The truth about Food Labeling

By Scott Sicherer, MDAs a parent shopping for safe foods for your child with food allergy, you have likely noticed that labels have improved in many respects. For example, the new US labeling laws require manufacturers to declare, in plain English, ingredients that are specific major allergens (such as egg, milk, wheat, soy, peanut, tree nuts, fish and Crustacean shellfish).

However, it is important to understand some limitations of the law. For example, the law does not cover all potential allergens (e.g., sesame, clam) so it may still be necessary to contact manufacturers for additional information about intended ingredients.Perhaps the most frustrating issue in labeling is the use of "advisory" labels which are not regulated by the new law. Advisory labels are those indicating that an allergen "may" be in the product, but is not an intended ingredient. You have probably noticed an increasing number of these labels with many different types of warnings.

The specific words used sometimes provide apparent additional information about the circumstances; for example, "processed in a facility that uses [an allergen]". The labels usually name the problematic allergen(s) ("may contain peanuts and almonds") though sometimes they are ambiguous ("may contain an allergen"). The following Q & A addresses some important questions I frequently get about these labels and incorporates the results of a recent study. Q: Labels saying "May contain" are showing up very frequently. Isn't it true that manufacturers are just covering themselves for legal reasons and maybe there is no risk? A: Currently, advisory labeling is voluntary and there are no clear guidelines.

However, I would not dismiss the warnings. Although companies may be using different internal guidelines, we must assume they are labeling with intentions to protect food-allergic consumers. In collaboration with the Food Allergy & Anaphylaxis Network we queried parents of children with food allergies about their avoidance of products labeled with advisory warnings. We found that people are increasingly ignoring these warnings. We think that people are ignoring the labels because they doubt their truth and are seeing more and more of these warnings, making it difficult to avoid the products. Although it is a frustrating situation,

I am concerned that there is a real risk. In addition, one could worry that once an advisory label is placed, perhaps the risk actually increases (though hopefully that is not the case). Q: Is it safer to eat products that say "made in a facility that processes" compared to ones that say "may contain" or "processed on equipment that processes" the allergen? For example I buy food in a grocery store which is a "facility" that also has peanut butter! A: Although our studies also found that parents interpret the words used on the labels as implying different risks, this assumption appears to be WRONG!

Researchers in Nebraska took 179 products with advisory labels for peanut, tested 2 different lots of each and found (7%) had detectable peanut. While contamination with peanut was found with various types of warnings on the label, items labeled as being prepared in a "shared facility" happened to have a higher rate of contamination and higher amount of peanut than ones labeled "may contain." This unexpected result indicates that the type of warning is NOT a reliable means to assess risk. Q: Is the amount of allergen in a product that says "may contain" enough to cause a reaction at all, or a severe reaction?A: The short answer is "yes it could be." There are many factors that determine how much of a food might trigger a reaction, and what the reaction might be in terms of severity. For example, some children are more sensitive to small amounts than others. Advisory labels do not indicate the risk of contamination or the amount of contamination.

Q: My child ate a product many times without a reaction, but we now see that it is labeled "may contain peanuts." Does this mean we need not worry anymore since he already tolerated it many times? A: Unfortunately, there is still a risk because the contamination could occur sometimes. The study mentioned above checked 2 lots of the products and sometimes only one lot was contaminated. In addition, the amount of contamination varied from time to time. Ideally, companies should do their best to exclude unintended allergens and avoid advisory labels

.Scott H. Sicherer, M.D. is Associate Professor of Pediatrics and a researcher at the Jaffe Food Allergy Institute at Mount Sinai in New York and author of "Understanding and Managing Your Child's Food Allergies (Johns Hopkins Press, 2006