Food-Allergic Consumer’s Perspective on Ingredient Labeling

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

15. Interpretation of Food Labelsby 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 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%

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 trustthat 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