Whether it's gluten
, dairy or any other substance that you're allergic to or intolerant of
, you need to know which foods contain the offending substance, for the sake of your safety and sanity. But labels warning that a food "may" contain the allergen, rather than definitively stating that it does, can be frustrating, confusing and dangerously tempting to ignore.
Voluntary advisory labels on packaged foods, such as "May contain traces of..." or "Manufactured in a facility which also processes..." have increased recently, with one study finding these now appear on more than half of all packaged foods in Australian supermarkets. Not surprisingly this is causing some confusion.
Mandatory and voluntary labelling
It's mandatory for peanuts, tree nuts, milk, eggs, sesame seeds, fish, shellfish, soy, wheat, royal jelly and sulphites (more than 10mg/kg) to be listed as allergens on food packaging if they are included as an ingredient.
However, voluntary advisory labels can also be placed on packaging by manufacturers to warn that there may be accidental cross-contamination of the food by allergens during processing of the food. For example, a chocolate bar may not contain nuts, but if it's made in a factory that makes other foods with nuts, there's a risk that tiny traces or even a fragment of nut may contaminate the bar.
As there's no standard wording, font or style specified, manufacturers use whatever wording they like - making the huge variety of so-called precautionary warnings confusing for consumers (see our other reports on food labelling).
How real is the risk?
It's impossible to know, but Murdoch Children's Research Institute (MCRI) in Melbourne found 90% of the top five foods at risk of contamination – chocolates, breakfast cereals, muesli bars and savoury and sweet biscuits – now carry some form of precautionary statement.
However, when tested, only seven per cent of these high-risk products with warning statements about peanuts actually had detectable levels of the nut. Other samples that had precautionary labelling for hazelnut, milk, egg, soy or lupin had no detectable level of those allergens present at all.
More than 50% of packaged processed foods in Australian supermarkets now show these precautionary warnings, and a study by the MCRI found that people with allergies have little idea whether the food really might be contaminated, or whether the manufacturer has just put the warning on to cover against legal action if someone does get sick from cross-contamination.
The MCRI study, which included parents of children with a history of anaphylaxis, found that 80% of those parents did not know if a food with a precautionary warning is safe, irrespective of the wording. Only five per cent felt they could "completely trust" food labels and tended to ignore warnings because they perceived them simply as a way for food manufacturers to cover themselves legally.
"We have no data on how many people who ignore labels suffer anaphylactic events, and we're planning to do a national study," says Professor Katie Allen, lead researcher from MCRI in Melbourne. "At this stage we think it's more likely that the increase in anaphylactic hospitalisations is due to the increase in allergies, but the problem with the current labelling system is that the 'may contain' statements transfer the assessment of risk of contamination from manufacturers to consumers."
As a result it's up to the consumer to decide, with no real information, whether to take the risk of eating a food, and people with serious allergies are left with a diminished choice of products they can consume with complete confidence.
To eat or not to eat...
It all comes down to a personal assessment of risk with the help of your doctor, Dr Rob Loblay, allergy unit director at the Department of Clinical Immunology, RPA Hospital, Sydney says. "Some people will find a food with a warning hasn't affected them in the past and doesn't affect them now and they continue to eat the food – others won't feel confident to take the risk.
"Despite the concerns of many people with coeliac disease, most can tolerate 20 parts per million of gluten, so occasional trace amounts aren’t such a huge issue," he says. "But for those allergic to nuts, a fragment – a quarter of a peanut – in a food can be life-threatening."
Some brands of chocolate that don’t list nuts can have nut traces, so Loblay advises anyone with a nut allergy to be wary of eating chocolates labelled ‘may contain nuts’ and only buy those labelled ‘nut free’. He says stringent avoidance of nuts may give children the best chance of growing out of their allergy.
People with certain severe allergies need to take ‘may contain’ messages very seriously, and call the manufacturer for advice if unsure. Checking the label every time in case the formulation changes is also essential, as this comment from website The Conversation shows:
"I recently had a nasty reaction to Cadbury chocolate biscuits. It was only after getting stabilised that I found a tiny circle on the front of the package saying ‘new allergen information’. The back of the package indicated that the biscuits, formerly labelled as ‘may contain traces of nuts’, were now made with hazelnut paste as a major component of the recipe.
"I spoke with Cadbury, whose attitude appeared to suggest that because they’d previously mentioned ‘may contain’ etc., I shouldn't have been surprised at the major change in recipe."
Going gluten free
According to Annabel Mackenzie from Coeliac Australia, people with coeliac disease could rely on certain Cadbury products as being gluten-free up until the company changed hands and ‘may contain gluten’ began appearing on products.
Cadbury didn't return CHOICE's calls, but according to a consumer's Facebook post, the company said they hadn't changed the formulation or the production methods. However, they were unable to guarantee that products would be free of gluten cross-contamination.
This raises the question: was there a risk of contamination previously, but no warning? Or is the risk still low and is the company’s simply putting out a standard statement to reduce potential lawsuits?
Experts call for clear labelling
"Labelling is also a big issue," says Dr Loblay. "It's easy for people to miss allergen information, and they often only find it after a reaction when they go back and look at the packet. The print is too small and hard for older people to read, and packaging can sometimes fold over, obscuring the warning.
"I'd like to see a recognisable standard health information panel on all packaging that is separate to the ingredients list and contains allergen warnings, additives and health claims. That way, everyone knows where to look."
The VITAL Solution
If many foods with warnings don't actually have allergen contamination, then why are manufacturers using unnecessary warnings.
"Allergens were not on the radar of manufacturers last century, but after mandatory allergen labelling began in 2002, most big manufacturers cleaned up their act," says Dr Rob Loblay. "However, avoiding all cross-contamination in a factory that makes different products requires a lot of time and investment - and in some cases, building separate facilities. In the small Australian market, this may not be cost-effective."
The good news is that there is a solution to this label confusion. The bad news is that it's not being widely used.
VITAL (Voluntary Incidental Trace Allergen Labelling) is a process to assess cross-contamination risk. Developed by food manufacturers, the industry group Allergen Bureau, NSW Food Authority and allergy support groups, it estimates the risk of cross-contamination in a factory and can tell if a product will be safe for 90% of people.
Under VITAL, a ‘may be present’ warning should only be placed on packaging by a manufacturer if the risk of contamination is assessed to be above a certain level.
It's a great idea but...
While VITAL can provide consumers with clarity around risk levels, there’s currently no way for people to know whether a product has been through the VITAL risk assessment or whether the manufacturer is adding the warning just in case.
"VITAL has been useful for raising awareness of cross-contamination among manufacturers," says Professor Katie Allen. "Food makers can tell via VITAL that the food would be safe to eat for about 90% of people with allergies, but because they can’t be 100% sure it’s safe for everyone, they're too scared to label it as safe.
"If they said something like ‘highly unlikely to contain nuts’, it would be much more useful."
Research from MCRI in 2012 also found that only 12.7% of foods with precautionary labels surveyed had been through the VITAL process, which means the other 87.3% of warnings are likely to be placed on products as an insurance policy for the manufacturer.
Would a VITAL logo work?
One option could be that manufacturers whose products have been put through the VITAL process would carry a VITAL logo so consumers could be confident that the risk had been assessed. Some allergen labelling advocacy groups would also like the VITAL process to be made mandatory for all food manufacturers, in order to reduce the number of unnecessary precautionary warnings.
"The idea is that VITAL can define the level below which 90% of people will not have an allergic reaction," says Dr Loblay. "VITAL may be useful to prevent acute anaphylaxis, but traces can still be a problem for the most sensitive people who must avoid all contact."
He prefers a harder line: "Food companies should be forced to use ‘may be contaminated with’ rather than the less confronting ‘may contain’. This would spur the food industry to put more effort into developing allergen-free foods, which would make it easier for consumers to trust the labels."
Better industry education
Maria Said from Allergy & Anaphylaxis Australia applauds the efforts of the Allergen Bureau and the food industry to improve labelling, but explains VITAL is still a work in progress to make warnings more believable for consumers.
The big players in the food industry are making an effort, Said says, but it’s the resource-poor smaller businesses that need more information and support from Food Standards Australia and New Zealand about how to label their products correctly.
"While a ‘may contain’ label may be less than perfect, a product with no precautionary label can be more dangerous if the manufacturer isn’t educated about the risks of cross-contamination."
"Food labelling in Australia has made great strides and is leading the world," says Said. "But the danger for people at risk of anaphylaxis lies less with labelling than with the food service industry, schools, and in private homes, where poor communication and/or lack of understanding of the risks can lead to severe and, sometimes fatal, reactions. "In 2012, an eight-year-old girl with a milk allergy died when given a piece of cake that she was told contained no milk."
Said also cites an incident in NSW where a man with a milk allergy was served a meal with cheese. He asked for a replacement dish containing no milk products, but was allegedly served the same dish again, suffered anaphylactic shock and was hospitalised.
Many people in the food service industry don't understand that when a customer says they have an allergy, it is illegal to serve them food containing allergens.
"State health authorities responsible for enforcing Food Standards regulations are overloaded, and the council inspectors who investigate events often aren't trained to investigate food allergy incidents properly," she says.
Said is calling for the food service industry to acknowledge food allergy as a serious safety issue, as well as for a national allergy management education plan.
"Allergic reactions happen all the time. People must report the events to the state food authorities to be investigated. This will help raise awareness of the problem."