Do you avoid products with precautionary labels ("may contain nuts" or equivalent wording)? We do. A fellow nut mum recently asked me why this was, as her doctors had advised that she could safely ignore such warnings. I thought it would be worth explaining my thinking.
Our doctors' advice
We were given the same advice when my son, D, was first diagnosed with a peanut allergy. Our allergy doctors told us (1) to check the ingredients list on food labels, to make sure there was no mention of peanuts or any other nuts and (2) that we could disregard advisory or precautionary labelling ("May contain nut traces", "Produced in a facility that also processes nuts" and so on).
I think the logic behind this advice is that:
- The risk of a food labelled "may contain" containing enough peanut to trigger an allergic reaction is extremely slim.
- As a side point, there is a concern that if we cut out "may contain" foods too, D could have a restricted diet.
Furthermore, given "may contain" labelling is completely voluntary (and will continue to be so when the new labelling regulations come into force in December 2014), is a product labelled "may contain nuts" any more dangerous than another product where the manufacturer knows there is a cross contamination risk, but chooses not to flag this on the label?
Cross contamination: assessing the risk
In the UK and EU, the ingredients list on prepacked food must be accurate. If even the tiniest amount of peanut (for example) has been intentionally added to the recipe, then "peanut" should be listed in the ingredients.
"May contain" labels are intended to alert consumers to the possibility of accidental cross contamination during the production process. So, for example, if your supposedly nut free breakfast cereal is produced in the same factory as nutty granola, the manufacturer might put "may contain nuts" (or an equivalent warning) on your cereal packet.
A few points worth making about "may contain" labels:
- They are voluntary. If there is no warning wording, you cannot safely assume there is no cross contamination risk.
- If the manufacturer chooses to use a "may contain" label, you have no way of knowing whether the risk is genuine or whether the manufacturer is just trying to cover its back.
- You cannot gauge the level of risk from how the warning is phrased. For example, a product labelled "Not suitable for nut allergy sufferers" is not necessarily more high risk than one labelled "May contain nut traces" (and vice versa).
An opposing view from the Anaphylaxis Campaign, Ireland and the University of Nebraska
In the early months following diagnosis, we followed our doctors' advice and focused only on the ingredients list. However, as I touched on in my recent post on Oreo, our attitude to "may contains" has evolved. When I started Nutmums.com in January 2013 (and particularly when I joined Twitter), I began reading a lot more about food allergies and allergen labelling law. I realised that many allergic people avoid products with advisory labelling. In fact, it seemed as if we were in the minority for not having sworn off "may contain" products.
I then discovered that the Anaphylaxis Campaign advises people to "heed the warnings every time" and that ignoring the warnings is "risky behaviour". Two recent studies have further underlined this approach:
- An Irish study tested 38 food products with peanut or nut "may contain" warnings. Peanut was detected in 5.3% (2 of 38) of the products tested. The study concluded "Although it appears that the majority of food products bearing advisory nut statements are in fact free of peanut contamination, advice to peanut allergy sufferers to avoid said foods should continue".
- Similarly a study by the University of Nebraska discovered detectable levels of peanut in 8.6% of foods labelled "may contain peanut" (or similar advisory wording). This study concluded that "Peanut-allergic individuals should be advised to avoid such products regardless of the wording of the advisory statement".
In the UK, the Food Standards Agency have:
"been working to reduce the unnecessary use of 'may contain' labelling and to provide clear advice to the public on why these labelling terms are used and what they mean."
The FSA hopes to publish the outcome of this work shortly.
Peanuts, murderers and lightning bolts
I read recently in the Metro that "People with a food allergy are more likely to be murdered than to die from their condition". A comforting statistic? Not really. As to my mind, psychopaths can come after anyone, but my son's one of those with a target on his back where peanuts are concerned.
Similarly for the adage that you're more likely to be struck by lightning than die from a food allergy. If you've got a peanut allergic child with a prior history of severe anaphylaxis, it kind of feels like your kid is the one with the 50 ft conducting rod pointing at them.
It's also not just about death (although, it goes without saying, that's the main overriding worry). I don't want my son to have ANY kind of allergic reaction, if I can possibly help it. I don't want him to be on life support again, even if within a week he is back home building Lego and watching CBeebies as if nothing has happened. I don't even want him to spend one night on the children's ward for observation after a mild reaction, IF I can help it.
The statistics about murderers and lightning bolts might offer me some perspective on his allergies generally. However, they're not something that would influence my decision on may contains. Avoiding a food labelled "may contain nuts" is something I can do. It's an element of this whole food allergy business that I can control. There may only be a slim chance that a food labelled "may contain nuts" actually contains enough peanut to trigger a reaction. It may therefore follow that the chance of a life threatening reaction from a "may contain" product is incredibly small. But it's not outside the realms of possibility and it's a risk that's easy to avoid.
Why we avoid products labelled "may contain nuts"
- If a manufacturer has decided to state that its product "may contain nuts", I take that statement at face value and avoid the product.
- Even if the chance of a reaction to a may contain product is extremely unlikely, that chance still exists.
- We're only dealing with a nut allergy, so, whilst it may mean more time spent searching for nut free options, I don't feel D has a restricted diet by avoiding products labelled "may contain nuts".
So, for now, for us, any product with a "may contain" label doesn't even make it as far as the shopping trolley. If there is no warning wording, I then have to resort to checking the manufacturer's website or emailing their customer services team.
For me it comes down to this. Would I forgive myself if I knowingly gave my son a product labelled "may contain nuts" and he had an allergic reaction? No. Would it be any comfort whatsoever, if a doctor then told me what had happened was "incredibly rare"? Precisely.
So, until the law on advisory labelling is improved, we will continue to avoid "may contains".
- Anaphylaxis Campaign, ‘May contain’ food labelling.
- Allergic Living, Advisory Labels: May Contain Confusion by Patrick Bennett.
- Irish Study: Survey of peanut levels in selected Irish food products bearing peanut allergen advisory labels by Robertson, Hourihane, Remington, Baumert & Taylor.
- University of Nebraska Study: Quantitative risk assessment of foods containing peanut advisory labelling by Remington, Baumert, Marx & Taylor.
- Metro, Food allergies ‘kill fewer people than murderers’ (25 November 2013).