food hypersensitivity food allergy & intolerance
TRANSCRIPT
In 2014, the European Food Safety Authority (EFSA) estimated that food allergies and intolerances occurred in approximately 3% of adults and children. Though it is generally accepted that the incidence of food allergies and intolerance in industrialised nations appears to be increasing, determining precise numbers is difficult due to relatively mild symptoms in some cases and the unreliability of self-diagnosis.
gluten fish
milk
crusta
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Food HypersensitivityFOOD ALLERGY AND INTOLERANCE
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This information leaflet is designed to answer many of the questions people may have in regard to food allergies and intolerances, collectively known as food hypersensitivities.
• Foodisoneofanumberofallergytriggers(pollen,dust,animaldander,latex)
• Afoodallergydiffersfromfoodintoleranceinthetypeofreactionbythebody
• Symptomsandtheironsetcanvarywiththetriggerandtheindividual’ssensitivity
• Peoplecanexperiencehypersensitiveresponsestomorethanonetypeoffoodorfoodingredient
• Somefoodscantriggerbothanallergicreactionandintolerance,e.g.milk,wheat
• Processingafood,e.g.cookingmayormaynotalteritsallergenicity
• Avoidanceiscurrentlytheonlywayofmanagingafoodallergyorintolerance
• Diagnosisofafoodallergyorintoleranceshouldinvolvemedicalconsultation
• Changestoyourdietshouldonlybeundertakeninconsultationwithsuitablyqualifiedexperts
• EUfoodlawidentifies14specificfoodallergensthatmustbedeclaredwhentheyareusedtoproduceorpreparefoods
• Therequirementtodeclare/labelfoodallergensdoesnotapplywhentheyarepresentatlowlevelsduetocross-contamination
• Forpre-packedfood,allergensmustbedeclaredinthelistofingredientsorelsewhereonthepackagingwherethereisnoingredientlist
• Allergeninformationfornon-prepackedfoodsinIrelandmustbeprovidedinwrittenformat
• Precautionarylabels(‘maycontain’)arevoluntarilyappliedbyfoodbusinesses
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TERMINOLOGY
Thedistinctionbetweenafoodallergyandintoleranceisnotdefinedinlegislation.Thoughinterpretationscanvary,expertsinthefieldconsiderafoodallergytobeahypersensitivereactiontoafoodthatismediatedbytheimmunesystem,particularlyinvolvingIgEantibodies(e.g.reactionstopeanut,soyaandeggs),cellularmechanismsorboth.Inaddition,autoimmuneadversereactionstofood(e.g.coeliacdisease)occurwhentheimmunesystemreactsabnormallytotheingestionofafoodorfoodcomponent.Anadversereactionthatdoesnotinvolvetheimmunesystemdirectlyisconsideredfoodintolerance,e.g.reactionstosulphites,lactose.
SYMPTOMS
Dependingonthefoodinvolvedandthesensitivityofindividuals,symptomsassociatedwithfoodallergyorintolerancecanappearimmediately(withinminutes)ortakeseveralhoursordaystomanifest.Symptomscanrangefrommildirritationtosevereorlifethreateninganaphylaxisandmayaffecttheskin,oralcavity,gastrointestinaltract,respiratorytractortheeyes.Becausemanyofthesymptomsassociatedwithfoodallergyorintolerancecanhaveunrelatedtriggers,medicaladviceshouldbesoughtbeforetakingremedialactionsuchasdietaryalteration.
almonds
Because many of the symptoms associated with food allergy or intolerance can have unrelated triggers, medical advice should be sought before taking remedial action such as dietary alteration.
ADVERSE REACTIONS TO FOOD
Autoimmune disorder(e.g. coeliac disease)
Food Allergy(Immune mediated)
IgE-mediated(e.g.peanutallergy)
Cell-mediated
IgE- and cell- mediated(e.g.milkallergy)
Enzymatic(e.g.lactoseintolerance)
Pharmacological(e.g.scombroidpoisoning)
Other and unknown triggers
Food Intolerance(Not-immune mediated)
Adversereactionstofood(adaptedfromEFSAScientificOpinionontheevaluationofallergenicfoodsandfoodingredientsforlabellingpurposes,2014).
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ANAPHYLAXIS
Anaphylaxisisarapidandpotentiallylife-threateningallergicreactioncausedbyexposuretoallergensincludingcertainfoods.Symptomsexperiencedduringanaphylacticreactionstofoodssuchaspeanutcanbegininthemouthandthroatwithinminutesofingestionandquicklyprogresstoaffectthepharynx,skin,respiratorytractandcardiovascularsystem,eitherindividuallyorincombination.Peoplesusceptibletoanaphylacticreactionsneedtocarrylife-savingadrenalineauto-injectordevicesincaseofemergency.Staffincateringfacilitiessuchasrestaurantsortakeawaysandinschoolsorotherinstitutionsshouldbeawareofsusceptibleindividualsandhaveappropriatetrainingtobeabletoprovideassistanceifrequired.
MEDICAL DIAGNOSIS IS IMPORTANT
Medicalconsultationisrecommendedwhenapersonbelievesthattheyorsomeoneintheircarearesufferingfromafoodallergyorintolerance.Accuratediagnosisisparticularlyimportantforchildrenorwherethesymptomscausesevereorpersistentdiscomfort.Incorrectdiagnosiscanresultintheactualcauseofahealthproblembeingoverlookedandinunnecessarydietaryrestrictions.
FOOD ALLERGY AND INTOLERANCE IN CHILDHOOD
Foodallergyandintolerancecanappearearlyinlifeasachildisgraduallyintroducedtonewfoodssuchascows’milk,egg,soyandfish.Thehypersensitivereactiontofoodexperiencedbymanychildrenrecedesovertimeastoleranceisdeveloped.However,theproportionofchildrenwhodeveloptolerancetosomeallergens,suchaspeanutisrelativelylow.Currently,theonlywayofmanagingfoodallergiesorintolerancesisbyeliminatingtheoffendingfoodoringredientfromthediet,butthisshouldonlybeundertakenundertheguidanceofsuitablyqualifiedexpertstominimisetheimpactonachild’sgrowthanddevelopment.
almonds
peanuts
cashew nuts
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ALLERGENS TRIGGER ALLERGIC REACTIONS
Mostallergenicfoodscontainoneormoreallergenicproteins(allergens)thattriggeranallergicreactioninsusceptibleindividuals.Someallergenicproteinsaresensitivetoprocessessuchascooking,thoughthisisnotareliablesafeguard.Forinstance,boiling(moistheat)peanutscanreducetheirallergenicpotentialbutroasting(dryheat)doesnot.Mostallergenicproteinsresistdegradationintheharshenvironmentofthehumanstomach,acharacteristicusedtoscreennewfoodingredientsfortheirallergenicpotential.
SOME FOODS CAN CAUSE BOTH AN ALLERGY AND INTOLERANCE
Certainfoodscanberesponsibleforbothanallergicreactionandintolerance.Forexample,milkproteinscancauseanallergicresponseinsomepeople,whileareducedabilitytometaboliselactose,theprimarysugarincow’smilk,iscalledlactoseintolerance.
COELIAC DISEASE
Hypersensitivitytogluten(coeliacdisease)isageneticallydetermineddisorderthatisestimatedtoaffect0.5-1%oftheIrishpopulationandforwhichglutenavoidanceistheonlytreatment.Glutenisawater-insolublemixtureofproteinsthatcandamagethemucosaofthesmallintestinesinpeoplewiththecoeliacconditionandisdefinedinEUlegislationas“a protein fraction from wheat, rye, barley, oats or their crossbred varieties and derivatives thereof”.
Foodscontainingnomorethan20mg/kgglutencanbelabelledas‘gluten-free’whilethoseprocessedspecificallytoreducetheglutencontentandcontainnomorethan100mg/kg,canbelabelledas‘verylowgluten’.Itispossiblethatafoodmadewithacerealcontainingglutencancarrya‘glutenfree’or‘verylowgluten’declaration.Coeliacscanavailofnaturally-occurringgluten-freecerealssuchasrice,maizeandsorghum.
milk
cereals
containing
gluten
wheat
oats
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Ingredientscontainingglutenarespecificallyprohibitedinthemanufactureofinfantformulaandfollow-onformula.Inaddition,processedcereal-basedfoodsandbabyfoodsintendedforinfantsandyoungchildrenundersixmonthsofageshouldindicatethepresenceorabsenceofgluten.
Foodslabelledas‘gluten-free’or‘verylowgluten’maybeaccompaniedbythestatements‘suitableforpeopleintoleranttogluten’or‘suitableforcoeliacs’.‘Gluten-free’or‘verylowgluten’foodsmayalsobeaccompaniedbythestatements‘specificallyformulatedforpeopleintoleranttogluten’or‘specificallyformulatedforcoeliacs’ifthefoodisspeciallyproduced,preparedand/orprocessedtoreducetheglutencontentorsubstitutethegluten-containingingredientswithotheringredientsnaturallyfreeofgluten.
milk
crusta
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eggs
Gluten is a water-insoluble mixture of proteins that can damage the mucosa of the small intestines in people with the coeliac condition and is defined in EU legislation as “a protein fraction from wheat, rye, barley, oats or their crossbred varieties and derivatives thereof”.
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FOOD ALLERGEN LABELLING
Manyfoodsandfoodingredientscantriggeranallergicreactionorintolerance,butonly14requirespecificallergenlabellingunderEUlaw(seelistbelow).Forpre-packedfood,foodallergensmustbedeclaredonthepackaging,e.g.inthelistofingredients,ifthereisone.Foodsthatdonotrequirealistofingredientmuststillindicatetheuseoffoodallergensbyusingtheword‘contains’followedbythespecificallergen(s).Foodbusinessessuchasrestaurants,delicatessens,canteens,takeaways,cafes,retailoutlets,hotelsetc.mustalsoprovidewrittenallergeninformationfor‘loose’foodthatisnon-prepackedorpackedfordirectsale(seesectionon‘loosefood’below).Certainderivativesoffoodallergensareexemptfromfoodallergenlabellingbecausetheproteincomponentsknowntoelicittheallergicresponsehavebeenremovedduringprocessing.
labelling
Regulation(E
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No1169/2011
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Certain derivatives of food allergens are exempt from food allergen labelling because the protein components known to elicit the allergic response have been removed during processing.
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Food allergens that require specific allergen labelling under the Food Information to Consumers (FIC) Regulation (EU) No 1169/2011:
1. Cereals containing gluten,namely:wheat(suchasspeltandkhorasanwheat),rye,barley,oatsortheirhybridisedstrains,andproductsthereof,except:
a) Wheat based glucose syrups including dextrose;
b) Wheat based maltodextrins;
c) Glucose syrups based on barley;
d) Cereals used for making alcoholic distillates including ethyl alcohol of agricultural origin.
2. Crustaceansandproductsthereof.
3. Eggsandproductsthereof.
4. Fishandproductsthereof,except:
a) Fish gelatine used as a carrier for vitamin or carotenoid preparations;
b) Fish gelatine or Isinglass used as fining agent in beer and wine.
5. Peanutsandproductsthereof.
6. Soybeansandproductsthereof,except:
a) Fully refined soybean oil and fat;
b) Natural mixed tocopherols (E306), natural D-alpha tocopherol, natural D-alpha tocopherol acetate, natural D-alpha tocopherol succinate from soybean sources;
c) Vegetable oils derived phytosterols and phytosterol esters from soybean sources;
d) Plant stanol ester produced from vegetable oil sterols from soybean sources.
7. Milkandproductsthereof(includinglactose),except:
a) Whey used for making alcoholic distillates including ethyl alcohol of agricultural origin;
b) Lacitol.
8. Nuts,namely:almonds(Amygdallus communisL.),hazlenuts(Corylus avellana),walnuts(Juglans regia),cashews(Anacardium occidentale),pecannuts(Carya illinoiesis(Wangenh.)K.Koch),Brazilnuts(Bertholettia excelsa)pistachionuts(Pistacia vera),macadamianutsorQueenslandnuts(Macademia ternifolia)andproductsthereof,exceptfornuts used for making alcoholic distillates including ethyl alcohol of agricultural origin.
9. Celeryandproductsthereof.
10.Mustardandproductsthereof.
11.Sesame seedsandproductsthereof.
12.Sulphur dioxide and sulphitesatconcentrationsofmorethan10mg/kgor10mg/litre,expressedasSO2.
13.Lupinandproductsthereof.
14.Molluscsandproductsthereof.
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CROSS-CONTAMINATION WITH FOOD ALLERGENS
Consumersmustbeinformedbythelabelwhenafoodisproducedwithoneormoreofthespecified14allergenicfoodingredients.However,suchlabellingisnotrequiredwherelowlevelsoftheallergenicingredientsarepresentasaresultofcross-contamination.Whereanundeclaredfoodallergenisdetectedatlowlevelsinafood,theFSAImaytakeproportionateactionbasedonanassessmentofthepotentialrisktopublichealth.
PRECAUTIONARY FOOD ALLERGEN LABELS
Foodbusinessessometimesuseadvisorylabelssuchas‘maycontain…’or‘producedinafactorythatuses…’toalertvulnerableconsumersthattheirproductmayinadvertentlycontainlowlevelsofcertainallergens.Whilesuchlabellingisvoluntaryandcanprovideavaluablewarningtoconsumerswhenprudentlyapplied,theyshouldnotbeusedbyfoodbusinessesasasubstituteforgoodmanufacturingpractices(GMP)orHACCPstrategies.Thespurioususeofprecautionarylabelscanresultinunnecessarydietaryrestrictionsandpossiblydesensitisepeoplewithfoodallergieswhomaythentakeriskswiththosefoods.AprecautionarystatementcannotbeconsideredafoodallergendeclarationasrequiredbyStatutoryInstrument(S.I.)No.489of2014.
PROVISION OF ALLERGEN INFORMATION FOR NON-PREPACKED (LOOSE) FOODS
UndertheFICRegulation(EU)No1169/2011,allergeninformationmustbeprovidedfornon-prepackedfoods.Thisincludesfoodsthatarepreparedbycateringestablishments,e.g.restaurants,takeawaysandhotels,foodandbeveragespresentedandsoldloose,e.g.unpackagedbreads,cheeses,draughtbeerandcider,foodpackagedonsitefordirectsaletothefinalconsumer,e.g.delicatessen,takeaway,andfoodprovidedbydistanceselling,e.g.orderedremotelyfordelivery,
TheFICRegulationpermitsEUMemberStatestodeterminehowallergeninformationfornon-prepackedfoodisprovidedwithintheirjurisdictions.InIreland,thisinformationmustbeprovidedinwrittenformatassetoutinS.I.No.489of2014.DetailsofhowfoodbusinessescancomplywiththisrequirementaresetoutintheFSAIinformationleafletAllergen Information for non-Prepacked FoodandGuidance Note 28 on Food Allergen Information for Non-Prepacked Foods in Ireland(www.fsai.ie).
www.fsai.ie
sms alerts
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MONITORING THE LABELLING OF FOOD ALLERGENS
Prepackedfoodsamplescollectedbyenvironmentalhealthofficersaretestedbythepublicanalystlaboratorieseachyearforthepresenceofcertainfoodallergens.Whenclearbreachesofthefoodallergenlabellinglegislationaredetected,afoodbusinessmaybeaskedtoplaceadditionallabelsonaproduct.However,dependingonthepotentialrisk,aproductmaybewithdrawnorrecalledandanotificationsenttotheEUrapidalertsystemforfoodandfeed(RASFF).Evenwherelabellingruleshavenotbeenbreachedbythepresenceofafoodallergen,theFSAImaytakeactionintheinterestsofconsumersafety,basedonanassessmentofthepotentialrisktopublichealth.
FSAI EARLY WARNING SYSTEM
In2009,theFSAIinitiatedanearlywarningsystemforpeoplewithfoodallergiesorintolerances,ortheirguardians,andwhohaveregisteredwiththeFSAI.Thissystemenablesreal-timetransferviaemailandSMStextmessagingofinformationaboutfoodallergyissuesastheFSAIbecomesawareofthem.RegistrationforthisresourcecanbemadethroughtheFSAIwebsiteathttps://www.fsai.ie/subscriptions/.
MAKE A COMPLAINT
ConsumerswithafoodallergyorintoleranceareencouragedtocontacttheFSAIdirectlywheretheyhavehadanadversereactiontoaprepackedfoodthattheysuspectmaynotbelabelledappropriately,ortoafoodconsumedinacateringestablishment.Wherepossible,asampleofthesuspectfoodshouldbesubmittedinordertoestablishthepresenceofparticularallergenicingredients.
USEFUL LINKS
• FoodInformationonPrepackedFoodshttp://www.fsai.ie
• AllergenInformationfornon-PrepackedFoodhttp://www.fsai.ie
• Gluten-FreeFoods:ReportoftheScientificCommitteehttp://www.fsai.ie
• GuidanceNoteNo.24:‘Gluten-free’and‘VeryLowGluten’Declarations(Revision1)http://www.fsai.ie
• GuidanceNoteNo.28:FoodAllergenInformationforNon-PrepackedFoodsinIrelandhttp://www.fsai.ie
• FSAISafeCateringPackhttp://www.fsai.ie
• BeFoodAllergenAwarePosterhttp://www.fsai.ie
• OpinionoftheScientificPanelonDieteticproducts,nutritionandallergies[NDA]ontheevaluationofallergenicfoodsforlabellingpurposeshttp://www.efsa.europa.eu/en/efsajournal/pub/32.htm
• FoodAllergyandIntolerance-GuidancefortheCateringIndustryhttp://www.safefood.eu/
• AnaphylaxisCampaignwww.anaphylaxisireland.ie
• CoeliacSocietyofIrelandwww.coeliac.ie
Theinformationprovidedinthisleafletwillbeupdatedregularlytoreflectanychangestolegislation,standardsorguidance.
Food Safety Authority of IrelandThe Exchange, George’s Dock, IFSC, Dublin 1, D01 P2V6
T +353 1 817 1300E [email protected]
www.fsai.ie
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