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Fear of Food


Fear of Food

January 1998 -- Perspectives

By: Andrea Allen
Contributing Editor

  A twenty-something woman, never a big milk-drinker but ever the ice-cream fan, stops for a cone on her way home from work. She knows it's not likely to sit well, and sure enough, by the time she gets home, her stomach is cramping. She has to lie down immediately, but by morning, she's feeling better.

  A thirty-something man who gets away to the shore a few times a year is dining on crab legs, his favorite dish, in his favorite seafood restaurant. On the way back to the hotel, he begins to break out in hives, and within minutes, his throat is constricting. His wife rushes him to the emergency room, where he's given a shot of epinephrine.

  A forty-something woman gives in to temptation at brunch with friends, and orders a bagel, despite her professed wheat allergy. Within an hour, she's exhausted and has to be driven home so she can go back to bed.

  A kindergarten boy is sampling a new breakfast cereal before getting ready for school. A few minutes later he's gasping for air. His pediatrician tells his parents to take their son and meet her at the emergency room -- and to take the cereal box with them so she can see it.

  Well-meaning friends and relatives have advised all of these uncomfortable diners that they are obviously suffering from food allergies. But are they?

  Of the four, only the vacationing man and the kindergarten boy have true food allergies. In the man's case, his adult-onset crab allergy took him by surprise, after years of consuming crab legs with no apparent problems. Had his severe anaphylactic reaction not been treated, it could have been fatal.

  Equally serious was the boy's response to the new cereal. The parents had pored over the ingredient statement looking for peanuts, which they knew their son could not tolerate, but the offending ingredient was not listed. As the doctor explained, however, ingredients from another of the company's cereals could have found their way into that box anyway.

  And the two women? The one indulging in the ice cream cone is most certainly lactose-intolerant, meaning that her body has stopped producing the enzyme lactase, which breaks down the milk sugar lactose. But is she allergic to dairy foods? Probably not.

  As for the woman who ate the bagel, her reaction is a mystery. Several health "experts" and nutritionists have told her that she is allergic to wheat, but her symptoms simply don't meet the criteria to be considered an allergic reaction. Wheat is one of the trendiest of the allergens fingered by self-styled experts these days. But some health and nutrition professionals insist that these types of reactions, to wheat and to other foods, are purely psychosomatic. Others aren't so sure. They agree that certain symptoms can be food-related, but hesitate to label them allergic reactions.

Perception vs. reality

  The woman who can't eat wheat, though, is convinced it's an allergy. And she's not alone. According to the American Academy of Allergy, Asthma, and Immunology, as many as one-third of adult Americans believe they have food allergies.

  In fact, however, fewer than 2 percent of adult Americans do have true food allergies. That figure is higher for children: About 5 percent have allergies -- but these are sometimes outgrown by adulthood. On the other hand, allergies previously undiagnosed can surface in adulthood; just ask the man whose vacation was ruined by the crab legs.

  Even though they affect so few consumers, food-borne allergens have the food industry's undivided attention. In 1996, there were 60 recalls resulting from unlabeled allergens, according to Steve Taylor, Ph.D., who heads the food science and technology department at the University of Nebraska, Lincoln. If that number doesn't seem very high, compare it with 1990 -- when there were no allergen-related recalls. "This is the fastest-growing reason for product recalls," Taylor says.

Heightened awareness

  Why the marked increase? According to Taylor, virtually everyone has become more vigilant in the past few years. "The allergic consumer is being more of an advocate for himself," the U.S. Food and Drug Administration "began to insist on recalls -- even Class I recalls," and the food industry is taking notice as well, he says.

  The increased vigilance is not unwarranted. A food allergy can be a serious condition; untreated, it can be fatal. Statistics are scarce, but according to Taylor, some estimates place the annual number of food-allergy deaths at about 100.

Antibodies go awry

  A true food allergy is really a case of mistaken identity. As described in the Harvard Health Letter, here's how it works: The immune system identifies a harmless substance, most often a protein, as an antigen -- a foreign protein. To fend off the invader, the body produces immunoglobulin E antibodies that, in turn, attach themselves to mast cells in different areas of the body: respiratory tract, lungs, bowels and skin. When the mast cells defend themselves by releasing histamines or leukotrienes, these chemicals trigger the allergy symptoms: vomiting, diarrhea, itching, hives -- even that anaphylactic reaction that can prove fatal.

  Fortunately, food allergens are harmless to most people; some are even quite nutritious. As such, they can hardly be banned from the food supply -- so it's up to the allergic consumer to inspect that ingredient statement thoroughly.

Preventive measures

  It's up to the food industry, however, to ensure that this will be enough. And so far, it's not. "Companies still don't have [the presence of unlabeled allergens] under control," Taylor says. "They don't have the scientific methodologies to bring it under control."

  By that, Taylor means that allergen-specific testing methods are either yet to be developed or not yet available for commercial use, depending on the allergen. Even so, manufacturers can do much to prevent cross-contamination in the first place. And that's a subject that's received plenty of attention at trade shows and in boardrooms throughout the industry lately.

  Few companies can afford separate processing and packaging lines for every single product and every single flavor and variety. That makes old-fashioned GMPs (Good Manufacturing Practices) and cleaning procedures for shared equipment especially crucial in preventing unlabeled allergens from sneaking into the package.

  As self-evident as that may be, it's not as easy as it sounds. The Institute of Food Technologists devoted an entire symposium to the subject at its annual meeting last June, in which speaker after speaker identified the challenges of keeping unlabeled allergens out of the food supply.

  "All of us live in a world of doing more with less," said Fred Hegele, director of quality assurance at General Mills. "The pressures of productivity improvement, speed to market, maximum flexibility, superior customer service, etc., require an extraordinary commitment by senior management and all employees.

A top priority

  "To add a new priority like food allergens to our plate, a high degree of awareness and commitment tantamount to crisis management is necessary," Hegele said.

  Even that level of commitment on the part of the manufacturer cannot always ensure that no one else will make a mistake, as Hegele noted. Something as simple as a printer's error, for instance, can mean a whole production run is mislabeled. At the opposite end of the production line, raw ingredients might be intermingled by the supplier -- well before they're delivered to the plant.

  Manufacturers seeking to develop preventive policies, such as General Mills,' can get help from several sources, including industry consultants and trade associations. A good starting point would be the Allergen Prevention Plan, developed by scientists from the National Food Processors Association, General Mills and Campbell Soup. The plan, which was published in the April 1997 Journal of Food Protection, was created to identify potential areas of contamination, and to build a preventive strategy.

  The plan makes numerous recommendations for food manufacturers, including:

  • the development of a cross-functional, allergen-prevention team, similar to teams formed for HACCP (Hazard Analysis Critical Control Points);
  • a system-wide review to evaluate all risks of product contamination;
  • close cooperation between manufacturers and their ingredient suppliers;
  • designing systems to be cleaned thoroughly and to be logistically sound;
  • ensuring correct packaging and labeling; and
  • making sure that employee training addresses each of these areas.
  In addition to making sure their houses are in order, food manufacturers have been vigilant about recalling mislabeled product -- as the increase in allergen-related recalls has shown. Of course, no food manufacturer wants to risk having FDA seize mislabeled product; a voluntary recall is far less costly in terms of both the negative publicity and the expense involved.

Waiting for ELISAs

  But as Taylor points out, improved testing methods are the ultimate answer. At the University of Nebraska's Food Allergy Research and Resource Program, of which Taylor is co-director, researchers are working on immunoassays called ELISAs, or enzyme-linked immunosorbent assays. These can be developed to detect the presence of either proteins from allergenic foods, or specific food allergens.

  Currently, the program has assays for peanut, milk and egg proteins -- the latter being especially suited to identifying egg residue in products such as egg-free pastas. None is commercially available yet, although the researchers do test product samples for manufacturers on a confidential basis.

  There are other ELISAs on the market; these are effective for detecting product adulteration, but are not sensitive enough to detect allergens, according to Sue Hefle, Ph.D., who co-directs the program with Taylor. A few manufacturers have come out with peanut assays, but according to Hefle, "the jury is still out" on these, pending further study.

  The food industry is not about to ignore its responsibility to prevent unlabeled allergens from reaching the food supply through biotechnology, maintains Joyce Nettleton, D.Sc., IFT's director of science communications. "It's in everybody's best interest to make sure that doesn't happen," Nettleton says.

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