Thursday, October 13, 2011

Food Allergy and Adverse Reactions: More Information

The combination of seeing some patients recently with suspected allergies to additives and recently published articles have led me to dedicate this entry to further education about food allergies.

1. What is "natural"?  The United States Department of Agriculture Food Safety and Information Service have a good list of definitions.  For meat and poultry, "A product containing no artificial ingredient or added color and is only minimally processed."

2. What about "hypoallergenic"?  The F.D.A.'s only statement on its definition applies to cosmetics, not foods. There are "no Federal standards or definitions. "The term means whatever a particular company wants it to mean." So the careful reader should become wary when reading this term.

3.  Can I rely on food labels?  Short answer: no, may be.  The FDA does have general guidelines.  In 2006, the Food Allergen Labeling and Consumer Protection Act became in effect. Eight of the commonest allergens were required to be listed on the labels if those eight allergens were even potentially present at any stage in the manufacturing of any ingredient in that food.  The intent was to help patients avoid them.  The eight allergens are: milk, eggs, fish, shellfish, tree nuts, nuts, wheat, and soybeans.  This has been effective.  BUT if a patient is allergic or has adverse reactions to other substances in foods, food labels can NOT be relied on.  Items for food processing, such as gelatin, do NOT have to be listed on labels, per the FDA, because they are deemed to have no effect on the food or be present in only trace amounts.  Unfortunately, trace amounts can be enough to trigger allergic reactions in highly sensitive individuals.

This is not to say that processing aids are not regulated.  They are and are defined clearly by such bodies as the European Union, FDA, and the Canadian government.

4. What else are in foods, besides foods?  Lots.  The FDA maintains a list of over 3,000 approved ingredients.  The categories include: preservatives, sweeteners, color additives (commonly called dyes), flavors and spices, flavor enhancers, fat replacers, nutrients, emulsifiers, stabilizers and thickeners, binders, texturizers, pH control agents and acidulants, levening agents, anti-caking agents, humectants, yeast nutrients, dough strengtheners and conditioners, firming agents, enzyme preparations, and gases. 

5. Have food dyes been linked to behavior problems in kids?  The short: no, but suspected.  This is a common topic in the media.  Here's a story on National Public Radio.  The FDA's stance is that food dyes, for they refer to them as color additives, are regulated and generally very safe.  In researching this, I learned some interesting facts.  There are only 7 artificial colorings approved plus 2 more for limited indications, in foods.   There are 2-3 dozen approved color additives for drugs, cosmetics, and medical devices.

6. Is it completely safe to eat in restaurants if they post or list all of their ingredients?  No, and this is not a knock against restaurants or food preparers.  The issue is called cross contamination, which means the transfer of harmful substances to foods.  This is inadvertent, but still a risk that depending on the severity of reactions must be considered.

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