Food allergy: human impact and forensic implications · 2020-02-09 · ©Allergy Action 2020...
Transcript of Food allergy: human impact and forensic implications · 2020-02-09 · ©Allergy Action 2020...
©Allergy Action 2020 Dungannon 101020
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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