Living with Food Allergies

1. Exploring the Allergic and Gluten-Free Marketplace Living with Food Allergies February 21, 2012 The Allergy/Asthma Information Association

2. The AAIA across Canada • National Office in Toronto • AAIA Atlantic • AIAA Québec • AAIA Ontario • AAIA Prairies/NWT/Nunavut • AAIA BC/Yukon

3. Our focus  3 A’s • A = Allergy • A = Asthma • A = Anaphylaxis Our motto 3 A’s

4. We provide services across Canada: • Information • Education • Support • Advocacy • Partnership

5. Our members • Most AAIA members are parents of children with severe food allergies, e.g. peanut, nuts, milk, egg, shellfish…. • A significant proportion have more than one food allergy • Many have persistent milk and egg allergies • Most find avoidance measures stressful • Brand loyal consumers

6. Our approach to food allergy Teaching the essential “food rules” and a risk management approach

7. What is food allergy? • An immune system reaction to a normally harmless substance (allergen) • Affects 7.5% (2.5 million) Canadians • Results from interaction of genetic tendency and sensitization • Cannot be cured but can usually be controlled

8. Allergy Statistics • One in 13 Canadians suffer from a significant food allergy • 1.93% with peanut allergy • 2.36% with tree nut allergy • 0.99% with fish allergy • 3.02% with shellfish allergy • 0.19% with sesame allergy Dr. Ann Clarke, Allergy Researcher, McGill University, 2010

9. What Is Anaphylaxis? • Potentially life-threatening allergic reaction requiring immediate treatment • Affecting about 2% of Canadians • Involving more than one body system (“systemic”) • Typical triggers include insect stings, medication, food, natural latex • Trace amounts can cause a severe or even fatal reaction • Cannot be cured – avoidance is key

10. Ten Most Common Food Triggers • Peanuts • Tree nuts • Shellfish / Seafood • Eggs • Mustard • Milk • Wheat • Soy • Sesame • Sulfites* *Sulfites are a food additive

11. Recognizing Ingredients • Milk: casein, sodium caseinate, whey, lactose, lactalbumin, cream, butter, other “lact” words ... • Eggs: albumin, conalbumin, globulin, livetin, lecithin, lysozyme, ovalbumin, other “ovo’ words … • Wheat: kamut, spelt, triticale, semolina, farina, bulgur, couscous, durum, einkorn, emmer, seitan, bran, flour, germ, starch, gluten …

12. Lactose Intolerance • Not an allergy, actually a lactase enzyme deficiency • Symptoms involve digestive system only (abdominal pain, bloating, diarrhea) • Symptoms do not occur if lactose-free dairy product is ingested or if the person takes lactase tablets at mealtimes

13. Celiac/Gluten-free • Celiac disease is a specific form of allergy (immune-mediated, but not IgE-mediated) • Treatment involves following a strict gluten-free diet (approx. 1% of population affected) • Digestive system and skin adversely affected by even a tiny amount of gluten ingestion • Gluten is the protein found in cereal grains; wheat, barley, rye, oats

14. Alcoholic Beverages • Alcohol with nuts: eg. Amaretto (almond); Bombay Sapphire Gin (almond); Frangelico (hazelnut); Kahana Royale (macadamia); Nocino (walnut); Southern Comfort (nut derivative); some vodkas mixed with nut ingredients. • Alcohol with eggs: Bols Advokat • Alcohol with milk: creamy liqueurs, Baileys • Alcohol with wheat/gluten: beer, whiskey, gin • Alcohol with sulphites: beer, wine, cider

15. Risk Management • Understanding food labels and assessing risk are complex tasks • Different levels of risk tolerance • Many patients demand 100% certainty, but 100% risk-free is impossible • Brand loyal consumers – consistency important for risk avoidance

16. Managing food allergies • Much progress has been made - peanut allergy is now relatively well understood by the public • Some allergens harder to avoid than others, e.g. milk , soy • More information available today – but increased awareness of minor risks may bring more stress • Allergic consumers, manufacturers, retailers and food servers share the responsibility

17. Cross-contamination • The transfer of an ingredient (food allergen) to a product that does not normally have that ingredient in it. A food that should not contain the allergen could become dangerous for someone who is allergic. It can happen: • during food manufacturing …shared production/packaging equipment • at retail through shared equipment…deli slicer for cheese/meat • during food preparation … equipment, utensils, hands

18. Preventing Allergic Reactions Prevention is key. Food safety for consumers depends on safe and reliable manufacturing practices. • Work with suppliers to ensure they have stringent allergen management processes • Develop and maintain good manufacturing practices • Understand food labelling regulations • Clear and accurate info on food labels is essential • Avoid using alternative names for food ingredients

19. Current Issues “May contain” phrasing • Is it overused in Canada on products with low risk? • Clear criteria and standards needed for the use of the various formats of this phrasing • Don’t eliminate it totally; better to have a warning than not. • Make it consistent and relevant; use for real risks • Such warnings suggest this product may not be the best choice for you - ultimate decision is still up to the consumer

20. Current Issues… continued Allergen Claims on Front • Danger that people will rely on this and not read the ingredient list • Negative versus Positive claims • What does “peanut free” mean – this may not be obvious to caregivers who may assume it includes all nuts

21. Current Issues… continued Brands …which version is it? • When a brand is marketed as being allergen free in one format but not in another, allergic consumers and caregivers are confused (eg. chocolate bars) • This is increasingly an issue in the marketplace and needs attention • Frequent changes lead to confusion

22. Current Issues…continued Crowded Labels • With more nutrition information on the label there is not a lot of room • Important to keep allergy info in an easy- to-read and easy- to-find format • Make sure allergen info is on outside as well as individual packaging • Grocery shopping is already very time consuming for allergy sufferers – clarity is important!

23. Issues facing someone with allergies • Limited products that are available and safe, especially when multiple allergens need to be avoided • Many allergic consumers ignore “may contain” disclaimer as many foods that should be “safe” will have warning • Confusing label – peanut free symbol does not mean nut free

24. Specific needs of someone with allergies • Clear & accurate ingredient labels • Readily available and reasonably priced food products that are “safe” • Need to avoid bulk food items (cross contamination & labeling concerns) • Peanut free diet - usually need to avoid tree nuts as well

25. Allergy friendly products • SunButter (sunflower seed spread) • NoNuts Golden Peabutter (golden brown peas spread) • Chapman’s Ice Cream • Guardian Angel Foods chocolate • Dare cookie products • Quaker granola bars • Peak Freans LifeStyle biscuits • Fleischmann’s Lactose-free margarine

26. What products are on the wish list? • Greatest demand for products free from: peanut, tree nut, milk, egg & soy • Milk free, egg free & nut free breads • Ice cream free from peanut/nut/egg/soy • Chocolate chips free from milk, soy, peanut/nut • Coconut free from peanut/nut • Milk free/soy free margarine • Frozen fruit dessert alternative to ice cream for milk allergic consumer

27. How can food industry help? • Create new allergy friendly food products • Reformulate existing products for allergic consumers • Dedicated facilities for allergen free products • Provide ingredient list as clear and readable as nutrition facts table • Avoid “may contain” disclaimer statement except when valid or needed (not as a generic legal disclaimer) • Disclaimer overused on low risk products-difficult for consumer to accurately assess risk

28. Summary • Allergen avoidance is a shared responsibility among consumers, manufacturers, distributors, retailers and food servers • Opportunity for Alberta food producers to capitalize on “free from” market • Readily available and reasonably priced safe food products – an achievable goal benefiting the allergic consumer

29. Connecting Canadians with Allergies, Asthma & Anaphylaxis from Coast to Coast Lilly Byrtus AAIA Regional Office 16531-114 Street Edmonton, AB T5X 3V6 prairies@aaia.ca 1-866-456-6651 AAIA National Office 295 The West Mall, Suite 118 Toronto, ON M9C 4Z4 1-800-611-7011 www.aaia.ca