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Food Hypersensitivity FOOD ALLERGY and INTOLERANCE Food Hypersensitivity FOOD ALLERGY AND INTOLERANCE nuts gluten milk crustaceans eggs celery Food Hypersensitivity FOOD ALLERGY AND INTOLERANCE 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. fish gluten milk crustaceans 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. • Food is one of a number of • Changes to your diet should only allergy triggers (pollen, dust, be undertaken in consultation animal dander, latex) with suitably qualified experts • A food allergy differs from • EU food law identifies 14 food intolerance in the type specific food allergens that must of reaction by the body be declared when they are used to produce or prepare foods • Symptoms and their onset can vary with the trigger and the • The requirement to declare/ individual’s sensitivity label food allergens does not apply when they are present • People can experience at low levels due to cross- hypersensitive responses to contamination more than one type of food or food ingredient • For pre-packed food, allergens must be declared in the list of • Some foods can trigger both an ingredients or elsewhere on the allergic reaction and intolerance, packaging where there is no e.g. milk, wheat ingredient list AND INTOLERANCE FOOD ALLERGY 1 • Processing a food, e.g. cooking • Allergen information for non- may or may not alter its prepacked foods in Ireland must allergenicity be provided in written format • Avoidance is currently the only • Precautionary labels way of managing a food allergy (‘may contain’) are voluntarily FOOD HYPERSENSITIVITY or intolerance applied by food businesses • Diagnosis of a food allergy or intolerance should involve medical consultation TERMINOLOGY SYMPTOMS The distinction between a food allergy and Depending on the food involved and the intolerance is not defined in legislation. sensitivity of individuals, symptoms Though interpretations can vary, experts associated with food allergy or intolerance in the field consider a food allergy to be a can appear immediately (within minutes) hypersensitive reaction to a food that is or take several hours or days to manifest. mediated by the immune system, particularly Symptoms can range from mild irritation involving IgE antibodies (e.g. reactions to to severe or life threatening anaphylaxis peanut, soya and eggs), cellular mechanisms and may affect the skin, oral cavity, or both. In addition, autoimmune adverse gastrointestinal tract, respiratory tract or reactions to food (e.g. coeliac disease) the eyes. Because many of the symptoms occur when the immune system reacts associated with food allergy or intolerance abnormally to the ingestion of a food or can have unrelated triggers, medical advice food component. An adverse reaction should be sought before taking remedial that does not involve the immune system action such as dietary alteration. directly is considered food intolerance, e.g. reactions to sulphites, lactose. ADVERSE REACTIONS TO FOOD Food Allergy Food Intolerance (Immune mediated) (Not-immune mediated) FOOD ALLERGY AND INTOLERANCE FOOD ALLERGY IgE-mediated Enzymatic 2 (e.g. peanut allergy) (e.g. lactose intolerance) Cell-mediated Pharmacological (e.g. scombroid poisoning) IgE- and cell- mediated (e.g. milk allergy) Other and unknown triggers FOOD HYPERSENSITIVITY Autoimmune disorder (e.g. coeliac disease) Adverse reactions to food (adapted from EFSA Scientific Opinion on the evaluation of allergenic foods and food ingredients for labelling purposes, 2014). Because many of the symptoms associated with food allergy or intolerance can have unrelated triggers, medical advice should almonds be sought before taking remedial action such as dietary alteration. ANAPHYLAXIS MEDICAL DIAGNOSIS IS IMPORTANT Anaphylaxis is a rapid and potentially Medical consultation is recommended life-threatening allergic reaction caused when a person believes that they or by exposure to allergens including certain someone in their care are suffering from foods. Symptoms experienced during a food allergy or intolerance. Accurate anaphylactic reactions to foods such as diagnosis is particularly important for peanut can begin in the mouth and throat children or where the symptoms cause within minutes of ingestion and quickly severe or persistent discomfort. Incorrect progress to affect the pharynx, skin, diagnosis can result in the actual cause respiratory tract and cardiovascular system, of a health problem being overlooked and either individually or in combination. People in unnecessary dietary restrictions. susceptible to anaphylactic reactions need to carry life-saving adrenaline auto- FOOD ALLERGY AND INTOLERANCE injector devices in case of emergency. Staff IN CHILDHOOD in catering facilities such as restaurants or takeaways and in schools or other Food allergy and intolerance can appear institutions should be aware of susceptible early in life as a child is gradually introduced individuals and have appropriate training to to new foods such as cows’ milk, egg, soy and be able to provide assistance if required. fish. The hypersensitive reaction to food experienced by many children recedes over time as tolerance is developed. However, the proportion of children who develop tolerance to some allergens, such as peanut is relatively low. Currently, the only way of FOOD ALLERGY AND INTOLERANCE FOOD ALLERGY managing food allergies or intolerances 3 is by eliminating the offending food or ingredient from the diet, but this should only be undertaken under the guidance of suitably qualified experts to minimise the impact on a child’s growth and development. FOOD HYPERSENSITIVITY almonds peanuts cashew nuts ALLERGENS TRIGGER ALLERGIC COELIAC DISEASE REACTIONS Hypersensitivity to gluten (coeliac disease) Most allergenic foods contain one or is a genetically determined disorder that more allergenic proteins (allergens) that is estimated to affect 0.5-1% of the Irish trigger an allergic reaction in susceptible population and for which gluten avoidance individuals. Some allergenic proteins are is the only treatment. Gluten is a water- sensitive to processes such as cooking, insoluble mixture of proteins that can though this is not a reliable safeguard. damage the mucosa of the small intestines For instance, boiling (moist heat) peanuts in people with the coeliac condition and can reduce their allergenic potential but is defined in EU legislation as “a protein roasting (dry heat) does not. Most allergenic fraction from wheat, rye, barley, oats or their proteins resist degradation in the harsh crossbred varieties and derivatives thereof”. environment of the human stomach, a Foods containing no more than 20 mg/kg characteristic used to screen new food gluten can be labelled as ‘gluten-free’ while ingredients for their allergenic potential. those processed specifically to reduce the gluten content and contain no more than 100 SOME FOODS CAN CAUSE BOTH AN mg/kg, can be labelled as ‘very low gluten’. ALLERGY AND INTOLERANCE It is possible that a food made with a cereal Certain foods can be responsible for containing gluten can carry a ‘gluten free’ both an allergic reaction and intolerance. or ‘very low gluten’ declaration. Coeliacs For example, milk proteins can cause an can avail of naturally-occurring gluten-free allergic response in some people, while a cereals such as rice, maize and sorghum. reduced ability to metabolise lactose, the FOOD ALLERGY AND INTOLERANCE FOOD ALLERGY 4 primary sugar in cow’s milk, is called lactose intolerance. FOOD HYPERSENSITIVITY milk cereals gluten wheat containing oats Ingredients containing gluten are specifically prohibited in the manufacture of infant formula and follow-on formula. In addition, Gluten is a water-insoluble processed cereal-based foods and baby mixture of proteins that can foods intended for infants and young children under six months of age should damage the mucosa of the indicate the presence or absence of gluten. small intestines in people Foods labelled as ‘gluten-free’ or ‘very with the coeliac condition and low gluten’ may be accompanied by the statements ‘suitable for people intolerant is defined in EU legislation to gluten’ or ‘suitable for coeliacs’. ‘Gluten- free’ or ‘very low gluten’ foods may also as “a protein fraction from be accompanied by the statements wheat, rye, barley, oats or ‘specifically formulated for people intolerant to gluten’ or ‘specifically formulated for their crossbred varieties coeliacs’ if the food is specially produced, and derivatives thereof”. prepared and/or processed to reduce the gluten content or substitute the gluten-containing ingredients with other ingredients naturally free of gluten. FOOD ALLERGY AND INTOLERANCE FOOD ALLERGY 5 FOOD HYPERSENSITIVITY milk crustaceans eggs FOOD ALLERGEN LABELLING Many foods and food ingredients can trigger Certain derivatives an allergic reaction or intolerance, but only 14 require specific allergen labelling under of food allergens are EU law (see list below). For pre-packed exempt from food allergen food, food allergens must be declared on the packaging, e.g. in the list of ingredients, labelling because
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