Food for thought
Training Matters â€“ hayfever and allergies â€“ April 2019
Food for thought
Food allergies are on the rise, but food allergen labelling remains inadequate, according to many organisations. Hereâ€™s what to look out for. By Sasa Jankovic
Allergies have hit the headlines a lot in recent months, in particular food allergies. The inquest into the death of a girl who suffered a fatal reaction to sesame in a Pret a Manger baguette shone a light on food allergen labelling last September, and the BBCâ€™s Panorama programme highlighted the debate over whether the delivery service Just Eat should advertise allergen information.
But even when food packaging is clearly labelled, consumers are still confused about food allergens, according to new research from Mintel (https://news.mintel.com/2174-637TB-10O75ICT50/cr.aspx), and it appears that many people are avoiding certain foods that they may not even be allergic to.
While pre-packaged goods are legally required to highlight on-pack the presence of any allergens, Mintel found that almost half (48%) of Brits are unsure whether or not allergen labels are clear, and a further 15% actively disagree that this is the case. The same number (48%) say that they, or someone in their household, avoid at least one food/ingredient - although only 20% do so due to an allergy or intolerance.
Meanwhile, three in ten (30%) people avoid certain foods/ingredients for other reasons (eg ethical, vegetarian) rising to 38% of under-25s. Dairy is the most commonly avoided food/ingredient (17%), followed by soya (16%), fish or shellfish (16%), red meat (15%) and lactose (15%).
Despite allergies or intolerances not being the main reason that consumers are avoiding certain foods or ingredients, Emma Clifford, associate director of food and drink at Mintel, says manufacturers still need to do more when it comes to clear labelling of allergens: â€œGiven the perceived lack of clarity and the dangerous health implications that ambiguous allergen labelling can have on consumers, there is a real need for companies to make the presence of allergens very obvious on labellingâ€, says Emma, â€œ[and] there is strong demand for a UK-wide labelling system for allergens which would unify the way in which companies communicate this information on packaging.â€
Another issue is that foods prepacked for direct sale are currently not required to carry allergen information, which could lead consumers to wrongly assume the absence of allergen information means the food does not contain allergens.
However, this could be on the way to being addressed, with results due from a consultation by the Food Standard Agency (FSA) on allergen labelling of â€˜prepacked foods for direct saleâ€™ which closed at the end of March.
Explaining the review, FSA chairman Heather Hancock says: â€˜Clear, accurate and visible allergen labelling is vital to protect the thousands of people at risk of allergic reactions, when buying their daily sandwich, salad or snack to eat on the go. Food businesses have a duty to protect people with food allergies and we welcome the real progress that many have made. This review is looking at whether businesses should do more to keep their customers safe [because] we all deserve food we can trust.â€
Common food allergies
The Association of UK Dietitians estimates that between 1-10% of adults and children have a food hypersensitivity, and around 11-26 million Europeans are thought to suffer from food allergy. Food allergies are a cause of particular concern in young children, where the incidence â€“ often life threatening â€“ is estimated to be greater in toddlers (5-8%) than in adults (1-2%) (Pawankar R, et al, 2013).
Although people can be allergic to any food substance, Allergy UK cites 14 major food allergens which should be mentioned (either on food labelling or menus) when they are used as ingredients in a food product or meal. These are:
Cereals containing gluten
Eggs â€“ more common in young children than in adults, and most children will outgrow it
Lupin â€“ the seeds of which are used to make flour used in pastries, pies, pancakes and in pasta. A number of studies have demonstrated a link between lupin allergy and peanut allergy - both foods are legumes
Milk â€“ cowâ€™s milk is one of the most common food allergies to affect babies and young children, with most children outgrowing it by the time they start school
Tree Nuts â€“ such as almonds, Brazil nuts, cashews, chestnuts, hazelnuts, macadamia nuts, pecans, pistachios and walnuts
and Sulphur dioxide (sometimes known as sulphites) â€“ used as a preservative in a wide range of foods including soft drinks, sausages, burgers, and dried fruits and vegetables
Symptoms of allergic reactions
Food allergies occur when the bodyâ€™s immune system becomes confused by harmless food proteins and releases a chemical called histamine to counter the perceived threat, which at the same time causes the common allergy symptoms of hives or swelling.
In children, food allergies are much more common amongst those who come from families where other members suffer from allergy, and babies with eczema are at a higher risk of having food allergies.
The first obvious symptoms of a mild to moderate food allergy typically affect the skin, the respiratory system and the gut. Allergy UK says the key signs to look out for are:
A flushed face, hives, a red and itchy rash around the mouth, tongue or eyes, which can spread across the entire body
Mild swelling, particularly of the lips, eyes and face
A runny or blocked nose, sneezing and watering eyes
Nausea and vomiting, stomach cramps and diarrhoea
A scratchy or itchy mouth and throat
More severe reactions can cause an anaphylactic shock, a life-threatening allergic reaction that requires immediate treatment with an adrenaline injection. Anaphylaxis occurs when the chemicals that cause the allergic symptoms are released into the bloodstream, as opposed to in most allergic reactions when the resulting chemicals are released locally into the tissues in a particular part of the body such as the skin or eyes.
Symptoms of anaphylaxis usually occur within minutes of exposure to the allergen but sometimes an hour or so later, and include:
Wheezing or chest tightness, similar to a severe asthma attack
Swelling of the tongue and throat, restricting the airways. This can cause noisy breathing (especially on breathing in), a cough or a change in voice
A sudden drop in blood pressure (called hypotension) leading to shock
Dizziness, confusion, collapse, loss of consciousness and even coma
The first line treatment for severe symptoms is adrenaline (epinephrine) given by an injection into the upper outer muscle of the thigh, and Allergy UK stresses the importance of acting fast: â€œAdrenaline is life saving and must be used promptly in anaphylaxis. Delaying the giving of adrenaline can result in deterioration and death. Adrenaline given in this way is a safe treatment and you should not hesitate to use it if required. It starts to work within minutes, reducing swelling, relieving wheeze and improving blood pressure. IF IN DOUBT, GIVE ADRENALINE FIRST and then call for help. Do not wait to see if the symptoms clear up â€“ call an ambulance immediately. If there is no response to the initial injection, current recommendations are to give a further adrenaline dose after 5 minutes.â€
Box out: Peanut allergy
Peanut allergy affects around one in 40 children and has seen an increase in incidents over recent years.
Symptoms of peanut allergy usually occur within minutes of contact with peanuts, but can also occur up to one hour later, and can range from mild hives to severe and life-threatening anaphylaxis.
Although it is not uncommon to be allergic to both peanuts and some tree nuts, peanuts are a legume rather than a nut, so a peanut allergy does not automatically mean an allergy to tree nuts. One member of the legume family that can affect people with peanut allergy is lupin as these seeds â€“ commonly made into flour in some European countries, Brazil and the Middle East â€“ share similar proteins with peanuts, so anyone who has ever had a severe reaction to peanuts should seek medical advice from an allergy specialist about getting tested to an allergy to these other foods.
Box out: Allergy, intolerance or sensitivity?
Food intolerance â€“ also called food sensitivity â€“ covers a range of conditions with unpleasant symptoms that occur every time a particular food is eaten.
There are many different types of food intolerance, which is different to food allergy: intolerances are not caused by the immune system and do not have the risk of a severe and potentially life threatening allergic reaction (anaphylaxis). Food intolerances are caused by a substance within the food itself or by the body which has problems with digesting that food (such as lactose intolerance due to a lack of the lactase enzyme whose job it is to break down the lactose in foods).
Symptoms commonly effect the digestive, skin and respiratory systems and may include flushing of the skin, urticaria (raised red, itchy rash), eczema flares or angioedema (deep swelling of the tissue). Digestive symptoms can include abdominal pain, diarrhoea, bloating, stomach cramps, and constipation. The respiratory system can also be affected, causing rhinitis, breathing difficulties and wheezing. Other symptoms include headaches and palpitations.
Food allergies happen when the immune system mistakenly recognises a food as harmful and an allergic response and symptoms are seen. People with a food intolerance may be able to tolerate a small amount of the food before they experience symptoms, whereas those with a food allergy will have to avoid the food(s) in question.
Allergy UK has a comprehensive range of free downloadable factsheets about different types of food allergy, including peanut allergy, egg allergy and milk allergy, at https://www.allergyuk.org/information-and-advice/conditions-and-symptoms/36-types-of-food-allergy
Hay fever â€“ or seasonal rhinitis â€“ is a common allergic reaction to pollen from grass, trees and weeds during the early spring and summer months. Allergy UK estimates that hay fever affects 1 in 5 children and adults in the UK,Â significantly affecting quality of life, work and school performance and attendance, and is a risk factor for the development of asthma.
Hay fever is caused when the body makes allergic antibodies (IgE) to certain pollens. In perennial allergic rhinitis the symptoms continue all year round and usually relate to indoor allergens including house dust mites, pets or moulds.
The symptoms of hay fever include:
Itchy eyes and/or throat
Sneezing, and a blocked or runny nose
Watering, red eyes (allergic conjunctivitis)
Headaches and blocked sinuses
Shortness of breath
The sensation of mucus running down the back of the throat, called â€˜post-nasal dripâ€™
All of these symptoms may become more severe when the pollen count is high.
Treatments and self care tips
While treatments prescribed for allergy can control the symptoms and reactions of hay fever, they do not cure it.
The most common allergy medication are antihistamines, which are available from a pharmacy without prescription. These can be used on their own for mild hay fever or in combination with an intranasal steroid spray for moderate to severe symptoms.
There are other ways you can advise your customers to manage their hay fever, many of which involve avoiding the allergen triggers in the first place. These include:
Using a barrier product inside the nostrils, which may help trap pollen before it has a chance to enter the airway
Keeping an eye on daily pollen forecasts daily and staying indoors when the pollen count is high
Washing hair and clothes after being outside on high pollen count days, and avoiding line drying clothes outside
Keeping windows closed at home and in the workplace when the pollen count is high
Wearing sunglasses outside, and keeping car windows up when driving on high pollen count days
Hay fever calendar
Mild weather conditions in the UK mean that people living with hay fever may experience symptoms much earlier than they used to, according to Allergy UK. Tree pollen starts at the beginning of the year, followed by grass pollen which affects the majority of people with hay fever, and weed pollen later in the year.
Tree pollenÂ Â Â Â Â Â Â Â Â Â Â Â Â February to June
Grass pollen Â Â Â Â Â Â Â Â Â Â Â May to July
Weed pollenÂ Â Â Â Â Â Â Â Â Â Â Â June to September Â
Â Â Â Â Â Â Â Â Â Â Â
-Ends-Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Word count: 2000 Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 25.03.19
This module busts the myths surrounding diarrhoea treatments and explores the products available OTC so you can recommend the right treatment.
Upgrade your contraceptive consultations by exploring the interactive pack to learn about a daily oral contraceptive pill
Record my learning outcomes
Inspiring stories related to health, fitness and the pursuit of wellbeing
Pain conversations - making effective recommendations
Explore our detailed case studies to help understand how to advise customers on different causes of pain.
19 Min Module
Relief from the nasal symptoms of allergy
With NHS England advising that OTC products should no longer be prescribed to treat mild-to-moderate hayfever, pharmacy’s role in supporting sufferers is more important than ever. This module includes self-care advice and product recommendations to aid customer conversations.
900 Min Module