Allergen control: the complete picture
Beyond then IFAAM study: what next for preventing and treating allergic reactions? – Professor Clare Mills, Manchester Institute of Biotechnology
Putting thresholds into practice – Dr René Crevel, René Crevel Consulting
Allergen Analysis – what should we consider when moving towards allergen thresholds – Pauline Titchener, Neogen
Thresholds and actions levels: a retailer's perspective – Juliette Jahaj, Sainsbury's
The TRACE peanut study – learning about thresholds to improve allergen labelling – Dr Shelley Dua, Addenbrookes Hospital
Keeping the allergic consumer safe – a view from the food service sector – Barry Moore, Performance Director, Gather & Gather
Beyond IFAAM: what next for preventing and treating allergic reactions?
IFAAM – Integrated Approach to Food Allergen and Allergy Management – is a Europe wide project designed to take forward the findings of the Euro Prevall work assessing the incidence and severity of food allergy across Europe.
A few of the findings of EuroPrevall that have informed the work of IFAAM:
IFAAM – Allergen Tool Management Box
The work of IFAAM is to use the findings of EuroPrevall to establish management tools for industry going forward.
Acceptable level of risk
However, for this work to go forward there is an urgent need to establish what consumers would regard as an 'acceptable level of risk'. Would tingling lips be acceptable while a drop in lung function would not be? Data is needed from sufferers to establish this but that data is is likely to prove in different parts of Europe and for different allergies.
There are new treatments for allergy based on immunotherapy principles being developed both in France and the US (see this blog for more details) with yet more waiting in the wings. These will change the dynamics in food allergy treatment as they will move it beyond a purely food industry issue into the realms of the pharmaceutical industry with all the possible investment that might bring with it.
Putting thresholds into practice: where are we now?
The path to thresholds
What is a threshold?
What constitutes a 'dose'? when it elicits -
So an 'eliciting dose' is a dose which you would expect to elicit a reaction in a percentage of the reactive population – probably aiming for 1–5% of that population.
What is needed to put thresholds into practice?
Risk Assessment Toolkits
Allergen management does fall with general food and food safety law which means that:
The European food safety group DG Santé (Directorate General for Health and Food Safety) further agreed in June 2016:
So where are we now?
Allergen Analysis – What we should consider when moving towards allergen thresholds
The widely used Camden BRI Guide 71 for food allergens states that thresholds are not applicable where:
Considerations when testing
Thresholds and and action levels: a retailer's perspective
Juliette Jahaj, Sainsbury's
As an allergy sufferer herself, Juliette Jahaj has a very personal interest in allergy and in the factories that she audits all over the world. But she also understands that allergy education is not necessarily as developed elsewhere in the world, where just having enough to eat is more of an issue than what is actually in the food. (She quoted one factory in India where her request for an ingredients list was greeted with the response – 'Ah but we are mean -– we don't give you the ingredients as well as the food – what do you think we are?')
The numbers of products being recalled because of allergy issues continues to go up but she believes that this has more to do with awareness than with an an actual increase in numbers. The vast majority of recalls continue to be for labelling errors.
However, there are areas where issues can arise. For example:
She pointed out that consumer understanding of allergens and of labelling issues remains extremely low, even among invested parents of allergic children.
The TRACE peanut study – learning about thresholds to improve allergen labelling
Dr Shelley Dua, Cambridge Peanut Allergy Clinic, Addenbrookes Hospital
Dr Shelley Dua, who has just joined the consultancy team at the Peanut Allergy Clinic, has been closely involved with the TRACE (Thresholds of Reactivity And Clinical Evaluation) study which aims to evaluate the extrinsic factors which may be relevant in an allergic reaction. She took us through the thinking behind the study and an update on it so far.
What is a threshold?
Why are there such wide variations between individual reactions?
'Host' factors – factors within each individual which may influence the severity of their reaction:
'Extrinsic factors' – factors which might also affect the severity of their reaction
Immunotherapy studies had showed that patients tended to loose some of their allergen tolerance when they were either tired or exercising.
Why does this happen?
The objective of the TRACE study is to establish how much exercise/sleep deprivation was needed to affect that patient's reactivity.
64 peanut allergics took part in the study and were divided into three groups:
The study is only just complete so the detailed results are not yet available but Dr Dua could tell use that it was clear that both sleep deprivation and exercise had a significant effect on reactivity.
Keeping the allergic consumer safe – a view from the food service sector
Barry Moore, Performance Director, Gather and Gather
As the father of a peanut allergic boy and the performance director for a large catering company, Barry understands the problems of allergy in food service better than most.
And his is aware that an estimated 25% of allergic consumers do have a reaction when they eat out, often when they eat in fast food outlets.
There are major inherent problems with dealing with allergies in food service:
This is the point of the AC's new campaign – Ask the Question
Ask the Question will follow the format of the campaign's enormously successful #Take the Kit campaign which included this incredibly hard hitting film and which highlighted the importance of always carrying your adrenaline injector pen with at all times. (If you have never seen the film, please watch it.)
Ask the Question will focus on always asking about allergens in a catered situation and the consequences of not doing so.
The AC are looking for funding now, so if you think you can help, do contact CEO Lynne Regent – she will be more than happy to hear from you.
Some points from the Q&A/Panel discussion
See the Anaphylaxis Campaign site for more on their conferences and support material.