BMJ  2005;331:1155-1156 (19 November), doi:10.1136/bmj.331.7526.1155

Editorial

European developments in labelling allergenic foods

More still needs to be done

The new European Union directive on food labelling, requiring manufacturers of packaged foods to detail clearly the presence of certain known allergens, comes into effect later this month.¹ This welcome legislation will directly benefit the many people who experience adverse reactions to foods and could save lives, given the increasing numbers of people with IgE-mediated food allergy who may develop anaphylaxis after even minimal exposure.^{2 3} Similar initiatives are being pursued in the United States, Australia, and New Zealand, indicating that the plight of those who live with the daily threat of allergic reactions to foods is, in some countries at least, at last being taken seriously.^4-6

Manufacturers of packaged foods containing any of 12 major allergens (see box) will, as of 25 November this year, be obliged by the European Union regulations to label these ingredients. Importantly, this new legislation removes the previously unhelpful "25% rule," which exempted labelling of constituent ingredients if they amounted to less than 25% of the final product, thereby resulting in an appreciable risk of inadvertent exposure to, for example, nuts in chocolates.⁷ Even use of the smallest quantities of these 12 ingredients will now require labelling.

Although many manufacturers have already begun implementing this new requirement, consumers need to be aware that stocks of products manufactured and packaged before 25 November may continue to be sold. It is also important to note that other ingredients of compound preparations may in some cases be exempt from labelling if they constitute less than 2% of the final product. Given that sensitisation may be increasing to, for example, certain stoned or exotic fruits such as apples or kiwi fruit used in small quantities in desserts or jams, this is worrying.^{8 9}

More concerning, however, is the exclusion from these EU regulations of freshly prepared foods, because most severe anaphylactic reactions to food occur when eating out in restaurants and cafes.¹⁰ Vulnerable people are left with one of two options—either to take the risk of asking about the ingredients of food and trusting in the advice of catering staff, many of whom will have not received any training in the dangers of food allergies, or to curtail or completely avoid eating out. The European Union should adopt the same requirements as Australasia, where all food suppliers have to make available to consumers detailed information on ingredients on the packaging, or on a display alongside the food, or to the purchaser on request.⁶

Specified food allergens covered by the new European Union directive Cereals containing gluten Crustaceans Eggs Fish Peanuts Soya beans Milk Nuts Celery Mustard Sesame seeds Sulphur dioxide and sulphates

Furthermore, this EU legislation will do nothing about the highly frustrating general warning "may contain traces of nuts."¹¹ To protect people with food allergies effectively, production lines for the main allergens should be separated completely from other production lines in factories and other settings for processing and packaging food products. In the meantime, food suppliers should provide consumers with a much clearer idea of the likelihood of trace exposure to nuts and other products.

Policy makers, legislators, and food suppliers need to appreciate that neither underplaying nor overplaying the risks of exposure to allergenic foods are helpful for those living with what is often a highly debilitating lifelong condition. People with food allergies need accurate, clear, and easily understood information to make truly informed choices and to live with and control their condition with a sense of confidence.

Division of Community Health Sciences, University of Edinburgh, Edinburgh EH8 9DX

(Aziz.Sheikh{at}ed.ac.uk)
Division of Community Health Sciences, University of Edinburgh, Edinburgh EH8 9DX

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We thank Sue Clarke and David Reading of the Anaphylaxis Campaign for helpful discussions on this subject.

Competing interests: AS has family members with serious food allergies and serves on the Scottish Executive's Review of Allergy Services in Scotland Working Group. CA has no competing interests.

References

1. Directive 2003/89/EC of the European Parliament and of the Council of 10 November 2003. Official Journal of the European Union 2003;308:15-8. http://europa.eu.int/eur-lex/lex/LexUriServ/LexUriServ.do?uri=CELEX:32003L0089:EN:HTML (accessed 9 Nov 2005).
2. Gupta R, Sheikh A, Strachan DP, Anderson HR. Increasing hospital admissions for systemic allergic disorders in England: analysis of national admissions data. BMJ 2003;327: 1142-3.[Free Full Text]
3. Sampson HA. Update on food allergy. J Allergy Clin Immunol 2004;113: 805-19.[CrossRef][ISI][Medline]
4. US Food and Drug Administration. Food Allergen Labeling and Consumer Protection Act of 2004. www.cfsan.fda.gov/~dms/alrgact.html (accessed 9 Nov 2005).
5. Food Standards Australia New Zealand. Food Standards Australia New Zealand's regulatory approach to food allergens. www.foodstandards.gov.au/mediareleasespublications/speeches/speeches2004/foodlabellingandcons2357.cfm (accessed 9 Nov 2005).
6. New Zealand Food Safety Authority. What's on a food label? Allergen labelling and advisory/warning statements. www.nzfsa.govt.nz/consumers/food-safety-topics/food-processing-labelling/food-labelling/fact-sheets/fs-2003-03-allergen-labelling.htm (accessed 9 Nov 2005).
7. Sheikh A, Walker S. Food allergy. BMJ 2002;325: 1337.[Free Full Text]
8. Roehr CC, Edenharter G, Reimann S, Ehlers I, Worm M, Zuberbier T, et al. Food allergy and non-allergic food hypersensitivity in children and adolescents. Clin Exp Allergy 2004;34: 1534-41.[Medline]
9. Lucas JS, Lewis SA, Hourihane JO. Kiwi fruit allergy: a review. Pediatr Allergy Immunol 2003;14: 420-8.[Medline]
10. BBC News. Eating out poses allergy risk. 2002 Sep 9. http://news.bbc.co.uk/1/hi/health/2245860.stm (accessed 9 Nov 2005).
11. Said M, Weiner JM. "May contain traces of...": hidden food allergens in Australia. More accurate food labelling would assist consumers and the food industry alike. Med J Aust 2004;181: 183-4.[Medline]

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