Finding a Path to Safety in Food Allergy Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy (2017) / Chapter Skim
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Food allergies typically develop within the first year of life but they can also develop later in life. Eight food groups are considered to be major allergens.
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In addition, food service establishments are not required to list food allergens, so an individual's safety depends on clear communication and on employees' knowledge of the allergen content of the food being served and on the establishment's management practices. Even with the most stringent management practices, accidents, such as cross-contact events, can still occur when people with a food allergy eat outside of the home.
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4. What steps can be taken to educate providers and the public in order to create safe environments for food allergic children both within and outside the home?
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The recommendations in this report focus on IgEmediated food allergies, which have better defined underlying cellular mechanisms and physiological reactions. Other food-related diseases, such as celiac disease, food intolerances (e.g., lactose intolerance)
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They also refer to mandatory and voluntary labeling of food allergens and to recall procedures followed when a product is contaminated with a food allergen. Cultural and societal practices refer to the particular diets and foods of regions and countries.
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is a feasible option to systemati cally examine the prevalence of food allergy by collecting data on 1 Oral food challenge is a feeding test that involves gradual, medically supervised ingestion of increasingly larger doses of the food being tested as a possible food allergen. The test is positive when the individual experiences food allergy symptoms, such as skin, respiratory, and gastrointestinal reactions.
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FIGURE S-2 Roadmap to food allergy safety in six actions.
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as an important group, are included in Chapter 3. Use Proper Diagnostic Methods and Provide Evidence-Based Health Care No simple diagnostic tests exist for food allergy, and the selection and interpretation of tests depend upon the nature of the disorder and the individual medical history.
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The hypothesis proposes that the practice of delaying the introduction of allergens may have contributed to the presumptive rise in food allergy prevalence. The committee recommends that public health authorities and clin ical practice guidelines include consistent, clear, and evidence-based advice for families and health care providers, including dietitians, about the potential benefits of introducing allergenic foods (e.g., peanut products, egg, dairy, and wheat)
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To plan for this campaign and develop media programs, public health authorities could con duct formative research with all potential audiences. The committee recommends that public health authorities, such as the National Institutes of Health and the World Health Orga nization, and professional organizations, such as the American Academy of Pediatrics; the American Academy of Allergy, Asthma & Immunology; American Academy of Family Physicians; and the Academy of Nutrition and Dietetics, regularly update guidelines on diagnosis, prevention, and management of food allergy based on strong scientific evidence, as emerging scientific data become available.
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C This includes identifying food allergies as well as man aging and treating them in various settings (e.g., home, school, restaurants) , as well as emergency management of anaphylaxis.
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Training Food Industry Personnel The committee found deficiencies in the knowledge of food industry personnel, including poor communication within the establishment, staff failure to prevent cross-contact, and lack of knowledge about hidden ingredients. The committee recommends that food industry leaders provide the necessary resources for integrating food allergy training (e.g., food allergen identification and preventive controls, effective risk com munication with customers)
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labeling policies are not effective in informing consumers about the risks from food allergens. In terms of voluntary labeling, unintentional allergens at levels that could cause a reaction can be identified on the labels of packaged foods using precautionary allergen labels (PALs)
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to establish Reference Doses. The FDA and the USDA should review the Reference Doses periodically, with particular attention to the remaining tree nuts for which data to establish Reference Doses are not currently avail able (i.e., almond, Brazil nut, macadamia nut, and pine nut)
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Guidance on effective approaches to inform consumers with food allergens in food service establishments could include menu designations of allergens and posters, and other forms of displaying information about food allergens in food establishments. The CDC Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs (the CDC Food Allergy Guidelines)
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convene a special task force that includes participants from the medical community, food companies, and advocacy stakeholder groups to establish and implement policy guidelines to: • Assure emergency epinephrine capabilities are in place for chil dren and adults in public venues, including schools, early care and education facilities, and on-board airlines; • Provide standardized food allergy and anaphylaxis first aid training (e.g., identification of major food allergens, signs and symptoms of allergic reactions, and emergency treatment pro tocols) to appropriate school and university health staff, early care and education providers, and on-board flight crews; and • Implement education standards for responding to and man aging food allergy emergencies in schools and early care and education facilities (e.g., CDC Food Allergy Guidelines)
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The committee envisions that this report will reach many stakeholders, including consumers, patients, health care providers, school leaders, food manufacturers, and food establishment managers, and serve as guidance for future understanding and management of food allergies. The committee also has confidence that the recommendations in this report, if implemented, will stimulate progress in the understanding of food allergies, reduce further uptakes in prevalence, and improve the quality of life of those with this chronic disease and their caregivers.
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