When you’re shopping for someone who has a food allergy, a trip to the grocery store is like a police investigation. Each product must be scrutinized. Labels are examined, each ingredient studied.
My 5-year-old son, Alexander, is allergic to almonds and hazelnuts, so my wife and I spend a lot of time trying to decipher food labels. If you miss something, even one word, you risk an allergic reaction.
Although federal law requires manufacturers to include allergen warnings on prepackaged foods, it’s not always clear which products contain allergens and which do not. The regulation doesn’t cover all types of foods, nor instances in which trace amounts of allergens may be present.
This has created a confusing and risky marketplace for my family and millions of others — roughly 8 percent of children have a food allergy. I set out to better understand allergen labeling and the problems consumers face. Here’s what I learned.
It’s easy to tell when certain allergens are present
Congress passed the Food Allergen Labeling and Consumer Protection Act in 2004, a rule book for manufacturers. Companies must place special warnings on prepackaged foods if they were made using certain allergens: milk, eggs, fish, shellfish, peanuts, wheat, soybeans and tree nuts.
If I grab a box of cookies from the store shelf, I might find a special warning printed near the ingredients list — “contains almonds” — because almonds are part of the tree nut family. If I don’t see one, I can be assured that the product wasn’t made using almonds.
But some allergens aren’t on the label
Sesame is the ninth most prevalent food allergy among adults in the United States. But the food was left off the list of major food allergens in the labeling law passed by Congress.
Manufacturers do not have to print a “contains sesame” message. It may even be hidden under “natural flavors” or “spices” on the ingredients label.
“I can’t even trust what’s written on the label anymore,” said Madeline L. Whitney, 18, a freshman at the University of Notre Dame who is allergic to sesame.
One morning this past October, Ms. Whitney ate a protein bar before a statistics exam. She checked the label, which noted “natural flavors” on the list of ingredients — but not sesame.
When Ms. Whitney sat down to take the exam, she started experiencing signs of an anaphylactic reaction. She readied her EpiPen.
“All of the sudden my tongue is just totally swollen and my throat is closing,” said Ms. Whitney. The reaction was so severe that she had to be injected with two doses of epinephrine before recovering at the university’s health clinic.
Stories like Ms. Whitney’s are driving a push by advocacy groups to mandate sesame labeling. The Food and Drug Administration is considering whether to add sesame to the list of major allergens.
“Sesame should be included as one of the top allergens that needs to be disclosed on labels,” said Lisa G. Gable, chief executive of Food Allergy Research & Education, a nonprofit organization based in McLean, Va.
Sesame labeling is already mandated in Canada, the European Union and Australia.
Traces amounts are difficult to track
Here’s where it gets even more complicated. Even if my box of cookies doesn’t include one of the mandated warning labels, the cookies may still contain an allergen.
Let’s say, back at the manufacturer, my cookies were put on the same conveyor belt used for almond cookies. Small bits of almond might have made it into my seemingly almond-free cookies.
This is called cross contact. And there’s no surefire way I can know it happened — the federal government does not require manufacturers to include labeling for possible cross contact of allergens.
As a result, food manufacturers developed their own unregulated labeling practices to alert consumers to potential cross contact. Here’s a sampling from a recent trip to the grocery store:
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Cookies: “May contain peanuts and tree nuts.”
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Chocolate bar: “Manufactured on the same equipment that processes almonds.”
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Bread: “Made in a bakery that may also use tree nuts.”
These short descriptions, often called “precautionary allergen labeling,” may alert consumers to some risks, but because the labels are unregulated, their meanings differ from company to company.
A 2017 study, published in The Journal of Allergy and Clinical Immunology: In Practice showed that consumers make “risk assessments” based on the words used in this kind of labeling.
“We’re making consumers decide, based on the wording of that precautionary allergen label, what seems safe for themselves or their child, and I think that’s a huge issue,” said Dr. Ruchi S. Gupta, a professor of pediatrics at Northwestern Medicine in Chicago and an author of the study.
Serious reactions result from cross contact
My child hasn’t had a reaction from cross contact in prepackaged food, fortunately. But other children certainly have.
“The whole world of food labeling is almost like a foreign language,” said Allison A. Ososkie of Vienna, Va.
Her 2-year-old son, Lincoln, is allergic to egg, milk, peanuts, tree nuts, soy and shellfish. This past spring, he had an anaphylactic reaction to crackers that may have been processed on equipment with milk products.
Anna M. Francis, an acupuncturist in Wheat Ridge, Colo., has a 6-year-old daughter, Penelope, who is allergic to egg, dairy, cashew, pistachio, cherry and blackberry. In 2015, Ms. Francis thought the snack bar she was giving her daughter was safe. She even called the company to ask about its equipment-cleaning process.
“My daughter had a bite and had an anaphylactic reaction,” said Ms. Francis. She wants the government’s regulation to include labeling for possible cross contact of allergens.
Sometimes the labels are just wrong
There’s something else consumers with food allergies have to worry about: incorrect packaging. Sometimes, during the manufacturing process, food made using one of the eight major allergens isn’t properly labeled.
In 2018, about one-third of F.D.A. recalls involved prepackaged foods that were erroneously labeled, according to data compiled by the agency.
It doesn’t get better at the bakery or deli
Remember my box of cookies? Let’s say I put it back on the shelf and head over to the store’s bakery for freshly prepared treats instead. Sadly, foods produced in a bakery or deli and “placed in a wrapper or container in response to a consumer’s order” are not covered under federal labeling requirements. The label on my box of cookies, packaged by a bakery worker, will not have any federally regulated allergen labels on it.
Manufacturers say safety is the priority
The labeling on the side of my box of cookies — whether it says “contains almonds,” “may contain almonds” or nothing at all — is determined by the food manufacturer.
So what goes into making the food that ends up on a shelf? And what kind of consideration is given to people with food allergies?
At Nestlé’s American operation, the key is applying “allergen management” across the expansive and complex operation, said David C. Clifford, director of food safety at Nestlé USA. He described the company’s approach as “objective, science-based, risk-based.”
“It’s a very serious responsibility that we have to feed the public, and the responsibilities around these systems extend horizontally across the organization,” said Mr. Clifford, who added that his team conducts allergen safety training throughout the company.
The Hershey Company also runs a training program for employees, it said in a statement. The training “includes video interviews with allergic children and their families who face the challenges of allergen management on a personal level every day of their lives.”
So here are some tips for finding safe food
Given everything we know about food allergen labeling, here is some advice.
Skip food with precautionary labels
When you’re scanning the shelves, if you spot precautionary labels beginning with “may contain” or “processed in the same facility as,” don’t buy them if they refer to your allergy, said Dr. Scott H. Sicherer, chief of pediatric allergy and immunology at the Icahn School of Medicine at Mount Sinai in New York.
“You shouldn’t make risk decisions based on what precautionary words are used on the label,” said Dr. Sicherer. “But rather, to be 100 perfect safe, just avoid products that have the precautionary label, if that’s a food that you’re avoiding.”
Reach out directly to food manufacturers
Instead of guessing what a label might mean, a few parents I spoke to take a proactive approach: calling companies to get answers, even if it is time-consuming.
“Maybe once a month I’m calling and trying to track something down,” said Julie V. Lunn, a bookkeeper and entrepreneur in Havre de Grace, Md., whose 3-year-old daughter, Alafair, is allergic to a variety of foods.
Look for products made in facilities that don’t use allergens
One way to simplify things is to seek out products made in allergen-free plants.
Enjoy Life Foods has one such facility, said Joel D. Warady, general manager of the company. He said employees are forbidden from bringing peanuts to work, and they must wear company-issued shoes that don’t leave the factory, in Jefferson, Ind.
MadeGood Foods, based in Ontario, swabs hands and tables to test for allergens, said Janice A. Harada, the company’s marketing manager.
Manufacturers like these cater to the allergy community, using branding to make it clear their foods are clear of allergens.
And that box of cookies I’ve been looking for? If its label says “made in a dedicated allergen-free facility,” it should be safe to give to my son.
