Food Production and the Problems of Eating Out for Nut Allergy Sufferers

Below is an article I wrote for Hwyl, the Arts supplement of the postgraduate newspaper The Cardiffian, which is associated with Cardiff University. It is about the problems of eating out for nut allergy sufferers and the considerations chefs must have when preparing meals in a kitchen environment with regard to allergens.

It features comments from Cardiff-based chef Dewi Reed and the Anaphylaxis Campaign, about this food production process.

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Nut allergies are fascinating and frightening medical conditions, which present sufferers with more problems when eating out than you might think.

Each allergy is unique to an individual and can vary in form and severity, producing contrasting allergic reactions from one person to another. The same person can have varying degrees of tolerance to different types of nut, so they may not be allergic to peanuts but extremely allergic to walnuts, for example.

To confuse matters further,some people’s allergies are so severe they can have a reaction by touching a surface which previously had nuts on it. This indirect reaction from nut particles makes food preparation and kitchen management vital to keep nut allergy sufferers safe when they eat out.

Deri Reed, the Cardiff-based Ethical Chef who specialises in vegetarian cuisine, is renowned for using fresh ingredients to create locally-sourced Welsh recipes, and commented on allergens.

Deri Reed: Chefs must be careful in the food preparation process [image courtesy of Jarod Carruthers]

He said: “As a chef you need to make sure all your staff are aware of changing and cleaning boards after preparation of nuts.

“But most restaurants will have nuts in the kitchen and are unlikely to take responsibility if there are traces of nuts found in foods, as a kitchen’s menu is usually ever-changing.”

Another consideration sufferers must bare in mind is nut oils used in the cooking process, but Deri insists this is a smaller threat.

The Ethical Chef, based in Whitchurch, added: “Food will hardly ever be cooked in nut oils, unless you are going to a fancy restaurant. However they might be used in dressings.”

The Anaphylaxis Campaign’s guidance for caterers in dealing with severe food allergies says: “Customers are still being ‘caught out’ by unexpected ingredients after receiving false assurances from staff that a particular food product is safe.”

The guidelines want restaurants to be honest about what is in food and state they should never guess about allergen presence. It also suggests a nominated person who knows this information should be on duty at all times.

So while eating out, a nut allergy sufferer has greater concerns than simply avoiding foods with nuts in. Rather scarily, nut-free food may have been accidentally contaminated in the kitchen.

While cities like Cardiff provide magnificent and varied choices for snacks, lunch and fine dining, it is still very difficult for nut allergy sufferers to feel safe while eating out.

Pre-Holiday Checklist for Nut Allergy Sufferers – 5 Useful Tips

January is a popular time of year for people to go on holiday, jetting off away from Britain’s winter cold. Or with 2013 now upon us, people might be starting to think about Easter and summer holidays. For nut allergy sufferers, there are a few extra considerations beyond the manic pre-holiday mayhem, which will make their lives a bit easier when managing their allergies abroad.

I’ve listed five useful things you can do before you board the plane or hit the road, which will make your holiday a bit more stress-free.

1. Learn a new language!

If you are going on holiday in a non-English speaking country, learning a few words or sentences could help you vastly. Even if you know the word for ‘nut’ in the language of your destination, it will certainly help you when studying food packaging ingredients in a foreign language. Sentences would be even more helpful for communication in a language you don’t speak. Do your homework before hand. Ask people fluent in the language or use Internet translator websites like Google Translate or BabelFish. I have vivid memories of asking an unsuspecting and increasingly-confused German shop-worker ‘I… have… a… nut… allergy. Does… this… food… have… nuts… in?’ in my rather detached German, whilst holidaying in the Black Forest. We got there in the end, and I stayed safe. I was very glad I had done my research before hand, and scribbled down a few useful sentences.

2. Your EpiPen is as important as your passport!

EpiPens are Very, Very Important Abroad. Make Sure You have Packed Them – PLEASE DO NOT FORGET THEM

Do not get on the plane without your EpiPen. In the usual mad packing rush, make sure you have it with you. Prioritise it highly and rank it alongside your passport. I cannot stress enough how important your EpiPen could be abroad. The same rules apply abroad as they do here – the EpiPen is a life-saver in an emergency situation. In foreign surroundings it could buy you the necessary time it takes to contact the emergency services. Also, EpiPen is a world-recognised brand, and will communicate to emergency services you suffer from Anaphylactic reactions. With this theme, I move on to tip 3…

3. Put on your SOS Talisman and forget about it!

If someone abroad sees one of the company products – whether this is a bracelet, a necklace or a keyring – there is every chance that they will recognise the brand. Consequently, they will recognise that you suffer from some allergy or condition. Make sure the information inside the Talisman is up-to-date before you depart, especially your doctor’s details, your medical condition and your vaccination history. If anything, the importance of the SOS increases if you are having an allergic reaction abroad because there is a greater chance that you won’t be able to communicate. The SOS is a great little tool, really easy to carry and very difficult to lose. So when you have put the piece of jewellery on in the first place, you don’t have to worry about it after that.

4. Inform Travel Companies about your Allergy. TWICE!

Inform Travel Companies About Your Allergy [Image courtesy of xlibber]

Whether you are travelling by coach, plane or any other means, it is really important to tell travel companies that you have an allergy – both when you book and on the day. This is especially important for people with more serious allergies who can have an allergic reaction through breathing in nut particles in the air (although even if your allergy is not this serious it is still important to inform such companies). On planes and coaches you are in confined spaces where this type of reaction is a serious threat, and the company will make provisions to make sure nuts are not consumed by anyone on-board. You might become the anonymous Mr/Mrs Unpopular for a moment or so, but it is certainly a sufficient precaution!

5. If You’re Not Sure, Don’t Eat It! Don’t take the Risk.

This is the hardest piece of advice to give, because people who know their own allergy have built up a set of personal rules with regard to what they trust eating. When you are on holiday, you will probably want to try the local cuisine. For some people it is one of the main attractions of holidaying abroad. But the last thing you want is to take a risk, consume nuts and end up in hospital. My mentality with food is that if I’m not sure, I don’t eat it. And for me, this mentality would be all the more prominent abroad where you are more likely to stumble upon food you have never had before. You might be disappointed at not being allowed to a certain cuisine when your friends and family are tucking in, but it is better to be safe than sorry.

For more details and tips, please have a look at the Allergy UK page for travelling abroad with a food allergy. It’s an excellent page. Finally and most importantly, enjoy your holiday! By taking these 5 simple steps your nut allergy won’t get in the way of you having the time of your life.

Mail Online Article – Student’s Allergic Reactions caused by Teacher’s Nut-Scented Candles

Just a short post, this. I found it an interesting read, and I think you might too.

I found an article on The Daily Mail’s online site, Mail Online, with nut allergies as a central theme. This story is based in Georgia, USA, where a teacher reportedly refused to stop lighting a nut-scented candle in her classroom when it was repeatedly giving a 16-year-old student an allergic reaction. The article says the teacher put out the candle before the nut allergy sufferer was in the room, but this would still give her student a reaction because there was nut oil in the air of the classroom when she later entered.

The article was published on 16 October 2012, and contains a video of the CBS Atlanta TV news report on the story. Give it a read/view – it is another example of how dangerous nut allergies can be even when a sufferer doesn’t actually eat one. Consumption of nuts through particles in the air is a concept that has come up a lot since I’ve been writing this blog. It is becoming apparent that this is a real and constant danger for people with very serious nut allergies.

The story is available at the link below:

http://www.dailymail.co.uk/news/article-2218712/Teacher-bullied-student-nut-allergy-refusing-stop-burning-scented-candle-caused-reactions.html

Article from Mail Online [Image courtesy of Edmond Wells]

The SOS Talisman: An Important Little Thing

My Talisman

I was given an SOS talisman when I was very young. I cannot remember exactly when, but I certainly had it during my primary school years and I may have received it even earlier than then. I wore it around my neck to school every day until I was about 13 or 14 and then stopped. I cannot recall why, but probably due to the inconvenience of connecting the minuscule loop to the chain every drowsy school-day morning.

I had never worn it since, until a few weeks ago when I needed to prove I had a nut allergy to explain why I was carrying EpiPens when I visited the public gallery in Cardiff Crown Court. But despite my reluctance to use it on a daily basis, I certainly see the merit of the SOS talisman.

SOS: My talisman and chain

Why are they Important?

The personal and medical information contained in the talisman – the exact details of which I will list later – could save vital time in an emergency situation. For example, if a nut allergy sufferer goes into anaphylactic shock the talisman can effectively communicate for them when it is not possible for them to do so. This is particularly important for their treatment, and can save the emergency services crucial time in making a diagnosis. Proper and quick treatment can save financial costs, as well as, of course, human lives.

The SOS medallion can be effective for a wide range of sufferers beyond people with nut allergies. For example; Diabetes, Autism, Emphysema and Anaemia, amongst others, can be helped by an SOS talisman, while people with hearing or visual impairments and those taking multiple types of medicine can also benefit from them.

Inside: The Paper Folds as such Inside the Talisman

The SOS talisman brand is also recognised internationally, so it can be very helpful when a sufferer is on holiday. It might be the difference in allowing someone to tell you if there are nuts in certain food, if the person knows what exactly you suffer from. In these cases, the talisman can break language barriers.

Also, as it states on the SOS talisman website, the medallion is: “Both water-tight and heat resistant, yet easily accessible in an emergency.” On mine, all you have to do is twist the top, and you are inside in 5 seconds.

Inside the Talisman

So what is inside the talisman? It is basically a folded up piece of paper with categories of information on. On the front, it has the SOS number while my basic yet important details are in the middle. These include my name, address and contact details of my parents and my doctor (with indications that they are GB numbers), as well as my religion.

Unfolded: The Paper Inside the Talisman Containing Important Information

Then on the back there is my allergy and the medicine that I would require in an emergency. There is also a list of the vaccinations that I have had and whether they are up to date. Penultimately, there is a list of any other medical conditions (i.e. hay fever) and finally there is more detail of my main allergy, for example the types of nuts I am most allergic to – Brazil nuts and Hazelnuts.

Other SOS Jewellery

There are other jewellery options other than the original talisman. There are a variety of bracelets, pendants, watch capsules and straps, available in stainless steel, gold, chrome, silver and many more. And this is only from the SOS talisman brand.

Others such as Universal Medical ID produce fashionable medical jewellery, and even sell other items like ID-engraved sports bands and even a USB dog tag!

But whether you choose fashion or simplicity, a nut allergy sufferer should have an SOS talisman and I should definitely use mine more often. SOS talisman markets its products with the line: “Jewellery that can save your life.” They are certainly not wrong.

Mail Online Article – Girl Dies After No Nut Warning on Takeaway Website

Mail Online Article 

I found this article on the Daily Mail’s Online site, published on 17 September 2012, about a girl who died after eating curry from a takeaway which wasn’t labelled as nut-containing. It shows that the changes in the Food Information Regulations (2013) outlined in my last post are needed very much. Have a read, and I’ve added a few personal thoughts below:

http://www.dailymail.co.uk/news/article-2204404/Nut-allergy-girl-killed-mouthful-chicken-curry-local-takeaway-warning-left-menu.html *

*Also, read some of the comments below the article by Mail Online readers. Some of them display good insights into the attitudes of nut allergy sufferers regarding food labelling, and state how nut allergies affect their lives.

Article Appeared on the Daily Mail’s internet site, Mail Online [Image courtesy of Edmond Wells]

Thoughts

This really does highlight how dangerous nut allergies can be, and how careful sufferers must be every minute of every day. As it stands, there is no legal requirement for takeaways to display allergen information, so there was no knowing that the food was not suitable for someone with a nut allergy.

The Food Standards Agency told me that the situation will change in 2013, when takeaways will be subject to the more stringent allergen rules that we see in restaurants. In short, the curry would have been labelled under the new legislation, warning that the product had been cooked with nut oil and ground almonds. It seems commonsensical that all products containing nuts should have a warning on them, when there are a large number of people with such dangerous nut allergies.

Personal Concerns about Eating Out

I only eat Home-Made Curry to be Sure Nuts Don’t Appear in it [Image courtesy of phdstudent]

I avoid curries, Indian and Chinese food. I know that many nut allergy sufferers enjoy these foods safely, but for me – and this is a personal opinion – I am afraid about accidental nut contamination of food in a kitchen environment where nuts are used so freely elsewhere. I don’t eat out very often, which is again a personal decision, because I haven’t got the control of the allergen that I suffer from.

The only way that I would ‘risk’ eating a curry is if it was home-made and I had the reassurance that nuts were not used to make it. I am also concerned about the use of nut oil in foods, as evident in the Mail Online article. But with nut oil, there is a much larger array of foods that it could appear in – and foods which you might not have even considered as being nut-containing. Although I am obviously aware of the serious nature of my allergy, I do not ‘worry’ about it on a daily basis. But nut oil is the main thing that worries me regularly.

Will the new Food Information Regulations change my attitude about this? I am afraid not. But I cannot reiterate enough how much I feel the Regulation changes are required. Sufferers need to know exactly what is in their food before they eat it. The Mail Online article is certainly proof of that.

Changes to Food Information Regulations in Wales (2013)

This post outlines the Food Standards Agency in Wales‘s response when I asked them what the 2013 changes to the Food Information Regulations for Wales entail. These changes relate to the information that consumers/purchasers of food are given with regard to allergens, within which nuts are inclusive.

Change #1 – Labelling of ‘Loose’ Foods

The Food Standards Agency’s response indicated that the main change will be the requirement of manufacturers to give labelling on ‘loose’ foods. It said: “This means foods from a take away, deli or coffee shop would all need to have allergen labelling.”

“However the regulations specify that this information can be given verbally, but businesses will have to have the information ready and available in an easily understood format when asked.”

Allergens: Coffee Shops must Label Food or Provide Verbal Information from 2013 [Image Courtesy of MrTopf]

I understand this to mean that all packaged or unpackaged food or drink, whether bought in a restaurant or a shop, will have to be labelled unless the seller is able to give a definitive and easy-to-understand list of the allergen information on request.

In essence, nothing will change for the manufacturers who already provide one of these two methods of informing the customer.

But it is a great reassurance that unpackaged food is now subject to such scrutiny, because I would suggest that ‘loose’ food is one of the biggest concerns for allergy sufferers. It is certainly right for allergen information on this unpackaged food to be available just as it is with packaged food, whether this is verbal of via food labelling. It is a definite improvement in my opinion.

Change #2 – Information on Labels

The second main change to the Food Information Regulations in Wales regards how allergen information is written on this food labelling. I have spoken about the existing rules on this topic somewhat extensively in my previous two posts, but what changes are in store from 2013 onwards?

The Food Standard Agency’s reply said: “All allergen information now has to be in the ingredients list, with the allergen in every ingredient highlighted so allergen sufferers know what to look for.”

Food Packaging: Chocolate Bars, for example, must Adhere to the 2013 Rules [Image Courtesy of david_pics]

“Although labels can still have an allergen box, they can no longer list the allergens within the box; only use it to signpost consumers to the ingredients list. These regulations only cover the labelling of allergens where they have been deliberately added as an ingredient in food, not the cross contamination of allergens in the manufacturing process.”

Therefore, where an allergen is an ingredient used to make the product, manufacturers can no longer state it  in the allergen section of the packaging, but can refer to the ingredients from here. There is no requirement to have an allergen section at all in these cases, but manufacturers must unequivocally state all allergens in their list of ingredients, regardless of whether they provide an allergen box.

But, as I interpret it, the rules regarding ‘accidental’ contamination, from a substance outside of the ingredients, have not changed. This means the May Contain labels that we have become accustomed to with nut presence will not disappear, as manufacturers cannot write these ‘accidental allergens’ in their ingredients lists because they are not exactly that – ingredients. I assume that the possibility of accidental contamination will continue to be listed in the allergen advice boxes on food packaging.

It is worth reiterating that these are the new regulations for Wales. There are changes for other countries also occurring in 2013, and the outline of the English changes can be found here.

I would like to thank the Food Standards Agency in Wales for providing me with the information about the Wales 2013 Food Information Regulations, and also details about May Contain labels as outlined in my last post. 

May Contain Traces of Nuts? Food Standards Agency Regulations

This post further examines food packaging and the information which manufacturers have to provide about the presence of nuts in their products. I asked the Welsh branch of the Food Standards Agency, based in Cardiff, about the guidelines manufacturers have to follow, why they can write the ambiguous phrase ‘may contain traces of nuts’ and whether they have to qualify such statements.

‘Accidental’ Nut Presence

Firstly, the term ‘accidental’ nut presence is one I have used to refer to nuts appearing in foods which don’t have them in the ingredients. For example, I talked a lot in my last post about nut particles theoretically entering the food via the air, which is perhaps why some manufacturers do not unequivocally state their food does not have nuts in when nuts are not used to make them.  But the actual term ‘accidental’ nut presence has come from me, not the Food Standards Agency.

Nut Allergy Sufferers need to be Careful with Chocolate Products [Image Courtesy of robbplusjessie]

Their line on the matter read: “Unlike the situation for deliberate ingredients, there are currently no statutory controls governing the labelling of the possible low level presence of allergens due to the cross-contamination of foods along the food supply chain.”

My understanding of this is that manufacturers have no obligation to label foods outlining the likelihood or the possibility that ‘accidental’ nut presence might exist in their products. So manufacturers don’t have to state the long, complicated and Scientific account about the probability of nut particles getting into the product via the air. This is often done in nut policy sections on websites, the best example of which is Kinnerton as we saw in the last post. Such an explanation does not have to appear on the products themselves, according to the Food Standard Agency, which is probably a sensible thing. Imagine writing that on a small chocolate bar like a Freddo!

I don’t know whether the familiar labelling: “This product has been made using equipment that has previously used nut ingredients” comes under the statute. It is obviously not as ‘accidental’ a contamination as nut particles contaminating through the air, but it could be described as ‘accidental’ and does occur “along the food supply chain.” If it is not covered by the statute it is quite reassuring because many manufacturers state this on their food packaging anyway, even though they would not be obliged to do so.  

May Contain labels

Nut allergy sufferer of not, I am sure you have seen the words: “This product may contain traces of nuts” written on some sort of food packaging. Many times I have pointed out its perceived ambiguity when the ingredients do not seem to contain nuts, the factory is listed as having no nuts, yet a message of caution is displayed.

Ambiguous: No Nuts, Cannot Guarantee Nut-Free

The Food Standards Agency wrote: “The Food Standards Agency… produced voluntary best practice guidance to ensure allergen labelling could be as effective as possible. The guidance states that advisory labelling should only be used when, following thorough risk assessment, there is a demonstrable and significant risk of allergen cross contamination.”

The way this is written struck me somewhat. I had perhaps anticipated the Agency to be telling manufactures to write this note of caution more frequently, but the words “should only be used”, “following thorough risk assessment” and “demonstrable and significant risk” would suggest they are urging manufacturers to be more selective in employing the label. This is perhaps in compliance with the wishes of nut allergy sufferers who, if they are anything like me or people I have spoken to, want cautious or  ‘scare’ messages to be used less. After all, it does limit what nut allergy sufferers can (or dare to) eat.

The Food Standards Agency also suggested looking at their on-line PDF file for more information on the use of May Contain labels and general allergen labelling.

Part of Section 3.3.1, about food labelling, reads:

“It is recommended that there is a clear distinction in the labelling information provided between ingredients that are deliberate components of the food (whatever the level of incorporation) and any possible allergen cross-contamination arising from production of the raw ingredients or during the manufacture or transport of the food.”

“However, information on deliberate ingredients and possible contaminants should be adjacent to each other and in the same field of vision as the ingredients list.”

As far as I can tell this sums up the guidelines for manufacturers. They have to distinguish between deliberate ingredients from possible cross-contaminated ingredients on their food packaging – and this is where the May Contain label derives from, and what it actually means for nut allergy sufferers.

My next post will be about the other topic I asked the Food Standards Agency about – new regulations for food packaging, which will enforce EU regulations on the UK. To be continued…