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FOOD ALLERGY & INTOLERANCE - thenacc.co.uk Talk - CHChan June 2017.pdf · Food Allergy Research...
Transcript of FOOD ALLERGY & INTOLERANCE - thenacc.co.uk Talk - CHChan June 2017.pdf · Food Allergy Research...
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FOOD ALLERGY & INTOLERANCE
21/06/2017
Dr Chun-Han Chan
SCIENCE, EVIDENCE & POLICY
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• Food is safe
• Food is what it say it is
• Consumers can make
informed choices about
what to eat
• Consumers have access
to an affordable healthy
diet, now and in the future
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Paul Tossell
(Team Leader)
Chun-Han Chan (Policy, Risk
Assessment & Allergen Thresholds)
Ned Mazhar (Policy& Risk Assessment)
Vacancy
(FAIR Programme Manager)
Erin Oliver
(Project Officer)
Jesus Alvarez-Pinera
(Project Officer - Home +)
Sarah Quinn
(Project Officer - Home +)
Food Allergy and Intolerance Branch
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What do we do?
• Research
– Clinical studies, risk modelling, analytical methods
• Food allergen labelling legislation
• Development of guidance, training and tools
• Technical advice and support to LA’s
• Risk assessment and Risk management
• Food allergy incidents, novel foods, processing aids
• Expert opinion – working groups, steering
committees, expert witness
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Food hypersensitivity
Food Allergy:
• A repeatable reaction to a food that involves the immune system
• Symptoms can appear within minutes, or up to several hours
after the person has eaten the food they are allergic to
Food intolerance:
• Most do not involve the immune system and are generally not
life-threatening. However, they can make someone feel very ill or
affect their long-term health
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Impact of food allergy
The symptoms can include:
• rashes (usually very itchy)
• tingling sensation in the mouth
• swelling of the lips, tongue, face
and throat
• difficulty breathing
• diarrhoea
• vomiting
• abdominal cramps
• and on rare occasions
anaphylaxis (shock / collapse)
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Coeliac disease – gluten intolerance
• Eating gluten leads to damage to the lining of the gut, which
affects absorption of nutrients
• If diet is not controlled, this can lead to malnutrition, anaemia,
osteoporosis and bowel cancer
• Need to avoid cereals containing gluten – wheat (spelt and
Khorasan), rye, barley and oats
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Food hypersensitivity in the UK
Estimated prevalence of
food intolerance is ~20%
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Food allergy: children and adults
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Food allergy: Misconceptions
• Fussy eaters / It’s a lifestyle choice isn’t it?
• Food allergy isn’t serious….
• They can pick it out / eat around the nuts….
• A little bit won’t harm you….
• If I cook it long enough / heat it up it will be fine…
• They shouldn’t be allowed to eat out if it is that
serious….
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Food Allergy: Reality (management)
• Food allergic reactions can be life threatening
• Condition managed through strict avoidance diet
• Need to obtain food ingredients information to avoid
offending food
• Eating out requires organisation – limited choice
and higher prices
• TRUST in the food business
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Food Allergy: Reality (social)
• Bullying at schools
• Feeling self conscious- don’t want to bring attention
to themselves
• Choice of suitable food options can be limited
especially with multiple food allergies
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Why should you care about food allergy?
• Food allergy is present in a proportion of the population, but
those not affected by the condition should still be aware
because they are:
• Food businesses and food handlers
• Modes of travel providing food e.g. airlines, trains, ships
• School teachers, carers, guardians, – those who have a
duty of care to those vulnerable due to age, mental health
• Friends and family
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FOOD ALLERGY: SCIENCE
Gathering evidence to inform policy
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Food Allergy Research Programme
Investigate causes and mechanisms for food allergy and
intolerance, the key themes are:
• Development of management thresholds for allergenic foods
• Route and timing of exposure to food allergens in Early Life
• Immunological aspects of food allergy
• Prevalence & characteristics of food allergy & intolerance
• Food allergen labelling and consumer choice research
www.food.gov.uk/science/research/allergy-research#toc-2
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FSA Research
• Responds to emerging issues in food allergy
• Funded research which characterised kiwi as a new
and growing food allergy
• Identified the skin as a probable route of exposure
leading to sensitisation
• Supported work to provide robust data to determine
the prevalence of food allergy in the UK.
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Research
• Consumer perceptions of current food allergen
labelling and their value and limitations.
• Forefront of new research which investigates how
the timing of introduction of common allergenic foods
into the infant diet influences the risk of infants
developing food allergy
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New Research: Adult Food Allergy
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Our interest in Adult Food Allergy
• Increasingly aware that levels of AFA is rising
• There is a lack of data to confirm these changes in
AFA, in particular its prevalence
• The foods associated with AFA more diverse
• Allergy-related mortality is said to be higher in adults
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Priority 1: Identify the prevalence of AFA
• There is a lack of good prevalence data
• Small-scale reports vary suggest 2-20%
• The impact of AFA is thus difficult to quantify
• How many adults have food allergies?
• Is this number growing?
• Who is at risk of developing AFA?
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Priority 2: Identify the characteristics of AFA
• Food allergy is very diverse, with multiple conditions
• Differ from the most prevalent childhood forms
• How serious is AFA?
• Which foods are implicated in AFA?
• Is the burden from some chronic, atypical allergic
conditions hidden?
• Is our consumer advice appropriate for these
conditions?
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Priority 3: Understand the immunology of AFA
• Managing AFA will rely on understanding its biology
• A long-term goal would be to control the disease
• Why do people develop AFA?
• Can we prevent AFA?
• Can we help manage or cure AFA?
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Proposed Work Stream
Study of prevalence
Study of characteristics
Understand the
public health impact
Generate interest
Revisit consumer
health advice
Encourage funding into
AFA immunology
Reduced burden on
public health
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FOOD ALLERGY POLICY
Developing evidence based
approaches to regulation
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Allergen legislation: Food information
• EU Food Information for Consumers Regulation No.
1169/2011
• Enforced in UK by Food Information Regulations
(1855/2014 (England))
• Allergenic ingredients information must be provided
• National provision to enable allergen information to be
given orally (needs to be verifiable) for non-prepacked
food
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Annex II Allergens – The Big 14
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What allergen information is provided
• Mandatory
• Declare deliberate use of allergenic ingredients or
processing aids (regardless of level of inclusion):
emphasised within the ingredients list
• Voluntary
• Unintentional presence of allergen in food
(precautionary allergen labelling)
• Absence of an allergen in food (free from claims)
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Allergen legislation: Food Hygiene
• Voluntary food information requirements:
• Not mislead
• To not be ambiguous or confusing
• “May contain” statements - Article 14 (2), (3b) Food
must not be unsafe…information to be provided to
avoid adverse health effect.
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Consequences of failure to comply
• Graduated approach to enforcement
• Failure to provide accurate allergen information can
result in criminal prosecution
• Unlimited fine
• Possible jail sentence
• Potential damage to reputation or brand
• Revoke license to trade
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FSA resources
www.food.gov.uk/allergen-resources
Detailed guidance
Quick start guide
Online training
Posters
Record templates
Signage
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Non-prepacked foods
• Know what allergenic ingredients are used
• Make this information available to your staff and
customers
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ALLERGEN MANAGEMENT
Solid processes for a safe outcome
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Allergens cannot be cooked out to make them safe. You must know what is in what and clean surfaces and equipment until they are visibly clean.
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Tips (1)
• Do you have a recipe? – helps with consistency
and costs
• Check your ingredients – never guess
• Keep a record of allergens in a dish
• Keep up to date record ingredients information
(check invoices, labels)
• Have a prompt in place when new ingredients are
received, let staff know of changes
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Tips (2)
• Decanted ingredients – keep labelling, use clean
containers, label containers
• Placement of allergenic ingredients – fall out
• Utensils – separate spoon for each ingredient pot / jar
– prevent cross contamination
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Tips (3)
• If someone asks for food to be made without an
allergen, check it can be made before you say ‘yes’
• Understand the request and communicate with
kitchen staff appropriately
• If you make food for someone with an allergy, make
sure work surfaces and equipment are thoroughly
cleaned
• Wash hands thoroughly before preparing food
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Beware of garnishes, dressings and sauces
Does it add another
allergen to the dish?
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Challenges within food service
• Cultural differences – understanding the importance
• Language and literacy
• Recording information
• Last minute substitutions
• Communication between kitchen staff and shifts
• Engaging the consumer
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COLLABORATIONS
Increasing out impact
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Shared messaging
Benefits
• Audience sharing via partnerships
• Access to different audiences
• Financially adventitious= Value for money
• Authority (regulatory) and trust (charities)
• Consistency and a powerful message
• Avoids message fatigue
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Patient support groups
• Development of consumer advice and industry guidance
• Allergy awareness messaging / marketing
• Clinical education / training days, seminars and conferences
• Shared research, insight and expertise
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Food Industry and Trade Bodies
• Development of industry guidance and training
• Joint messaging and dissemination
• Sharing of industry data and insight
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Training, best practice guidance
Professional membership organisations
Catering organisations