A Closer Look at Food Allergens. What You Need To Know.

Food allergen labeling has evolved tremendously in the United States over the past few decades. Prior to 2004, no mandatory labeling laws were in effect for food allergens, meaning manufacturers did not have to specifically call out ingredients that may have been a potential food allergen. 

However, things changed in 2004, and Congress passed the Food Allergen Labeling and Consumer Protection Act (FALCPA), which required the mandatory labeling of eight major food allergens on food packaging. These foods included milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soybeans. 

A recent 2020 study showed that the data used to identify these allergenic foods was developed over the previous decade that began with a working paper in 1993 on food allergens. This paper was presented to the Codex Committee on Food Labeling, which was then followed by a Food and Agriculture Organization (FAO) Technical Consultation on Food Allergens in 1995. The FAO report was based heavily around the pediatric population, using data on food allergies from a clinical setting. However, it was an instrumental part in the labeling of the top 8 food allergens. Both the Codex and FAO report led to the creation of “a list of foods of concern” in 1999 as part of the Codex General Standard for the Labeling of Prepackaged Food (Codex Alimentarius, 2001). 

Nearly 16 years went by before the next major update to food allergy laws was passed in the U.S. In April 2021, the Food and Drug Administration (FDA) signed into law the Food Allergy Safety, Treatment, Education, and Research (FASTER) Act, which declared sesame as the ninth major food allergen in the United States. Given the expense and time needed for companies to reconfigure packaging to comply with this new law, the changes officially go into effect in January 2023.

While there is currently no set threshold that the FDA considers when making a case to consider a food being added as a potential allergen, it’s important to understand the complexity of food allergies and just what the research shows regarding their prevalence. Let’s take a closer look. 

Food Allergy Prevalence: What the Research Shows

As noted above, much of the available data that helped shape the top eight allergenic foods in the U.S. relied heavily on pediatric data concerning the prevalence of the top food allergens that were then extrapolated to the general population. That same recent 2020 review also pointed out that research supporting specific foods becoming labeled as food allergens in the U.S. has relied on self-reports, leading to a greater chance of false-positive results. 

While blood tests and skin prick tests can help to identify food allergies, they both can also yield false-positive results 50 to 60 percent of the time. A highly accurate diagnostic test is considered an oral food challenge (OFT), that allows the patient and allergist to closely monitor a dose response of a specific allergenic food over a period of time. This is also used to help identify a threshold amount of a particular allergenic food a person may be able to tolerate as well.

Performing tests like these are beneficial to identify food allergies, yet they are costly and time-intensive, meaning they are often not performed in much of the research used to identify prevalence data surrounding food allergens. Instead, simpler, more cost-effective means such as surveys relying on self-reports are used. 

According to Sherry Coleman Collins, MS, RDN, LD, food allergy registered dietitian at Southern Fried Nutrition and consultant to the National Peanut Board, “There is certainly a significant issue with potential over-reporting of food allergies.”

As an example, Collins shared a study published in 2011 that showed when children underwent oral food challenges after food avoidance due to a suspected food allergy, 83 to 94% of the foods being avoided were able to be reintroduced to the diet. Similar results have been found in other studies.

In fact, Collins went on to share that in the 2016 review titled, Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy published by the National Academies of Sciences, Engineering and Medicine, researchers concluded that the true prevalence of food allergies in the U.S. is not known. Given the fact self-diagnosis is overwhelmingly unreliable because so many other adverse food reactions can masquerade as food allergies, it’s important Collins notes to continue to examine ways research can more accurately identify true prevalence data of food allergies. 

Although over-reporting is a concern, the unfortunate nature of food allergies is to be overly cautious rather than under cautious given they can be life-threatening. Until more feasible means of more precisely measuring a food allergy can be done on a larger scale, surveys will continue to be the best method to gain data at this time. 

Given the fact self-diagnosis is overwhelmingly unreliable because so many other adverse food reactions can masquerade as food allergies, it’s important to continue to examine ways research can more accurately identify true prevalence data of food allergies. 

The Addition of Sesame: Why This Matters

A recent 2019 study found that .23% of U.S. adults and children are allergic to sesame. While that number may seem small, it’s actually quite mighty. After speaking with Dr. Shelly Vaziri Flais, M.D., an author with the American Academy of Pediatrics and professor at Northwest University’s Feinberg School of Medicine, the addition of sesame to the list of major food allergens is an important step for those with a sesame food allergy that are looking to identify safe foods they can have. 

As labeling laws stood in the past, sesame used as a spice or seasoning didn’t have to be labeled in the ingredient list and could be coupled under the name spice blend/mix/etc. often seen in many ingredients statements. For someone with a sesame allergy, this would make navigating many packaged food products rather challenging. 

Collins points out that the specific foods listed as potential allergens vary widely across the globe. “Some of it is based on the prevalence within the population and sometimes it’s in order to help consumers more easily identify potentially allergenic foods. Sesame is a good example of the latter. While it impacts a very small percentage of the population, for those who do have a potentially severe food allergy to sesame, it can be very difficult to identify in packaged foods. The addition of sesame to the labeling law requires that sesame be disclosed clearly if it is used as an intentional ingredient.”

Dr. Flais agreed, sharing that for a family trying to navigate mealtimes with multiple mouths and food allergies to consider, it’s important for clear and transparent labeling to be listed. As a fellow food allergy mom herself, Dr. Flais empathized with the struggle food allergy patients have when dining out and shared she often recommends to her patients cooking at home more. 

“I try to encourage my moms to cook with as many whole ingredients as possible to help kids learn from a young age how to cook for their own allergies, making them better equipped to handle their nutrition as they grow and develop,” shares Dr. Flais.

Global Food Allergens: Similarities and Differences

To date, there is no formal list of global food allergens that require mandatory labeling on foods. Given each culture has traditional dishes and foods that comprise a large part of their regular diet, it’s interesting to see where each country differs when it comes to labeling foods as allergens. 

The University of Nebraska, Lincoln, has a wonderful Food Allergy Research and Resource Program that has a hub for monitoring the food allergens identified in many countries globally. As evidenced by their International Regulatory Chart, Japan is the only country out of the countries identified that does not list soy as an allergen. Since soy is present in numerous forms throughout Japanese cultural cuisine, it’s not surprising that this would not necessarily be listed as a top food allergen. 

Many countries align in listing milk, shellfish, fish, egg, peanuts, and tree nuts as food allergens, with wheat/gluten being more divisive. Some countries list foods like fruits and vegetables such as mangos, tomatoes, and celery as allergens, while others list spices such as mustard on their allergen list.  

While Dr. Flais and Collins see the benefit of having a global allergen list to label foods; it’s likely a very distant thought when coming to fruition. 

Collins notes that when considering the global nature of consumer packaged goods, this change could have some potential benefits. “For instance, if there was an agreed-upon list of allergens, it could simplify the import/export process of foods, which would be a good thing. It would ensure that wherever the food is manufactured, the labeling would clearly provide the information needed by individuals with food allergies and reduce the risk of accidental ingestion.” 

Where To Go From Here

Research is continuing to evolve as diagnostic tools become more widely available for consumers and practitioners to assess food allergies. In the meantime, it’s important to work with a group of trained healthcare professionals, like a registered dietitian nutritionist, if you or someone you know has been diagnosed with a food allergy. Reading labels is important as manufacturers can make mistakes, but eliminating foods without proper oversight sets individuals at risk of poor nutrient intakes and potential disordered eating tendencies, giving rise to concern for other conditions to develop. 

At the click of your finger, literally, apps like Backstop are popping up to provide concerned parents and individuals access to trained professionals who can help guide them in navigating their (or their littles) food allergy journey. 

Want to learn more about food allergies? Read these articles:

• Making Sense of Food Allergies
• The Facts About Food Allergies