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Mary Hazel GOWLAND Food allergy: innovation in advocacy, research and training to support and protect those at risk Commentary (Volume 1) and Publications (Volume 2) submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy from Kingston University by Mary Hazel GOWLAND June 2018 1 Contents Acknowledgements ...................................................................................................................... 5 Abstract ........................................................................................................................................ 7 List of abbreviations ..................................................................................................................... 9 1 Introduction ....................................................................................................................... 12 Background ........................................................................................................................ 12 A personal note .................................................................................................................. 12 2 The research outputs ......................................................................................................... 14 Papers in journals P1 – P29 ................................................................................................ 14 Abstracts for oral presentations and conference posters A1-12 ........................................ 31 Book chapters B1 - B4 ........................................................................................................ 36 Other work and achievements W1 - W24 .......................................................................... 38 3 Career progression ............................................................................................................. 42 4 Allergy and associated conditions – Discussion .................................................................. 54 4.1 Food allergen avoidance .............................................................................................. 55 4.2 Food hypersensitivity ................................................................................................... 56 4.2.1 Food Allergy .............................................................................................................. 57 4.2.2 Oral allergy or pollen-food allergy syndrome ............................................................ 57 4.2.3 Other mechanisms .................................................................................................... 57 4.2.4 Coeliac disease and ‘food intolerance’ ...................................................................... 58 4.3 Food Allergy Prevalence ............................................................................................... 59 4.4 Anaphylaxis .................................................................................................................. 63 4.5 Severity of allergic reaction .......................................................................................... 64 4.6 Quality of Life ............................................................................................................... 66 4.7 Is there a cure for food allergy? ................................................................................... 67 4.8 Prevention of food allergy ............................................................................................ 68 5 Food allergen management – Discussion .......................................................................... 70 5.1 Processing .................................................................................................................... 72 5.2 Precautionary Allergen Labelling .................................................................................. 72 5.3 Basic Toxicology ........................................................................................................... 74 5.4 Allergen Reference Doses, Action Limits and Thresholds ............................................. 81 5.5 Deterministic allergen risk assessment ........................................................................ 87 5.6 Probabilistic allergen risk assessment .......................................................................... 89 6 The early days - advocacy and the foundation of the Anaphylaxis Campaign – Discussion93 6.1 Developing skills and knowledge .................................................................................. 94 2 6.2 Early research ............................................................................................................... 96 6.3 Work with the media ................................................................................................... 97 6.4 Developing as a researcher and consumer / patient advocate .................................... 97 6.5 The Anaphylaxis Campaign member database and allergy product alerts ................... 98 6.6 Understanding fatal and ‘near miss’ allergic reactions to food .................................. 102 6.7 Media recognition – further awareness ..................................................................... 103 6.8 Expert patient – early journal papers ......................................................................... 103 7 Allergy Action – Discussion............................................................................................... 105 7.1 ‘May contain’ labelling – assessing the impact of nut and peanut warnings on prepacked foods ................................................................................................................................ 106 7.2 Consumer advocacy ................................................................................................... 107 7.3 Improving access to allergy health care ..................................................................... 108 7.4 Sesame allergy ........................................................................................................... 109 7.5 Developing resources and training tools .................................................................... 110 7.6 Work to ensure food law protection for consumers with food allergies, intolerances and coeliac disease ................................................................................................................. 111 7.7 Evidence to the House of Lords enquiry into Allergy.................................................. 112 7.8 Further work to ensure food law protection for consumers with food allergies, intolerances and coeliac disease ...................................................................................... 113 8 Implementing an action plan - Discussion ........................................................................ 117 8.1 Work with local authority environmental health and trading standards officers....... 119 8.2 Work with food manufacturers – establishing best practice for allergen controls and information for prepacked foods ..................................................................................... 120 8.3 Work with caterers and businesses selling ready to eat foods – establishing best practice for allergen controls and information for non-prepacked foods ...................................... 121 8.4 Developing materials and training for Environmental Health and Trading Standards Officers throughout the UK .............................................................................................. 121 8.5 Developing and delivering a cross-border training programme and conferences in Ireland ......................................................................................................................................... 122 8.6 Update research study on current allergy-related activities undertaken by UK Local Authority Food Safety and Standards Enforcement Officers 2008 ................................... 122 8.7 European research collaborations - Informall and Europrevall .................................. 124 8.8 Teenagers and young adults ...................................................................................... 124 8.9 Modelling the outcome of allergic reactions .............................................................. 125 8.10 Review of progress to date - 2008 ............................................................................ 125 8.11 Research into living with a nut and / or peanut allergy ............................................ 126 8.12 MSc courses in Allergy .............................................................................................. 127 8.13 Training partnership in Scotland .............................................................................. 127 3 8.14 Support for the London 2012 Olympics.................................................................... 128 8.15 Investigating Anaphylaxis Campaign member data and market research ................ 128 8.16 The Food Information to Consumers Regulation ..................................................... 128 8.17 Bringing the new regulation into practice ................................................................ 129 8.18 Food fraud: allergen substitution in the food supply chain ...................................... 131 8.19 R v Zaman – a landmark case ................................................................................... 131 8.20 Following the EU Food Information to Consumers Regulation ...............................
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