The Latest Reaction to Food Allergies

May 2003

Thanks to increased media coverage, food allergies are finally getting the attention they deserve. Whether it’s the story of a child who dies after one bite of a peanut-laced treat, or celebrities such as “Hercules” star Kevin Sorbo speaking out for the cause, it’s made consumers sit up and take note.

According to The Food Allergy and Anaphylaxis Network (FAAN), food allergies cause the deaths of 150 to 200 Americans each year. And with 3 million Americans suffering from peanut allergies — the leading cause of severe allergic reactions — it’s no surprise that many airlines are yanking peanut packets from their regular snack service for fear of mid-air allergic reactions.

The truth about allergens
About 90% of all allergic reactions are related to eight foods: peanuts, tree nuts, fish, shellfish, eggs, milk, soy and wheat. A true food allergy involves an immunological response to a particular food. The body creates specific IgE antibodies to that food, which attach themselves to mast cells. Upon consumption of a food one is allergic to, the food allergen attaches itself on the antibody, causing the mast cell to explode and release massive amounts of chemicals and histamines throughout the body. This triggers one or more of a battery of allergic symptoms affecting the skin, respiratory, GI or cardiovascular systems. To combat these reactions, epinephrine is administered.
Although food-allergy thresholds have not been officially established, a recent study (Journal of Allergy and Clinical Immunology, April 1999, S.H. Sicherer, A. Munoz-Fulrong, A.W. Burks and H.A. Sampson), reported that the threshold doses for subjective peanut reactions were between 100 micrograms (1/1500 peanut) up to 1 gram (about 6 1/2 peanuts).

The ability of a given individual to form IgE antibodies against food is an inherited disposition. Infants with a family history of allergies may be two to three times more likely to develop allergies. This year the American Academy of Allergy Asthma & Immunology (AAAAI), Milwaukee, presented findings that people with asthma and food allergy have a specific variation of the gene CD14. New studies are being directed at the hereditary nature of peanut allergies.

Children suffer most
For the 2% to 2.5% of Americans suffering from food allergies, finding allergen-free foods is a daily challenge. Unfortunately, food allergies hit children the hardest; 5% of children under three in the United States have food allergies. The most common food allergens for children are eggs, milk, and peanuts. They may outgrow some allergies, especially to milk and soy, yet for peanut, fish, or shrimp allergies, it’s less likely.

Allergic reactions in children can be severe. A study (The American Family Physician, October 1997, John Anderson, M. D.) was published that looked at six children and adolescents who died from food anaphylaxis and seven that nearly died. Of these 13 children, all ate an allergenic food previously undetected in a prepared product, such as cookies or cake, a restaurant meal or candy. The deaths occurred in those who did not receive epinephrine within one hour of eating the food.

The list of parental worries continues. A study at Arkansas Children’s Hospital, Little Rock, concluded that most children with food allergies do not meet the recommended servings of the Food Guide Pyramid. AAAAI reports that children with peanut allergy have higher anxiety levels than children with diabetes, and 94% of teens reported social isolation due to their allergy.

Unfortunately, the only current treatment for food allergies is a strict diet of avoidance. Every food label must be studied for byproducts of allergens. For a severely allergic person, eating out is like playing Russian roulette. The Environmental Health News reported that 75% of all food-allergy deaths involve food prepared away from home. Places that routinely use nuts, such as Asian restaurants, bakeries and ice cream shops, have a high potential for peanut contamination. Some severely allergic people can incur reactions from airborne fish proteins, such as from frying fish or shellfish, or with an allergen-laden kiss.

Manufacturer responsibility
The management of food allergies depends on reading food labels and trusting that the contents of the package match the label. For that reason, food manufacturers play a large role. Rework addition, product carryover due to use of common equipment, production scheduling or allergenic product above exposed product lines are all possible areas of contamination.

When consumers reported reactions to foods that were not declared on the food label, FDA took notice and conducted a study, “Food Allergen Partnership.” This study examined 85 ice cream, bakery, and candy firms in Minnesota and Wisconsin for the presence of peanut and egg allergens on food-processing lines. Even though peanuts were not declared on the product label, 25% of final food-product samples tested positive for peanut allergens. FDA’s Compliance Policy Guide, entitled “Statement of Policy for Labeling and Preventing Cross-contact of Common Food Allergens,” helps FDA regulators identify problems in manufacturing and labeling practices that may result in allergic reactions from the eight most common allergens. FDA is taking steps to require that particular wording in ingredient statements is clear about allergens — failure to comply results in product recalls.

The labeling requirements have some loopholes that may result in allergic reactions, such as collective naming of flavors or certain colors and spices. FDA recommends that processors declare allergenic ingredients in these names. Another problem is that the food manufacturer assesses whether the allergens that find their way into products are significant enough to report, which causes judgment errors and leads to product recalls. Assay tests are very useful in detecting allergenic food residues in products. They are available to manufacturers and assist in detecting allergenic food contamination, testing for such popular food allergens as almond, egg, milk, peanut, whey and walnut.

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