Alex Gazzola explores the problems and consequences of living with one or more allergies to usually non-reactive foods.
When it comes to food allergies and intolerances, most of the conversation, information and research focuses on gluten and the so-called top 14 allergens – principally milk, eggs, nuts, peanuts, soya, gluten-containing grains and sesame. With ‘free from’ food, gluten-free is undoubtedly king, with milk / dairy-free a distant runner-up, and others such as ‘egg free’ or ‘nut free’ lagging way behind.
Labelling legislation established in 2014 requires manufacturers to emphasise these 14 allergens in their lists of ingredients. The usual method of emphasis is bold, but others – such as underlining, CAPITALS, colour, shading or a combination of these effects – are also permitted, provided that they stand out from other ingredients.
This is all well and good if your allergens are among the 14 – but what if they’re not?
There are no reliable figures for allergies to beans, to exotic fruits, to alliums (onion, garlic, leek), to spices, to meats, and to other foods, but they certainly exist. Allergies to hundreds of foods have been clinically recorded, and there’s no reason to suppose that any particular food is guaranteed to be universally safe. Even bland or seemingly innocuous foods are occasionally problematic.
Although they should not emphasise them, manufacturers are obliged to list these ‘non-top 14’ ingredients on their packaging, so that if they include onion in a product, they must accordingly add ‘onion’ to their list of ingredients. So far, so good.
But such transparency only applies with ‘wholefood’ ingredients, meaning there are two problems for those with more unusual or less recognised allergies:
1/ The derivation or source of any processed ingredients used in a product need only be declared when it is one of the top 14 allergens.
So, a simple ‘flavouring’ compound must be described as ‘barley malt flavouring’, for example, on the list of ingredients, if derived from barley (which is a gluten-containing cereal).
Alternatively, the allergen in such a scenario may be given in brackets: for instance, ‘flavouring (from milk)’, if the ingredient is derived from milk.
However, the expression ‘natural flavouring’ or even just ‘flavouring’ – without further embellishment – is permitted if the derivation of that flavouring is onion, tomato, mushroom or any other ingredient not among the ‘top 14’.
In practice, some thoughtful or transparent food manufacturers may well declare what the source may be, but as they are under no obligation to do so, many will not, often for understandable reasons (for example, to keep the ingredients list brief, if the size of packaging is already limiting space for essential other information).
2/ The ingredients of compound ingredients – such as mayonnaise in a tuna pate – must be declared if constituting over 2% of the final product.
So in the list of ingredients for that product, you may see something like this: tuna (fish), butter (milk), mayonnaise (rapeseed oil, egg, vinegar, salt), salt, sugar, lemon juice.
But, if constituting under 2%, the compound ingredients need only be declared if they are one of the ‘top 14’. If you have an allergy to a spice or a herb, typically used as mixtures or blends, and in relatively amounts, you’ll commonly find – to your frustration – the expression ‘spices’ or ‘mixed herbs’ on ingredients, with no further clarification.
These two situations above make it tough for sufferers of unusual food allergies, because all ingredients must be read individually, and every vague or non-wholefood ingredient that could potentially be ‘concealing’ the trigger allergen needs to be assessed or further investigated. Often, this will require a phone call to the manufacturer – which is of course inconvenient, especially if you’re at a supermarket and in a rush.
Cross contamination risk
A further potential problem comes with cross-contamination.
Whereas a product recall will be instigated for wheat flour cross contamination, it is unlikely to be done for corn flour cross contamination, for example. Even a close look through the product recalls listed on the Food Standards Agency website fails to reveal one on record due to a non-top-14 allergen that didn’t constitute a non-allergy related health risk.
Furthermore, precautionary allergy labelling – ‘may contain traces of milk’ or ‘made in a factory where peanut is handled’ – which is voluntary and unlegislated anyway, is unheard of with regard to allergens outside the top 14.
Individual Food Allergies
Some rarer food allergies are harder to manage than others. For instance, a lettuce allergy may be simpler to cope with. Lettuce, a bland vegetable, is unlikely to be used to derive a ‘flavouring’ ingredient, and so will in all probability only appear in whole form – in a prepared salad or ready-made sandwich, for example.
Others are more complex. Here are a few.
This is particular difficult, as corn is widely used in ‘free from’ products, and because corn is a source ingredient for many ingredients in general, such as vegetable gum, vegetable shortening, vegetable protein, vegetable starch, ‘thickener’, glucose or fructose syrup, and many more.
Also difficult, but depending on severity. Garlic especially is used as a flavouring in many processed foods. Anila’s Sauces is a brand of sauces which is free from onion and garlic. Garlic may ‘hide’ in a ‘spice’ mix.
Red pepper / chilli allergy
Peppers (ie capsicums) are related to chilli peppers / paprika, so if you are allergic to one, you may be allergic to all. Again, ‘spices’ is best avoided.
Balsam of Peru / Vanilla / Cinnamon allergy
Balsam of Peru is an aromatic resin derived from a South American tree, which is used in cosmetics and fragrances and in topical medicinal or therapeutic creams such as the haemorrhoid cream Anusol and Chinese or Tiger Balm. It is via these topical applications that increasing numbers of people are becoming sensitised to balsam of Peru, necessitating an avoidance of perfumed personal care products such as deodorants and after shaves which may contain it.
But balsam of Peru contains similar chemical components to other aromatic spices and botanicals, and those with this allergy may occasionally also need to avoid citrus peel, vanilla, cinnamon, cloves, cardamom, nutmeg and curry mixture, all of which could turn up in confectionary, chewing gum, soft drinks, Christmas foods and drinks and other foods, often only as ‘flavouring’.
Severe allergies to kiwi, strawberry, peach and banana, for example, are well known. Any sweet products, desserts, fruit salads, confectionary are potential sources. Take care with ‘fruit flavour’ or ‘fruit flavouring’ – the first will be derived from real fruit (the name of which may not be declared), whereas the second may not be from fruit at all, and derived synthetically. Be also aware that, potentially, flavour derived from one fruit, such as kiwi, may be used in a product bearing the name of another, such as a strawberry yogurt.
In practice, many who react to fruit have Oral Allergy Syndrome – which is related to hay fever – and may only react to raw fruits. If this is the case, processed ‘flavouring’ ingredients, pasteurised juices and cooked desserts, for instance, will probably be safe.
Lentil / Pulse / Bean allergy
These are all legumes – as are the most feared food allergen, peanut. Many with peanut allergy or soya bean allergy also react to one or more other legumes, but they can exist independently of these as well. Vegetarian or vegan foods, especially, are the ones to watch out for. Chickpea flour may also be used in gluten-free foods.
Quite rare in the UK, but a minority of those effected by egg allergies are also allergic to chicken, and it’s a similar scenario between milk and beef. Vegetarian food will of course be safe, and any meat presence will in practice be clearly declared.
The rules for restaurants, pubs, food service providers and for foods sold loose (rather than pre-packed) are not as strict as labelling regulations for foods and drink you might find on your supermarket shelf.
In such cases, the food service providers are under no obligation to give you the ingredients of the foods present – although they are obliged to give you the names of all of the top 14 allergens present. In practice, they should be able to tell you most – such as if onion has gone into a stew – but where hey may fall down is with ingredients used by chefs, such as spice mixes or stock cubes. Chefs are unlikely to check whether there’s fenugreek in their spice mix, or chives in their dried herb mix – although may be able to investigate if you ask.
The intense focus within the catering industry over the last year on the top 14 allergens is likely to have ‘deflected’ attention even further away from other ingredients used in kitchens and catering. While cooks may take extreme care to avoid cross-contamination of top 14 allergens, they’re unlikely to be as careful with the rarer foods – unless you ask them. As with any allergy, calling in advance, explaining your situation, and reiterating the problem to waiting staff when you arrive, are all advisable.
Medicines / Supplements
Ask your doctor to check anything he or she prescribes you. Odd flavourings can be surprising additives. There is a case on record of a girl with banana allergy having an anaphylactic reaction to penicillin which had been flavoured with banana essence to make it more palatable for children to take.
Be wary of herbal supplements, which may contain various botanical or herbal extracts. Read labels carefully or call manufacturers.
Alex Gazzola, a specialist writer on food, diet and nutrition, is the author of ‘Coeliac Disease: what you need to know’, participant in the FreeFrom food awards and site editor of Methylisothiazolenone Free for those allergic to this common preservative.
This article first appeared in Allergy Newsletter No.116, Spring 2016.