Beyond the Label: Insights into Allergens for Food Businesses

Abstract

Allergens and sensitivities affect millions worldwide, yet misconceptions about food allergies persist. From historical discoveries to modern challenges in allergen management, Stella Holt explores what food businesses need to understand about allergens to ensure safety, respect, and transparency for every customer.

‘No one had allergies when I was a child!’

Coming from Greek, the term ‘allergy’ was first coined in 1906, by Austrian Paediatrician, Clemens Peter Pirquet von Cesenatico. ‘Allos’ meaning ‘other’ or ‘altered’, and ‘Ergos’ meaning ‘reaction’, led to the term we know today, but the understanding of it is very different. There are references to the symptoms of hay fever in a book published in Paris 1564. There are also historical records of ancient Romans, Greeks, and Egyptians suffering skin rashes and respiratory problems they had attributed to certain substances, though none of them can be either proven or disproved.

In 1819, Dr John Bostock at St Thomas's Hospital in London, UK, first linked ‘summer catarrh’ to flowering plants and pollen. From there research took place and we now know that it can be much worse than a ‘summer cold’ to which our parents and grandparents referred, and there are many substances known to cause allergic reactions in those who are sensitised.

An allergy is an unexpected reaction to a substance by the immune system. If everyone had the same reaction to the same substance, it would be called a poison.

The initial reaction occurs only after a person has been sensitised to the substance—that is, when the immune system tags the substance as an invader and responds to it upon subsequent exposure. The reactions range from mild symptoms such as sneezing, slight itching, or vomiting, to severe reactions including asthma, hives (swollen, reddened, and itchy patches of skin), difficulty swallowing, swelling of the mouth, throat, and airways, a drop in blood pressure, collapse, and even death.

An allergen is the substance which causes the allergic reaction and is most often the protein element.

Around the world there are varying lists of foods that must be declared by food businesses, with 9 in the USA, 14 in the UK and EU, 10 in Australia, and 29 in Japan.

Bearing in mind that it is the protein that is responsible for causing the reaction, it is important to understand that these often go by different names. For instance, someone following the Six Food

Elimination Diet under hospital supervision may be given a long list of alternative names to look for in the ingredient lists of bought foods. A few examples include Sodium Caseinate (from milk), Lecithin/E322 (from egg or soya), Lysozyme/E1105 (from egg or soya), and Hydrolysed Whey Protein (from milk). Peanuts may also be known as Groundnuts, Monkey-nuts, Goober pea, or Cacahuete. Some people are unaware that Edamame and Soya are the same thing, or that Tofu is Soya.

Recently, a customer asked if a cookie contained sesame and was told, ‘No, it just has tahini in it.’ This response might leave someone speechless. It can be quite astounding that chefs do not always know their ingredients, because of scientific names or chemical compound terms in

ingredient lists.

One comment that we often hear is, ‘A little bit won’t hurt’, or ‘It's only a little bit, just try it, it won’t kill you’.

The Food and Agriculture Organisation of the United Nations and the World Health Organisation, and more recently, the Food Standards Agency (FSA) UK, have been in discussion about thresholds for Eliciting Doses of allergens, these range from ED01-ED05^{(3, 4)}. FAO/WHO Establishes Recommended Threshold Values for Allergens in Foods.

These recommended thresholds may be incorporated or approved into the CODEX standards, specifically for PAL (Precautionary Allergen Labelling), commonly known as ‘May Contain’ labelling. What this will mean in practice, however, remains to be seen. Kill or cure?

The medicine spoon above contains one gram of salt (Image 1).

One gram is equal to one million micrograms or 1000 milligrams. All medicine is measured in either milligrams or micrograms, and we know that other therapies, such as homeopathy, Bach Flower Remedies, and more, treat maladies with minute amounts of substances. A small pill containing just 25 micrograms of thyroid medication (Image 2) can sustain a patient for an entire day, despite its tiny size. To put this in perspective, one gram of salt is equivalent in weight to the active ingredient in 40,000 of these pills. Similarly, Losartan, a medication commonly used to treat high blood pressure, is usually taken in 50-milligram doses, meaning that a single gram could represent 200 doses—enough to benefit many patients.

For individuals with food hypersensitivity (FHS), this illustrates the importance of knowing their specific trigger thresholds. Unfortunately, there is currently no way for an FHS individual to reliably determine their exact threshold, or ‘eliciting dose’ (ED), on any given day. Allergic reactions can vary based on things such as combination with other food, environmental substances, stress levels, illness, exercise, as well as knowing what their trigger is initially. Life for the Food Hypersensitive person is literally like walking through a minefield moment by moment.

According to Allergy UK, there are around 2,000,000 people in the UK who are diagnosed with food allergies. Then there are those with Coeliac disease, EGIDs, Diabetes, etc. who all need to be careful with their food, making it an estimated 20% to 40% of the population.

That's a very significant number of people, and Allergy UK predict that 1 in 2 people will have at least one food allergy by 2026.

All chefs and cooks are well aware of the ingredients in their dishes. They understand how to store foods in sealed, labelled containers and use separate equipment to maintain basic food hygiene. So why allergen management remains such a huge challenge is, frankly, baffling. Whilst we have our list of 14 notifiable allergens, we must acknowledge that anyone may be allergic to anything. Having a list does not mean it is exclusive.

When EU Regulation No 1169/2011 came into effect in December 2014⁽¹⁾, several high-profile chefs caused a stir, protesting about ‘not giving away their recipes.’ But restaurant diners aren’t after the recipes—they simply want to know what ingredients are in their food. What they expect is honesty, transparency, and respect. From the initial contact, whether that be on the phone, via a website, or by email, through to the plate of food on the table, it is essential the customer can be confident that the business knows what they are doing. Reception staff and pot-wash are just as important as the chef preparing the meal, or the business owner. Everyone needs to know what the ingredients are, how to keep them separate, how to have a conversation with the customer. Life with food allergies is stressful and frightening, the last thing a customer needs is to be made to feel unwelcome, a nuisance, or that they are ‘making it up’. FHS customers are, literally, putting their lives in your hands.

When food businesses take their responsibility to produce safe food for everyone seriously, and make sure they are legally compliant regarding allergen management, there really should be no problems catering for the FHS diner.

There are laws in place about allergen and nutritional information, for all food businesses. There is a higher, and growing, demand for ‘Free-From’ foods due to the ever-increasing numbers of people with food allergies. We know that food manufacturers often have things go wrong, this is evident by the number of recalls reported from the FSA. Whether for allergens present, allergens not declared, or products incorrectly packaged, there have been 43 allergy alerts, plus 8 updates, implicating 185 products for England and Wales between 1st January and 23rd September 2024⁽²⁾. This tells us that something is wrong, and that food manufacturing needs more support, training and monitoring.

The thing that is really hard to accept is that many food businesses expect the FHS diner to accept substandard items or give only one option on the menu that is suitable. There have been numerous instances where a restaurant offers a fruit salad as the only alternative dessert or defaults to a chocolate brownie as the gluten-free option. This approach feels like a token gesture—lacking real choice and thoughtfulness. Eating out can almost be like your mother telling you as a child, ‘You have 2 choices, take it, or leave it’. If the only ‘choice’ is to ‘leave it’, it could cost the business dearly.

In today's world of social media, reputations are quickly made or broken—provide a poor experience, and word spreads fast; offer a positive one, and the buzz resonates just as strongly within the allergy community. One business owner was heard to say, ‘That's OK for someone who needs gluten-free, but I wouldn’t serve it to everyone else, it's horrible.’ Why would anyone be happy to serve something that they consider as being ‘horrible’ to any customer?

To refer to my opening statement, ‘No-one had allergies when I was a child’. Wrong! Yes, people did have allergies when you were a child. It was probably dismissed as ‘a summer cold’ or ‘a rash.’ When someone passed away from anaphylaxis, it was often attributed to ‘natural causes.

Now we are better educated. There has been, and continues to be research, discussion, discoveries, and developments in testing and treatments.