From Michael Walker (Food Standards Agency Board Member and Public Analyst)

Anaphylaxis - Allergens - Sampling and Analysis

Food Allergy (IgE, Th-2-type induction by food proteins) is a major concern for many and its prevalence appears to be increasing. It affects at least one in 200 adults and one child in 70 now has peanut allergy. Symptoms are unpredictable but can be life threatening. There are about 6-10 recorded deaths per year from food induced anaphylaxis (and many more near misses). Sampling officers and Public Analysts have been involved in some instances where life was at risk.

An increasing number of Local Authorities have expressed interest in taking samples of products with a view to having them tested for the possible presence of allergens. For example - some products have been found to contain undeclared peanut on testing (usually following an anaphylactic incident). This can arise in two main ways :-

1. the inclusion of ingredients that are not declared (for various reasons) and
2. cross contamination.

Other Authorities have sampled "nut free" products and products claiming that they "may contain" nuts for testing. Gluten-free samples have also been tested.

There is a need for guidance on what areas would benefit from sampling/analysis activity in order to achieve best outcomes. (For example, areas of trade that allergic consumers avoid anyway may not be fruitful to sample from). There may be wasted resource and backfiring PR unless there is a consistency of approach. The outcomes need to be of use in educating both allergic people and food businesses.

Below is a draft paper on allergen sampling. This has been prepared with considerable assistance from Haxel Gowland of Anaphylaxis Campaign although any errors and ommmisions are my responsibility. I emphasise this is very much a first draft and apologise if it is "teaching granny to suck eggs". However, I know there is a lot of activity contemplated by TSOs and EHOs.

SAMPLING FOR FOOD ALLERGY TESTING

Food allergy is an immune response leading to the formation of immunoglobulin E (IgE) antibodies. Food Allergy is a major concern for many and its prevalence appears to be increasing. It affects some 1 in 200 adults and some forms can be life threatening. There are about 5 deaths per year from allergy related incidents (and many more near misses).

As a result of heightened awareness there is increased interest in sampling and analysis for allergens. A useful background to the issues generally is the Food Standards Agency Board paper on Food Intolerance and Allergy. This may be obtained from the FSA Website at :-
www.food.gov.uk/multimedia/pdfs/fsa030204.pdf. The report is in Adobe Acrobat (pdf) format and the free Adobe Acrobat Reader is needed to read the paper.

As with all sampling activity, two essential pieces of planning should be in place prior to the actual sampling.

1. Outcomes

There needs to be some thought given to outcomes that are going to be of benefit to allergic consumers.

This means having in mind what to do when/if positive results are obtained. In all probability you will want to give advice to the outlet. This may be a small catering establishment where a simple hazard analysis approach to potential allergens will be of benefit. It may be a large manufacturer, or anything in between. Much sampling will be informal but, if there has been an anaphylactic incident formal sampling may be necessary.

2. Co-ordination with the Public Analyst

Allergens are tested for batch wise (owing to the analytical technique). The laboratory will need to obtain the ELISA (or PCR) specific to the allergen being tested for (Peanut, Gluten etc.). Sufficient samples need to be submitted to make this viable and this aspect should be discussed at least 3 - 4 weeks prior to the sampling activity. (One-off incident-related samples can be dealt with by other means).

WHAT TO SAMPLE

There are, again, two broad areas. In addition an appendix lists some useful information.

3. Prepacked Food

The Home Authority principle should be followed. You may wish to assess whether or not a manufacturer has addressed allergens in a structured way (HACCP). There may well be a procedure (backed up by testing) in place. Concentrate on those manufacturers where no allergens policy is in place. Chocolate may have low level nut contamination (harvested with the cocoa) and although well recognised by the major players smaller manufacturers using chocolate may need advice).

5. Non-Prepacked Food

Food sold loose or prepacked for direct sale has limited labelling and so is a problem for allergic consumer.

There is a difference between problems arising from cross contamination and those arising from undeclared ingredients. The latter have the potential to be more serious in terms of the allergic response elicited but are more straightforward infringements of labelling provisions for prepacked food.

4.1 Catering Outlets

Serious food allergy incidents have occurred with teenagers living away from home for the first time. So sampling and testing might be focused on geographic areas with a high student population.

In Northern Ireland a project is being run in take-away outlets which involves sampling a "peanut probable" meal (e.g. with Satay sauce) followed 20 - 30 minutes later by asking (different officer) for a peanut free meal. Information is concurrently gathered on awareness (EHOs and outlet). Follow-up will involve advice to the peanut positive outlets.

4.2 Flour Confectionery

SME baked goods outlets contain multiple opportunities for cross contamination. Sampling here needs careful thought.

5. Advice

Suggested key messages to give catering outlets:

• Be extra alert when handling nuts seeds and other allergens. Invite dialogue with customers about ingredients
• Tell the truth about a food (I don't know if it contains nuts) Never Guess
• Call a dish what it is - if it contains nuts etc make that clear
• Have an emergency procedure - pre-meditation can save a life.

A suggested notice:

Use Allergies as a heading so customers who haven't a problem don't waste their time reading it.

You are quite entitled to use nut etc ingredients but also recognise that for some they are very dangerous - invite the customer to share the problem - we'll help if we can, and if we can't we'll say so.

Just having the notice raises awareness - staff and public - and acts as a reminder to staff so change the notice from time to time - different colours, images etc.

Sharing Information

Finally, it is important that information is shared so writing up your experiences and outcomes is important. These could be disseminated on a regional basis and co-ordinated and more widely disseminated by LACORS, CIEH, ITSA, FSA etc.
Logging information - whether the allergen was an unrecognised ingredient or a possible contaminant is useful.

Background Information

Useful background information can be obtained on the following Websites and references :-

The Food Standards Agency Website www.food.gov.uk
See especially www.food.gov.uk/multimedia/pdfs/fsa030204.pdf which is in Adobe Acrobat (pdf) format. The free Adobe Acrobat Reader is needed to access this reference.

The Anaphylaxis Campaign Website www.anaphylaxis.org.uk

Hazel Gowland's site www.allergyaction.org
See also "Advice to Consumers Eating Out", also paper "Role of EHOs and TSOs" - also translation information - other languages.

The Institute of Food Science and Technology Website www.ifst.org.

Food Standards Agency Be Allergy Aware materials - ref and phone no. - available in English and 8 community languages.

The Role of environmental health officers in the protection of allergic consumers.
Leitch, I., Blair, I.S., and McDowell D.A., Int. J. of Environmental Health Research 11, 51 - 61, (2001)

Food Allergy and Intolerance Current issues and concerns
Ed. Victoria Emerton 2002 Leatherhead Publishing ISBN 0 85404 881 2 (Available through Royal Society of Chemistry)

Appendix

Some questions and answers

• Frying foods eg chips in a refined (vegetable) oil which has subsequently been recontaminated with an allergen (eg peanut) can trigger symptoms
  Chips fried in recontaminated oil have proved peanut positive.

 
• Burger outlets - does the sesame cross contaminate? Is there any work going on to find out?

 
• Satay sauce is made with peanuts.

 
• Marzipan, praline and frangipane are made with nuts (Continental chocolate may well include praline paste as an ingredient).

 
• Pesto sauce is made with nuts (Pine kernels are not always counted as tree nuts but can trigger allergic symptoms in people with cross-reactive nut allergy.

 
• Waldorf salad contains nuts.

 
• Sesame can be included in tahini, gomashio and hummus.

 
• Whey and casein must be avoided by people with milk allergy.

 
• Caesar salad dressing normally contains anchovies, Worcestershire sauce may do. (Worcestershire sauce has also been made using walnuts.)

 
• Coronation chicken has been found to be peanut positive. (Peanuts and almonds may be ingredients but unrecognised by the business or the consumer.)

 
• Salad dressing can be made with unrefined oils that can contain allergenic protein(eg hazelnut, walnut, sesame).

 
• Peanuts are of prime importance in the cooking of Indonesia and Malaysia. African, (esp. West African - e.g. groundnut "chop" a stew with chicken) Chinese, Thai, Vietnamese and Mexican dishes can contain nuts especially in marinades.

 
• Milk protein can be present in creamy curry dishes like masala and of course in ham as binder.

 
• More surprising allergens which some consumers need to avoid include other legumes (beans, chick peas) kiwi, strawberry, Quorn and mustard.