FCAAIA Notes: Precautionary food labeling (PAL) does not apply to foods that are intended to contain a known common food allergen. The vast majority of packaged foods  with PAL do not contain food allergens. But, a small percent do and some of those may accidentally contain enough to trigger a reaction in the most sensitive patients.  And, the specific wording of the PAL does not identify foods most or least likely to be contaminated.

So, what should you do? It depends on the advice your allergist gives you and your level of comfort.  Many studies have shown the impact that food allergy has on quality of life.  Should we make it worse by avoiding EVERYTHING with a PAL? Maybe not. Of course, if you have ever reacted to a packaged food accidently cross-contaminated you should then avoid them all.

(Source: http://www.medscape.com/viewarticle/871402?nlid=110513_3821&src=WNL_mdplsfeat_161108_mscpedit_aimm&uac=112079PK&spon=38&impID=1230603&faf=1 Nov. 8, 2016. For Medscape articles: User name: FCAAIA, Password: Allergies)

Misperceptions about precautionary allergen labeling (PAL) influence purchasing practices of consumers with food allergies, a study has shown.

“Almost half of allergic individuals or parents of allergic children in both the United States and  Canada believe that these labels are required by law, with up to 40% purchasing food with PAL,” Mary Jane Marchisotto, MBA, from Food Allergy Research and Education Inc (FARE), McLean, Virginia, and colleagues report in an article published in the Journal of Allergy and Clinical Immunology.

The findings demonstrate the challenges faced by people with food allergies and caregivers of food-allergic children in deciding the safety of food products. The results also highlight the role physicians can play in educating patients and families about the laws and practices surrounding PAL to minimize unnecessary risk for allergen exposure, the authors write.

When an allergen or allergen-containing ingredient is deliberately added to a food, mandatory declaration on the label is required by law.

In contrast, precautionary statements are made by food manufacturers and importers on a voluntary basis to inform consumers of the possibility of the inadvertent presence of allergens, as in the case of cross-contamination of manufacturing equipment. Such statements are not required by law, however, nor are there regulations stipulating the wording and location of them on the labels when they are used, which contributes to inconsistency in consumer interpretation and understanding, the authors write. Examples of PAL statements include “manufactured in a facility that also processes allergen” or “may contain allergen.”

To examine the influence of food labeling on purchasing habits, consumer knowledge of allergen thresholds for PAL, and opinions on thresholds and food choices, the investigators surveyed 6684 individuals from the United States and Canada who were caregivers of a food-allergic child (84.3%) or who themselves had a food allergy (22.4%). They used a survey developed by FARE for the US Food and Drug Administration, which also included questions about allergy prevalence, reaction severity, and diagnosis.

Of the respondents, 29.0% were unaware that the names of major food allergens were legally required to be reported on labels, whereas nearly 46% either were unsure (16.9%) or incorrectly believed (28.8%) that PAL is required by law, and nearly 37% were unsure (28.2%) or incorrectly believed (8.5%) that the inclusion on labels is based on the amount of allergen present, the authors report.

Further, the wording of PAL statements appears to influence consumer buying practices. Specifically, 74.8% of respondents reported that they would buy foods labeled with “good manufacturing practices used to segregate ingredients in a facility that also processes allergen,” whereas 40.3%, 16.7%, and 12.3%, respectively, reported buying foods with labels stating, “manufactured in a facility that also processes allergen,” “manufactured on shared equipment with products containing allergen,” and “may contain allergen.”

Multiple logistic regression models examining adjusted associations between outcomes and respondent characteristics revealed the following significant associations:

  • The odds of purchasing foods with vs without PAL were significantly lower among participants with a history of severe allergic reaction (odds ratio [OR], 0.69; P < .05) and were significantly higher among participants with peanut allergy (OR, 1.59; P < .01).
  • Parents of children with food allergy were less likely than other respondents to buy food labeled with “may contain allergen” (OR, 0.69; P < .01).
  • Respondents with food allergy themselves were more likely than other respondents to buy foods with PAL (OR, 1.56; P< .01).
  • Respondents with more than one food-allergic person in their home were less likely than other respondents to purchase food with any type of PAL (OR, 0.6; P < .01).
  • The likelihood of purchasing foods labeled “manufactured in a facility that also processes allergen” was greater among individuals who had been diagnosed with food allergy for more than 10 years (OR, 1.30; P < .01).
  • Canadians were more likely than Americans to buy foods that used “may contain allergen” and less likely to buy products that used other forms of PAL (OR, 2.42; P < .01).

The high prevalence of consumer misconceptions and confusion around PAL points to the need for usage and language standardization “to help consumers make informed food choices,” which would remove the burden of evaluating risk from patients and caregivers, the authors write. “However, until this is in place, it is critical that the physicians counsel families with food allergy on PAL.” Such guidance should stress the importance of reading labels and emphasize that PAL is not required by law in the United States and Canada, nor is it determined by the amount of allergen present, they note.

“By providing such anticipatory guidance, physicians can help patients and their families better understand their food choices so that they can make better informed health decisions regarding the management of their food allergy.”

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