food allergy: human impact and forensic implications · 2020-02-09 · ©allergy action 2020...

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Food allergy: human impact and forensic implications

February 10th, 2020

Hazel Gowland BA, PGCE, PhD, MREHIS, FIFST, FRSPH

©Allergy Action 2020 Dungannon 101020

Disclosures

Visiting Fellow University of Southampton and Lecturer on MSc Allergy

Imperial College Lecturer on MSc Allergy

Member of Register of Experts – Food Standards Agency

Food Special Interest Group member - RSPH

Safefood Food Safety Knowledge Network Expert

Scientific Committee Member – IFST

EAACI Task Force Member – Adolescents and young adults

Joint Award in Allergy Awareness with REHIS – training qualification

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Hazel Gowland: Allergy Action

Advocacy

Early peanut& nut allergy

1994 Anaphylaxis Campaign

Policy shapingRegulators

Caterers Schools

HospitalsPrisons

Research

Consumer behaviour

Fatal anaphylaxis

Regulation

Clinical studies

Training

EHOs TSOsPublic analysts

CliniciansScientists

UndergraduatesPostgraduates

ManufacturersSuppliersRetailersCaterers

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Food allergy in the news

Watchdog

Panorama

ITV News

Disruptors

Labelling

Prosecutions

Natasha’s Law

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What is changing?

• Prevalence of different food allergies?

• Understanding reaction severity

• Landmark fatal reactions

• Lessons learned• Changing purchasing

behaviour• Legislation used• Enforcement activity• Consumer expectations• Social media

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Help staff to understand food avoidance

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Food Allergy: What are the risks?

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Action and Treatment Symptoms can be unpredictable and may change throughout life

Adrenaline auto-injectors • Epipen • Jext• Emerade

Given in the thighCall 999

• Anaphylaxis• Difficulty breathing • Faint or floppy

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Hospital admissions increase

Turner, P.J., Gowland, M.H., Sharma, V., Ierodiakonou, D., Harper, N., Garcez, T., Pumphrey, R., Boyle, R.J. (2014). Increase in anaphylaxis-related hospitalization but no increase in fatalities: An analysis of United Kingdom national anaphylaxis data, 1992-2012. Journal of Allergy and Clinical Immunology, 135 (4), pp. 956–963

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Prevention by early dietary interventionBabies who are likely to develop food allergy

Exposure without eating eg via eczema broken skin

can sensitise

Exposure by early consumption – regularly eating the food allergen

can protect

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Immunotherapy with foodSupervised consumption of the food allergen

Start well broken down by cookingEg Milk in biscuit

Then increasingly intactEg Fromage frais

• Doesn’t work for all• Side effects • Life-long consumption?

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Immunotherapy with pharmaPharmaceutical products being developed

Calibrated increasing doses of peanut flour in capsules for consumption • May not work for all• Side effects – GI?• Life-long consumption?

Drops under tongue

Skin patches for peanut and other foods

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Fatal cases: 1988 - 2019

Fatal allergic reactions to foods

237 cases

Gender: Male 110 Female 120 Not known 7

Age: 5 months to 88 years

Average age: 23 years

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Young people: tragic circumstances.Milk in yogurt used to bind meat in a doner kebab

Unlabelled sesame in the dough of a baguette

Peanut present in Indian food requested nut free

2cm x 2cm piece of cheese down back of shirt in school break

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UK: Fatal reactions to foods 2003-2018

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What are the risks to businesses supplying food?

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Amy May Shead

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Avoiding food allergensKnowing what EXACTLY to avoid

Knowing where it is used

Reading labels

Talking to staff

Finding substitutes

Looking up online

Being ready to manage symptoms

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Labelling – changing behaviourMore food is sold online and through third party businesses

Consumers still need to know:• Ingredients• #14allergens• Other #allergens• #Maycontain

Law• Food Safety• Food Standards• Health and Safety

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#14allergens

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EU Food Information Regulation 1169/2011 #14 allergens on packets and in catering

Food safety law • food sold must be what people ask for• food sold must be safe (including suitable for people with

health sensitivities)

Other protection• Health and Safety at Work• Civil claims• Negligence

Voluntary best practice

Regulation

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Beyond #14 allergens

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UK Prosecutions January 2014 – end January 2020 by allergen

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UK Prosecutions January 2014 – end January 2020 - Food supplied

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Controlling allergen risksGood handwashingDelivery checking

Managing ingredient information Communicating ‘may contain’

Allergen segregation by:• Time• Space• Covering / wrapping• Cleaning

Maintaining dishwasher• Pre-rinsing• Temperature• Correct product

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May contain – where did this risk arise?

Factory FoodserviceField

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How much is too much?

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Thresholds and severity

Affected by

• Asthma• Eczema• Medication• Infection• Exercise• Stress• Lack of sleep• Age• Alcohol• Hormones eg PMT

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Life skills for young adults• Recognise symptoms• They may change over

time• Never go off on your own• Always tell / take a friend• Carry AAIs all the time• Download on your phone• Obtain trainer AAIs -

practice with friends and family

• 2nd AAI in other leg• Don’t stand up. Roll on

floor

https://www.resus.org.uk/anaphylaxis/emergency-treatment-of-anaphylactic-reactions/

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Self care challenges• Asthma management –

prescription costs

• Not carrying AAI even if prescribed

• Unfamiliar with AAI

• Self awareness of vulnerabilities eg PMT, infection

• Posture

• 2nd pen in other leg

• Alcohol, drugs?

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Social challenges• Need for peer support –

confident competent friend

• Denial of risk

• Breaking own avoidance rules

• Other lifestyle choice – eg vegetarian

• Emergency management

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Key message for both consumers and businesses

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ALLERGY ACTION allergytraining.com

Hazel Gowland BA, PGCE, PhD, MREHIS, FIFST, FRSPH

@AllergyAction

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