Food HypersensitivityFOOD ALLERGY AND INTOLERANCE

gluten

nuts

milk

crusta

ceans

eggs

celery

In 2014, the European Food Safety Authority (EFSA) estimated that food allergies and intolerances occurred in approximately 3% of adults and children. Though it is generally accepted that the incidence of food allergies and intolerance in industrialised nations appears to be increasing, determining precise numbers is difficult due to relatively mild symptoms in some cases and the unreliability of self-diagnosis.

gluten fish

milk

crusta

ceans

Food HypersensitivityFOOD ALLERGY AND INTOLERANCE

1

FOO

D A

LLER

GY

AN

D IN

TOLE

RA

NC

EFO

OD

HY

PER

SEN

SITI

VIT

Y

This information leaflet is designed to answer many of the questions people may have in regard to food allergies and intolerances, collectively known as food hypersensitivities.

• Foodisoneofanumberofallergytriggers(pollen,dust,animaldander,latex)

• Afoodallergydiffersfromfoodintoleranceinthetypeofreactionbythebody

• Symptomsandtheironsetcanvarywiththetriggerandtheindividual’ssensitivity

• Peoplecanexperiencehypersensitiveresponsestomorethanonetypeoffoodorfoodingredient

• Somefoodscantriggerbothanallergicreactionandintolerance,e.g.milk,wheat

• Processingafood,e.g.cookingmayormaynotalteritsallergenicity

• Avoidanceiscurrentlytheonlywayofmanagingafoodallergyorintolerance

• Diagnosisofafoodallergyorintoleranceshouldinvolvemedicalconsultation

• Changestoyourdietshouldonlybeundertakeninconsultationwithsuitablyqualifiedexperts

• EUfoodlawidentifies14specificfoodallergensthatmustbedeclaredwhentheyareusedtoproduceorpreparefoods

• Therequirementtodeclare/labelfoodallergensdoesnotapplywhentheyarepresentatlowlevelsduetocross-contamination

• Forpre-packedfood,allergensmustbedeclaredinthelistofingredientsorelsewhereonthepackagingwherethereisnoingredientlist

• Allergeninformationfornon-prepackedfoodsinIrelandmustbeprovidedinwrittenformat

• Precautionarylabels(‘maycontain’)arevoluntarilyappliedbyfoodbusinesses

2

FOO

D A

LLER

GY

AN

D IN

TOLE

RA

NC

EFO

OD

HY

PER

SEN

SITI

VIT

Y

TERMINOLOGY

Thedistinctionbetweenafoodallergyandintoleranceisnotdefinedinlegislation.Thoughinterpretationscanvary,expertsinthefieldconsiderafoodallergytobeahypersensitivereactiontoafoodthatismediatedbytheimmunesystem,particularlyinvolvingIgEantibodies(e.g.reactionstopeanut,soyaandeggs),cellularmechanismsorboth.Inaddition,autoimmuneadversereactionstofood(e.g.coeliacdisease)occurwhentheimmunesystemreactsabnormallytotheingestionofafoodorfoodcomponent.Anadversereactionthatdoesnotinvolvetheimmunesystemdirectlyisconsideredfoodintolerance,e.g.reactionstosulphites,lactose.

SYMPTOMS

Dependingonthefoodinvolvedandthesensitivityofindividuals,symptomsassociatedwithfoodallergyorintolerancecanappearimmediately(withinminutes)ortakeseveralhoursordaystomanifest.Symptomscanrangefrommildirritationtosevereorlifethreateninganaphylaxisandmayaffecttheskin,oralcavity,gastrointestinaltract,respiratorytractortheeyes.Becausemanyofthesymptomsassociatedwithfoodallergyorintolerancecanhaveunrelatedtriggers,medicaladviceshouldbesoughtbeforetakingremedialactionsuchasdietaryalteration.

almonds

Because many of the symptoms associated with food allergy or intolerance can have unrelated triggers, medical advice should be sought before taking remedial action such as dietary alteration.

ADVERSE REACTIONS TO FOOD

Autoimmune disorder(e.g. coeliac disease)

Food Allergy(Immune mediated)

IgE-mediated(e.g.peanutallergy)

Cell-mediated

IgE- and cell- mediated(e.g.milkallergy)

Enzymatic(e.g.lactoseintolerance)

Pharmacological(e.g.scombroidpoisoning)

Other and unknown triggers

Food Intolerance(Not-immune mediated)

Adversereactionstofood(adaptedfromEFSAScientificOpinionontheevaluationofallergenicfoodsandfoodingredientsforlabellingpurposes,2014).

3

FOO

D A

LLER

GY

AN

D IN

TOLE

RA

NC

EFO

OD

HY

PER

SEN

SITI

VIT

Y

ANAPHYLAXIS

Anaphylaxisisarapidandpotentiallylife-threateningallergicreactioncausedbyexposuretoallergensincludingcertainfoods.Symptomsexperiencedduringanaphylacticreactionstofoodssuchaspeanutcanbegininthemouthandthroatwithinminutesofingestionandquicklyprogresstoaffectthepharynx,skin,respiratorytractandcardiovascularsystem,eitherindividuallyorincombination.Peoplesusceptibletoanaphylacticreactionsneedtocarrylife-savingadrenalineauto-injectordevicesincaseofemergency.Staffincateringfacilitiessuchasrestaurantsortakeawaysandinschoolsorotherinstitutionsshouldbeawareofsusceptibleindividualsandhaveappropriatetrainingtobeabletoprovideassistanceifrequired.

MEDICAL DIAGNOSIS IS IMPORTANT

Medicalconsultationisrecommendedwhenapersonbelievesthattheyorsomeoneintheircarearesufferingfromafoodallergyorintolerance.Accuratediagnosisisparticularlyimportantforchildrenorwherethesymptomscausesevereorpersistentdiscomfort.Incorrectdiagnosiscanresultintheactualcauseofahealthproblembeingoverlookedandinunnecessarydietaryrestrictions.

FOOD ALLERGY AND INTOLERANCE IN CHILDHOOD

Foodallergyandintolerancecanappearearlyinlifeasachildisgraduallyintroducedtonewfoodssuchascows’milk,egg,soyandfish.Thehypersensitivereactiontofoodexperiencedbymanychildrenrecedesovertimeastoleranceisdeveloped.However,theproportionofchildrenwhodeveloptolerancetosomeallergens,suchaspeanutisrelativelylow.Currently,theonlywayofmanagingfoodallergiesorintolerancesisbyeliminatingtheoffendingfoodoringredientfromthediet,butthisshouldonlybeundertakenundertheguidanceofsuitablyqualifiedexpertstominimisetheimpactonachild’sgrowthanddevelopment.

almonds

peanuts

cashew nuts

4

FOO

D A

LLER

GY

AN

D IN

TOLE

RA

NC

EFO

OD

HY

PER

SEN

SITI

VIT

Y

ALLERGENS TRIGGER ALLERGIC REACTIONS

Mostallergenicfoodscontainoneormoreallergenicproteins(allergens)thattriggeranallergicreactioninsusceptibleindividuals.Someallergenicproteinsaresensitivetoprocessessuchascooking,thoughthisisnotareliablesafeguard.Forinstance,boiling(moistheat)peanutscanreducetheirallergenicpotentialbutroasting(dryheat)doesnot.Mostallergenicproteinsresistdegradationintheharshenvironmentofthehumanstomach,acharacteristicusedtoscreennewfoodingredientsfortheirallergenicpotential.

SOME FOODS CAN CAUSE BOTH AN ALLERGY AND INTOLERANCE

Certainfoodscanberesponsibleforbothanallergicreactionandintolerance.Forexample,milkproteinscancauseanallergicresponseinsomepeople,whileareducedabilitytometaboliselactose,theprimarysugarincow’smilk,iscalledlactoseintolerance.

COELIAC DISEASE

Hypersensitivitytogluten(coeliacdisease)isageneticallydetermineddisorderthatisestimatedtoaffect0.5-1%oftheIrishpopulationandforwhichglutenavoidanceistheonlytreatment.Glutenisawater-insolublemixtureofproteinsthatcandamagethemucosaofthesmallintestinesinpeoplewiththecoeliacconditionandisdefinedinEUlegislationas“a protein fraction from wheat, rye, barley, oats or their crossbred varieties and derivatives thereof”.

Foodscontainingnomorethan20mg/kgglutencanbelabelledas‘gluten-free’whilethoseprocessedspecificallytoreducetheglutencontentandcontainnomorethan100mg/kg,canbelabelledas‘verylowgluten’.Itispossiblethatafoodmadewithacerealcontainingglutencancarrya‘glutenfree’or‘verylowgluten’declaration.Coeliacscanavailofnaturally-occurringgluten-freecerealssuchasrice,maizeandsorghum.

milk

cereals

containing

gluten

wheat

oats

5

FOO

D A

LLER

GY

AN

D IN

TOLE

RA

NC

EFO

OD

HY

PER

SEN

SITI

VIT

Y

Ingredientscontainingglutenarespecificallyprohibitedinthemanufactureofinfantformulaandfollow-onformula.Inaddition,processedcereal-basedfoodsandbabyfoodsintendedforinfantsandyoungchildrenundersixmonthsofageshouldindicatethepresenceorabsenceofgluten.

Foodslabelledas‘gluten-free’or‘verylowgluten’maybeaccompaniedbythestatements‘suitableforpeopleintoleranttogluten’or‘suitableforcoeliacs’.‘Gluten-free’or‘verylowgluten’foodsmayalsobeaccompaniedbythestatements‘specificallyformulatedforpeopleintoleranttogluten’or‘specificallyformulatedforcoeliacs’ifthefoodisspeciallyproduced,preparedand/orprocessedtoreducetheglutencontentorsubstitutethegluten-containingingredientswithotheringredientsnaturallyfreeofgluten.

milk

crusta

ceans

eggs

Gluten is a water-insoluble mixture of proteins that can damage the mucosa of the small intestines in people with the coeliac condition and is defined in EU legislation as “a protein fraction from wheat, rye, barley, oats or their crossbred varieties and derivatives thereof”.

6

FOO

D A

LLER

GY

AN

D IN

TOLE

RA

NC

EFO

OD

HY

PER

SEN

SITI

VIT

Y

FOOD ALLERGEN LABELLING

Manyfoodsandfoodingredientscantriggeranallergicreactionorintolerance,butonly14requirespecificallergenlabellingunderEUlaw(seelistbelow).Forpre-packedfood,foodallergensmustbedeclaredonthepackaging,e.g.inthelistofingredients,ifthereisone.Foodsthatdonotrequirealistofingredientmuststillindicatetheuseoffoodallergensbyusingtheword‘contains’followedbythespecificallergen(s).Foodbusinessessuchasrestaurants,delicatessens,canteens,takeaways,cafes,retailoutlets,hotelsetc.mustalsoprovidewrittenallergeninformationfor‘loose’foodthatisnon-prepackedorpackedfordirectsale(seesectionon‘loosefood’below).Certainderivativesoffoodallergensareexemptfromfoodallergenlabellingbecausetheproteincomponentsknowntoelicittheallergicresponsehavebeenremovedduringprocessing.

labelling

Regulation(E

U)

No1169/2011

direct s

ale

Certain derivatives of food allergens are exempt from food allergen labelling because the protein components known to elicit the allergic response have been removed during processing.

7

FOO

D A

LLER

GY

AN

D IN

TOLE

RA

NC

EFO

OD

HY

PER

SEN

SITI

VIT

Y

Food allergens that require specific allergen labelling under the Food Information to Consumers (FIC) Regulation (EU) No 1169/2011:

1. Cereals containing gluten,namely:wheat(suchasspeltandkhorasanwheat),rye,barley,oatsortheirhybridisedstrains,andproductsthereof,except:

a) Wheat based glucose syrups including dextrose;

b) Wheat based maltodextrins;

c) Glucose syrups based on barley;

d) Cereals used for making alcoholic distillates including ethyl alcohol of agricultural origin.

2. Crustaceansandproductsthereof.

3. Eggsandproductsthereof.

4. Fishandproductsthereof,except:

a) Fish gelatine used as a carrier for vitamin or carotenoid preparations;

b) Fish gelatine or Isinglass used as fining agent in beer and wine.

5. Peanutsandproductsthereof.

6. Soybeansandproductsthereof,except:

a) Fully refined soybean oil and fat;

b) Natural mixed tocopherols (E306), natural D-alpha tocopherol, natural D-alpha tocopherol acetate, natural D-alpha tocopherol succinate from soybean sources;

c) Vegetable oils derived phytosterols and phytosterol esters from soybean sources;

d) Plant stanol ester produced from vegetable oil sterols from soybean sources.

7. Milkandproductsthereof(includinglactose),except:

a) Whey used for making alcoholic distillates including ethyl alcohol of agricultural origin;

b) Lacitol.

8. Nuts,namely:almonds(Amygdallus communisL.),hazlenuts(Corylus avellana),walnuts(Juglans regia),cashews(Anacardium occidentale),pecannuts(Carya illinoiesis(Wangenh.)K.Koch),Brazilnuts(Bertholettia excelsa)pistachionuts(Pistacia vera),macadamianutsorQueenslandnuts(Macademia ternifolia)andproductsthereof,exceptfornuts used for making alcoholic distillates including ethyl alcohol of agricultural origin.

9. Celeryandproductsthereof.

10.Mustardandproductsthereof.

11.Sesame seedsandproductsthereof.

12.Sulphur dioxide and sulphitesatconcentrationsofmorethan10mg/kgor10mg/litre,expressedasSO2.

13.Lupinandproductsthereof.

14.Molluscsandproductsthereof.

8

FOO

D A

LLER

GY

AN

D IN

TOLE

RA

NC

EFO

OD

HY

PER

SEN

SITI

VIT

Y

CROSS-CONTAMINATION WITH FOOD ALLERGENS

Consumersmustbeinformedbythelabelwhenafoodisproducedwithoneormoreofthespecified14allergenicfoodingredients.However,suchlabellingisnotrequiredwherelowlevelsoftheallergenicingredientsarepresentasaresultofcross-contamination.Whereanundeclaredfoodallergenisdetectedatlowlevelsinafood,theFSAImaytakeproportionateactionbasedonanassessmentofthepotentialrisktopublichealth.

PRECAUTIONARY FOOD ALLERGEN LABELS

Foodbusinessessometimesuseadvisorylabelssuchas‘maycontain…’or‘producedinafactorythatuses…’toalertvulnerableconsumersthattheirproductmayinadvertentlycontainlowlevelsofcertainallergens.Whilesuchlabellingisvoluntaryandcanprovideavaluablewarningtoconsumerswhenprudentlyapplied,theyshouldnotbeusedbyfoodbusinessesasasubstituteforgoodmanufacturingpractices(GMP)orHACCPstrategies.Thespurioususeofprecautionarylabelscanresultinunnecessarydietaryrestrictionsandpossiblydesensitisepeoplewithfoodallergieswhomaythentakeriskswiththosefoods.AprecautionarystatementcannotbeconsideredafoodallergendeclarationasrequiredbyStatutoryInstrument(S.I.)No.489of2014.

PROVISION OF ALLERGEN INFORMATION FOR NON-PREPACKED (LOOSE) FOODS

UndertheFICRegulation(EU)No1169/2011,allergeninformationmustbeprovidedfornon-prepackedfoods.Thisincludesfoodsthatarepreparedbycateringestablishments,e.g.restaurants,takeawaysandhotels,foodandbeveragespresentedandsoldloose,e.g.unpackagedbreads,cheeses,draughtbeerandcider,foodpackagedonsitefordirectsaletothefinalconsumer,e.g.delicatessen,takeaway,andfoodprovidedbydistanceselling,e.g.orderedremotelyfordelivery,

TheFICRegulationpermitsEUMemberStatestodeterminehowallergeninformationfornon-prepackedfoodisprovidedwithintheirjurisdictions.InIreland,thisinformationmustbeprovidedinwrittenformatassetoutinS.I.No.489of2014.DetailsofhowfoodbusinessescancomplywiththisrequirementaresetoutintheFSAIinformationleafletAllergen Information for non-Prepacked FoodandGuidance Note 28 on Food Allergen Information for Non-Prepacked Foods in Ireland(www.fsai.ie).

www.fsai.ie

sms alerts

9

FOO

DA

LLER

GY

AN

DIN

TOLE

RA

NC

EFO

OD

HY

PER

SEN

SITI

VIT

Y

MONITORING THE LABELLING OF FOOD ALLERGENS

Prepackedfoodsamplescollectedbyenvironmentalhealthofficersaretestedbythepublicanalystlaboratorieseachyearforthepresenceofcertainfoodallergens.Whenclearbreachesofthefoodallergenlabellinglegislationaredetected,afoodbusinessmaybeaskedtoplaceadditionallabelsonaproduct.However,dependingonthepotentialrisk,aproductmaybewithdrawnorrecalledandanotificationsenttotheEUrapidalertsystemforfoodandfeed(RASFF).Evenwherelabellingruleshavenotbeenbreachedbythepresenceofafoodallergen,theFSAImaytakeactionintheinterestsofconsumersafety,basedonanassessmentofthepotentialrisktopublichealth.

FSAI EARLY WARNING SYSTEM

In2009,theFSAIinitiatedanearlywarningsystemforpeoplewithfoodallergiesorintolerances,ortheirguardians,andwhohaveregisteredwiththeFSAI.Thissystemenablesreal-timetransferviaemailandSMStextmessagingofinformationaboutfoodallergyissuesastheFSAIbecomesawareofthem.RegistrationforthisresourcecanbemadethroughtheFSAIwebsiteathttps://www.fsai.ie/subscriptions/.

MAKE A COMPLAINT

ConsumerswithafoodallergyorintoleranceareencouragedtocontacttheFSAIdirectlywheretheyhavehadanadversereactiontoaprepackedfoodthattheysuspectmaynotbelabelledappropriately,ortoafoodconsumedinacateringestablishment.Wherepossible,asampleofthesuspectfoodshouldbesubmittedinordertoestablishthepresenceofparticularallergenicingredients.

USEFUL LINKS

• FoodInformationonPrepackedFoodshttp://www.fsai.ie

• AllergenInformationfornon-PrepackedFoodhttp://www.fsai.ie

• Gluten-FreeFoods:ReportoftheScientificCommitteehttp://www.fsai.ie

• GuidanceNoteNo.24:‘Gluten-free’and‘VeryLowGluten’Declarations(Revision1)http://www.fsai.ie

• GuidanceNoteNo.28:FoodAllergenInformationforNon-PrepackedFoodsinIrelandhttp://www.fsai.ie

• FSAISafeCateringPackhttp://www.fsai.ie

• BeFoodAllergenAwarePosterhttp://www.fsai.ie

• OpinionoftheScientificPanelonDieteticproducts,nutritionandallergies[NDA]ontheevaluationofallergenicfoodsforlabellingpurposeshttp://www.efsa.europa.eu/en/efsajournal/pub/32.htm

• FoodAllergyandIntolerance-GuidancefortheCateringIndustryhttp://www.safefood.eu/

• AnaphylaxisCampaignwww.anaphylaxisireland.ie

• CoeliacSocietyofIrelandwww.coeliac.ie

Theinformationprovidedinthisleafletwillbeupdatedregularlytoreflectanychangestolegislation,standardsorguidance.

Food Safety Authority of IrelandThe Exchange, George’s Dock, IFSC, Dublin 1, D01 P2V6

T +353 1 817 1300E info@fsai.ie

www.fsai.ie

Join us on LinkedIn

Follow us on Twitter @FSAIinfo

Say hi on Facebook

Visit us on Instagram

Subscribe to our Youtube channel

©FSAI 2019