On 7 & 8 April 2011 the IFST's Midland branch organised the IFST Spring Conference - Allergens - How to keep control in food production. Jon Poole, CE of IFST noted that the focus on the management of allergens remained a topical issue of great concern to food producers, regulators and consumers alike. Ruth Dolby, Chair of the Midland Branch remarked that the conference had taken delegates on a journey to some very practical tools for allergen management and that these could be used to enhance the quality of life for allergy sufferers and underlining the issue that allergen reaction is often fatal, an issue the food industry must not forget.
Abstracts, presentations and podcasts
A History of Food Allergy – The Evolving Story Over The Last Two Decades
David Reading OBE, Co-Founder and Vice President of Anaphylaxis Campaign
Podcast: MP3
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Abstract: Co-Founder and Vice President of Anaphalaxis CampaignThe history of food allergy goes back centuries but it wasn’t until recent times that it became accepted as a relevant and serious health issue. In 1993 the UK media reported several deaths from allergic reactions to nuts and this triggered deep alarm throughout the food industry. With public demand for action growing, the Anaphylaxis Campaign was set up to raise awareness.
Early in 1994 the new organisation was drawn to the attention of the Food Minister, Nicholas Soames, and his discussions with the charity’s founders led to an awareness drive throughout the food and catering industries. Severe allergy became a “scare story” in the media – with a tendency to focus on the more extreme situations. In the early days the Anaphylaxis Campaign received hundreds of letters from families affected, painting a picture of extreme public anxiety. Research showed that one in 200 children was allergic to peanuts – a figure which more than doubled over the next decade.
Many sectors of industry responded positively. Individual companies looked hard at their allergen management and labelling. Codes of practice were set up, e.g. by the British Retail Consortium and Food and Drink Federation. The European Commission began to discuss mandatory allergen labelling for certain key foods, which came to fruition in 2003. MAFF and later the Food Standards Agency published guidance for industry and set in motion a research programme that continues to the present time.
From those early days, the spread of “may contain” labelling caused intense frustration among consumers. Furthermore it was clear that a range of foods beyond those on the EU list were capable of causing allergic reactions. These include seeds, pulses, fruits and vegetables. An increasing number of cases of pollen-food syndrome were reported.
Growing awareness led to the number of allergy-related food alerts rising. The FSA and various allergy charities launched systems of informing consumers when alerts occurred. The number of annual alerts peaked in 2008 at around 65.
Today there is promise of answers on the horizon to the many mysteries surrounding food allergy. Work is on-going to determine the threshold doses that are capable of triggering reactions; research may help science to understand why people become allergic; and one day it may be possible to “switch off” allergy altogether.
A Global Perspective on Food Allergens
Prof. Steve Taylor, PhD, Director of the Food Allergy Research & Resource Program, University of Nebraska-Lincoln, USA
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Abstract: Food allergies have emerged to become a prominent public health issue over the past 20 years. While the prevalence of food allergies appears to be increasing, the awareness of food allergies by consumers, public health authorities, medical professionals, and the food industry is growing even faster. This situation has put considerable stress on the food industry because awareness and education regarding food allergies was quite limited 20 years ago; allergen management strategies were essentially non-existent. During this short period of time, the food industry has made remarkable progress in terms of allergen management and control. However, lest complacency develop, we must acknowledge that additional progress remains possible.
The food industry now has the tools needed to assist with allergen management and control. First and foremost, a variety of methods exist to detect trace residues of allergenic foods that might contaminate other foods from shared equipment, shared facilities, or agricultural practices. With these methods, the presence and often an estimate of the level of allergen residue can be known. While detection methods are now widely applied, the selection of the optimal test method and the interpretation of the results of the analysis remain challenging areas for the food industry. All allergen detection methods are not created equal! And, the best method for one application may not be optimal for another!
The widespread application of allergen analysis has led to increased recalls of food products with undeclared allergens in the USA. Furthermore, it has led to the increased labeling of food products and especially precautionary/advisory labeling (e.g. “may contain x”). While such developments have served to increase the well being of food-allergic consumers, they have also led to a lowering of quality-of-life because of the difficulties in implementation of avoidance diets.
Once analytical results are available, the prospect of quantitative risk assessment becomes more feasible. However, this prospect remains elusive and has not yet been widely applied by industry or public health authorities. In recent years, considerable information has developed on threshold doses for allergenic foods and the use of statistical dose-distribution modeling to estimate population thresholds. Scientists can now confidently predict the percentage of allergic consumers who might react adversely to ingestion of a food with a known level of allergenic contamination. If the dose-distribution model for thresholds is coupled with the analytical results on the amount of allergen residue present in a food product and knowledge of the consumption patterns for that food, probabilistic modeling can be applied. More widespread use of probabilistic modeling would allow the industry to make wiser choices about the use of precautionary/advisory labeling.
A Vision for Allergen Management Best Practice in the Food Industry
Dr Rachel Ward, Scientific Regulatory Affairs Manager, PepsiCo Intl.
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Abstract: Allergenic foods have become recognised as a food safety hazard over the last two decades. Over the same period, knowledge about the biology and clinical characteristics of food allergy have grown, together with information that can be used to assess the risk more accurately. While current practices in allergen management have increased the safety of food products to allergic consumers, the standards applied by different manufacturers remain divergent in the absence of agreed approaches to risk assessment. This has been reflected in a considerable expansion of precautionary labeling and a concomitant reduction in consumer’s trust, resulting in risk-taking. To address these issues, this paper advocates a risk management approach based on a common agreed set of principles, leading to consistent and well-understood management action levels across the food industry. The approach also recognises that minimising the risk from allergenic foods is a shared responsibility of all the stakeholders involved. Action levels, by permitting a consistent use of precautionary labelling and clear communication of the allergen status of a food, will play a crucial role in ensuring that risks from allergenic foods are reduced as far as possible.
A Regulators Perspective on Allergen Management in the Food Industry
Sue Hattersley, Head of Food Allergy Branch, Food Standards Agency
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Abstract: This presentation will give the background to the issue of allergen labelling legislation and the best practice guidance issued by the UK Food Standards Agency on allergen management and the communication of allergen cross contamination risks to the consumer. As allergen management thresholds have not yet been agreed internationally, a regulators approach to the assessment of the risks posed by food allergen incidents will be discussed, and specific examples given. The presentation will also outline what is being done to take forward the development of agreed allergen management thresholds and set out what still needs to be done.
Food Allergy: A Complex Social Dilema
Tony Hines MBE, FIFST, MICPEM, Head of Food Security and Crisis Management Manager, Leatherhead Food Research
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Abstract: Suffering from a food allergy or being the parent of an allergy patient is an often complex and stressful experience. This presentation will highlight some of the complex social issues faced by parents and patients alike. It will also introduce the worrying introduction of allergen bullying and the even more disturbing trends of cyber bullying through social networking sites. Examples will be cited from the UK, America and Canada with some graphic, unsettling examples of the issues families and children face. To challenge this issue, Tony will argue that allergen management needs to climb the corporate agenda and become an integral part of corporate social responsibility.
‘Taking the Risk out of Allergen Risk Assessment’. Practical Tools and Techniques for Successful Allergen Control
Simon Flanagan, Head of Speciality Analysis & Food Allergen Services, Reading Scientific Services Ltd
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Abstract: Against a backdrop of allergen labelling regulations that differ widely around the world, the issue of allergen management continues to present a big challenge for food producers. There is still a lot of uncertainty in the industry about how best to manage allergens, as evidenced by the fact that allergen-related issues still account for approximately 50% of all recalls in the US & UK. Undeclared allergens are increasingly becoming an issue in other EU member states as seen in the dramatic increase in RASFF (Rapid Alert System for Foods and Feeds) notifications sent out in 2009 (127).
In order to protect allergic consumers from exposure to undeclared allergens, many food manufacturers have implemented allergen control programmes founded on risk assessment (using HACCP principals) & utilising prerequisite programmes. As there is currently no internationally agreed regulatory guidance with respect to the management of allergen cross-contamination or acceptable population based action levels, this has lead to an inconsistency in risk assessment, mitigation and management systems. The speaker will cover the evolution of allergen risk assessment from a pure ‘hazard’ to a risk based ‘approach’ and describe new methodology which utilises data from the latest scientific studies. This new allergen risk assessment ‘toolkit’ has been successfully piloted in a wide range of different sectors within the food industry.
Allergens Across the EU and Thresholds of Concern
Clare Mills, Institute of Food Research
E.N. Clare Mills1, Alan R. Mackie1, R.W. Rene Crevel2, Kirsten Beyer3, Peter Burney4, Montserrat Fernandez-Rivas5, Barbara Ballmer-Weber6.
1Institute of Food Research, Norwich Research Park, Colney, Norwich,UK.
2Safety & Environmental Assurance Centre, Unilever Colworth, Sharnbrook; UK.
3Department of Paediatric Pneumology and Immunology, Charité University Medical Centre, Berlin, Germany.
4Imperial College London; Associations, Belgium
5Allergy Department, Hospital Clinico San Carlos, Madrid, Spain.
6 Department of Dermatology, University Hospital, Zurich, Switzerland
Abstract: Concerns about food allergies have increased over the last 20 years, with tragic incidents of fatal reactions, often involving young people eating foods like peanuts and tree nuts. The lack of good quality data on how many people suffer from food allergies, which foods they react to and how much of a food can cause a problem, has been hampering the development of effective management strategies to optimize the quality of life for allergic patients. There has also been no data on the impact of food allergies on quality of life or an estimate of its cost to society. We have been addressing these issues through the EuroPrevall project (Mills et al 2007) which has built on EU-funding spanning 3 framework programmes to develop a world-leading pan-European research community. Cohorts covering the main climatic regions of Europe have been developed in infants through a birth cohort (Keil et al 2010), community surveys in school-age children and adults (Kummerling et al 2009) and an outpatient clinic study. Complimentary studies in Ghana, Western Siberia, India and China (Wong et al 2010) are allowing us to gain insights into how different dietary patterns and exposure to microorganisms affect food allergies. Data from these cohorts are indicating there is a marked heterogeneity in the incidence of food allergies across Europe. Confirmatory double-blind placebo controlled food challenge diagnosis has being undertaken using foods as they are eaten with titrated doses, data from which will allow informed management of levels of allergens in foods and minimize the use of precautionary labels like “may contain”. The cohorts will also facilitate validation of novel in vitro diagnostics, based on individual components, which are being explored in collaboration with a world-leading European-based diagnostics company.
In order to manage allergens in foods in factory environments and undertake effective risk assessment it is necessary to have data on how much of a problem food can trigger an allergic reaction and how it is affected by food processing, as well as a knowledge of how other factors, such as infections and alcohol consumption, may affect individual responsiveness (Madsen et al 2009, Crevel et al 2008). Such knowledge will also assist those involved in developing analytical methodology for determination of allergens in foods to effectively assess analytical performance (Kerbach et al 2009). International efforts to determine allergens in foods have been led notably by the Food Allergy Research and Resource Programme in the USA, and more recently in the EuroPrevall project. Data has been collected when determining the clinical reactivity to foods using, wherever possible, standardized double blind placebo controlled food challenges (DBPCFC). The challenge protocols give the active allergenic ingredient in titrated doses and have thereby allowed information on “no observed effect levels” [NOELs] and “lowest observed effect levels” [LOELs] to be obtained for major allergenic foods in individuals suffering from food allergies drawn from across Europe using the same matrices (Crevel et al 2008). Active ingredients have been used which correspond to commonly available food ingredients and include:
- Peanut – a lightly roasted defatted peanut meal
- Hazelnut – a ground hazelnut flour preparation
- Celeriac (celery root) – commercial celery spice
- Egg – hens’ egg as pasteurized egg white
- Milk – cows’ milk as spray-dried skimmed milk powder
- Fish – as freeze-dried cod fish powder
- Shrimp – as pureed whole shrimp
Two food matrices, similar to normal food products, have been prepared for undertaking the challenges. These include a chocolate mousse dessert formulated by one industrial partner, Unilever, and manufactured by them and Kraft, together with a dark chocolate matrix (peanut and hazelnut only) prepared by Nestlé. The sensory properties of the active and placebo formulations were assessed to ensure the active dose was effectively blinded. An alternative burger matrix recipe adapted from one developed by the University of Nebraska, USA for shrimp challenges proved effective at blinding the large amounts of shrimp required. Alternative recipes were developed for use with young children and infants – with a pudding type matrix and infant formula being used in infants and young children. For peanut and hazelnut a comparison of the dessert matrix and dark chocolate bars has also been undertaken. Analysis of the dose response curves using a severity scoring system is currently underway and will provide much needed data to support development and application of probabilistic approaches to allergen risk management in future.
Acknowledgements
This work was funded by the EU through EuroPrevall (FP6- FOOD-CT-2005-514000).ENCM and ARM were also support through an Institute Strategic Programme grant from the UK Biological and Biotechnological Sciences research Council. Support of the UK Food Standards Agency through T07062 in undertaking analysis of EuroPrevall threshold data.
References
Crevel RW, Ballmer-Weber BK, Holzhauser T, Hourihane JO, Knulst AC, Mackie AR, Timmermans F, Taylor SL. (2008) Thresholds for food allergens and their value to different stakeholders.Allergy. 63(5):597-609.
Keil T, McBride D, Grimshaw K, Niggemann B, Xepapadaki P, Zannikos K, Sigurdardottir ST, Clausen M, Reche M, Pascual C, Stanczyk AP, Kowalski ML, Dubakiene R, Drasutiene G, Roberts G, Schoemaker AF, Sprikkelman AB, Fiocchi A, Martelli A, Dufour S, Hourihane J, Kulig M, Wjst M, Yazdanbakhsh M, Szépfalusi Z, van Ree R, Willich SN, Wahn U, Mills EN, Beyer K. (2010) Allergy. 65(4):482-90.
Kerbach S, Alldrick AJ, Crevel RWR, Domotor L, DunnGalvin A., Mills ENC., Pfaff S., Poms R.E. , Popping B. Tomoskozi S (2009). Managing foodallergens in the food supply chain- viewed from different stakeholder perspectives. Quality Assurance and Safety of Crops & Foods 1:50-60.
Kummerling I, Mills EN, Clausen M, Dubakiene R, Pérez CF, Fernández-Rivas M, Knulst AC, Kowalski ML, Lidholm J, Le TM, Metzler C, Mustakov T, Popov T, Potts J, van Ree R, Sakellariou A, Töndury B, Tzannis K, Burney P. Allergy.(2009) 64(10):1493-7.
Madsen CB, Hattersley S, Buck J, Gendel SM, Houben GF, Hourihane JO, Mackie A, Mills ENC, Nørhede P, Taylor SL, Crevel RWR. (2009) Approaches to risk assessment in food allergy: report from a workshop ''developing a framework for assessing the risk from allergenic foods".Food Chem Toxicol. 47(2):480-9.
Wong GW, Mahesh PA, Ogorodova L, Leung TF, Fedorova O, Holla AD, Fernandez-Rivas M, Mills ENC, Kummeling I, van Ree R, Yazdanbakhsh M, Burney P. Allergy. (2010) 65: 385-390.
Mills ENC, Mackie AR, Burney P, Beyer K, Frewer L, Madsen C, Botjes E, Crevel RW, van Ree R. (2007) Allergy 62 (7):717-22.