-Allergic Consumer’s Perspective on Ingredient Labeling Anne Munoz-Furlong FAAN

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

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

4. 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

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

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

7. What does it mean to have food allergies?  Vigilant label reading for foods, bath products, pet foods, medications-- everything  Trace amounts can cause a reaction  Just one little bite can hurt  Epinephrine is the only medication to stop a severe reaction

8. 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

9. 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

10. Impact on Quality of Life Sicherer, Noone, Munoz-Furlong Ann Allergy Asthma Immunol 2001

11. Label reading

12. 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

13. 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

14. Common Foods In Unexpected Places EggTree Nut MilkPeanutsFish 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

15. Interpretation of Food Labels by Parents of Food Allergic Children Joshi, Mofidi, Sicherer JACI 2002

16. 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

17. 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

18. Consumer Behavior FAAN Labeling Study Would Never purchase a product that says:  Contains Allergen 99%  May contain Allergen95%  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%

19. 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

20. 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

21. 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

22. Thresholds from the Consumer’s Perspective  Education is key  Outreach needed for: physicians and registered dietitians patients and their families food industry

23. 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

24. Conclusion  Current labeling and manufacturing practices present enormous challenges to food-allergic individuals

25. 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