The Epipen epidemic – how is the industry coping with allergens?

As the number of allergy sufferers in the UK rises, what can food companies do to ensure they aren’t putting consumers at risk?

13 December 2019
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With the number of allergy sufferers on the rise, particularly among young people, one ill-informed waiter or one poorly labelled sandwich could mean the death of a child, and, potentially, the death of a business.

In 2016, the threat became a reality. Fifteen-year-old Natasha Ednan-Laperouse died of anaphylaxis on board a flight to Nice after unknowingly eating sesame contained in a Pret baguette.

Less than a year later, 18-year-old Owen Carey died after eating a grilled chicken burger in Byron. Carey, who had an allergy to dairy and made staff aware of it, was not told that the chicken was marinated in buttermilk.

The long-term rise in allergy sufferers is staggering – there was a five-fold increase in peanut allergy sufferers alone in the years 1995-2016. Two million people in the UK have a food allergy, and allergies of one kind or another currently affect 20% of people in Europe, a figure expected to rise to 50% by 2025.

A rise in sufferers means a rise in reactions. UK hospital admissions for anaphylactic shock in children have increased by 72% in the last five years, and a 2016 report by Allergy UK found that one in four people with allergies have suffered a reaction whilst dining out.

The young are the most at risk, says Lynn Regent, Anaphylaxis Campaign CEO. According to a 2018 report by Anaphylaxis Campaign in collaboration with the FSA, only 49% of 14-24-year-olds always pack their medication when eating out, and just 14% said that they felt ‘extremely confident’ asking for allergen information.

“The issue is that even in the few deaths that we get, which is between 10-20 a year, the majority are in the 15-25 age group,” she says. “They’re young people who for the first time are eating a lot away from home, they’re risk takers, they want to eat the same as their friends.”

Risk takers or otherwise, children should not have to die in order to prompt a response, believes FSA CEO and chairman of Pret’s food advisory panel, Tim Smith.

He emphasised the importance of pro-active action when he spoke at MCA’s Food To Go Conference in January, imploring the industry to show “leadership to do the right thing, rather than waiting to be regulated into taking action. I would say that right now, we are falling short, and have been for some years.”

Constructive changes

Since the death of Owen Carey, Byron staff are now required to ask customers if they have any allergies or dietary requirements, rather than relying on the customer to raise the topic, and the word allergen is highlighted on the order ticket when staff are informed. These are constructive changes, although, given that Carey communicated his allergy to staff before ordering, the difference these would have made in his case are unclear.  

For assistant coroner Briony Ballard, Byron’s efforts aren’t enough. Speaking at the Carey inquest at Southward coroner’s court in September, Ballard argued that all menus should include a red ‘A’ next to any dish containing allergens.

In response, Aimee Leitner-Hopps, Byron’s technical manager, told the court this would lead to 95% of items on the menu carrying the mark. “I don’t think that the benefit would be there,” she said. “The benefit is in having the discussion and making sure everybody is aware of a customer having an allergy.”

At Pret, whilst the business was not informed about Natasha’s death until a shocking nine months after the tragedy, the response has been fast and thorough. In May the brand announced their commitment to a five-point allergy plan to better protect the allergic consumer.

“Labelling is only one part of the solution,” says Clare Clough, Pret UK MD. “We are looking at this end-to-end, reviewing our supply chain, changing our product development, updating our kitchen processes and transforming the customer experience in-shop. This is all so we can provide our customers with the information they need to make the right choice for them.”

Natasha’s Law

In June this year, Defra announced ‘Natasha’s Law.’ Due to come into force in October 2021, the legislation will require all food businesses to highlight allergens and include full ingredients labelling on pre-packaged food.

In line with this, the FSA will be launching an allergen awareness campaign and publishing an updated version of its ‘Safer Food Better Business’ guide, instructing businesses on the action they should be taking in relation to food allergens.

No one would argue that the intentions behind Natasha’s Law, and the FSA drive intended to support it, aren’t honourable and justified. But Kate Nicholls, UK Hospitality CEO, worries about the practicalities of implementation across the sector.

“In environments where there’s a freshly cooked, daily-changing menu, the practical implications of full labelling and disclosure would be quite challenging,” she says.

“There is that fine balance – you cannot take responsibility entirely away from the allergic customer. As somebody with food allergies myself, it is my responsibility to make sure that what I’m eating is safe. If somebody came back to me and said they could not guarantee no cross-contamination, then that’s an honest conversation and it’s better than taking a risk with somebody’s health.”

An FSA research project carried out this year found that for food products with and without advisory labelling, some contained ‘sufficient undeclared allergen residue,’ enough, in fact, to ‘pose a risk to public health.’ Cross-contamination is a force unto itself, label or no label.

The sensitivity of the topic makes the responsibility debate contentious. Leon CEO John Vincent’s caution that those with serious allergies ought to “consider carefully whether you choose to dine with us” experienced a monumental backlash in January this year.

Regent argues that there’s responsibility to be taken on both sides, that “someone with an allergy will constantly be assessing risk. But they need help. The restaurant needs to take responsibility for knowing exactly what’s in the food that they’re serving.”

The challenge is to manage and share such responsibility, without entering into a tiresome and unproductive blame game.

Modern response

There is no shortage of theories on what is causing the rise in allergy sufferers in the first place.

A popular answer is the hygiene hypothesis. This argues that if children are cleaner, or have less contact with disease when they’re young, their immune systems can’t mature properly or develop appropriate responses to potential allergens.

More recently, some researchers have blamed a lack of vitamin D, which is essential for lung and immune system development, while others prefer the microbiome theory, claiming processed foods and antibiotics have harmed our natural immune system.

In short, other than the fact that the UK, Canada and Australia are seeing the most prominent rise globally, nobody knows anything for sure. The rise in allergy sufferers constitutes a very real and very modern cultural epidemic, and requires an equally modern response.

Modern technology is already gaining an ever-increasing role in the eating and drinking out sector. From digital menus to pay-in apps, the ease and adaptability of tech continues to facilitate the consumer experience. Beyond improving customer experience or engagement, could technology provide the answer to customer safety?

“I think technology is fundamental,” says Ellis Northover, head of business development at NT Assure. “There is limited information that you can print on a label, as well as the environmental impact of printing on paper. If I could access all the data before I could make a decision about a purchase on a phone, app or tablet it would be incredibly beneficial, particularly if I’m cautious about the food that I’m eating.”

Northover is the co-founder and director at Dinepilot App. Aimed at providing consistent food information, the app acts as both a data storage system for businesses and a trusted source of ingredient information for consumers.

Updated several times an hour, the app includes full ingredient declarations and nutrition information, as well as highlighting allergens. Pret, Mitchells and Butlers and TGI Friday’s are already on the app, and Northover says they are in talks with several other brands that seem capable of living up to Dinepilot’s data principles.

“Before we work with a brand, we will insist that they comply with our 10 principles of good quality data. The data has to be live, the organisation has to have good quality management systems in place and the food hygiene rating for the site must be 3 or above – if they’ve got a 1 or a 2 then we won’t put that site on because that might be indicative of the food hygiene or other allergen or management issues,” he says.

It’s certainly a step in the right direction. The app’s real-time updating functionality allows businesses to change with the growing epidemic, providing a solution beyond the reactive. However, although Regent sees the value in apps, she also worries about their effectiveness.

“Lots of people are very keen to develop apps, and that’s fine, but they have to be in real time because otherwise they can be dangerous. The other issue is that everyone automatically thinks that a 15-25-year-old is always going to be using apps. I think that sometimes we overestimate that.”

Debbie Daley from Instinctif Partners’ crisis and recall management team argues that whilst tech is useful, it isn’t a fool-proof solution and must aid, rather than replace, verbal communication.

“If you’re leaving it down to consumers asking about allergens, and they’re not confident about being really clear about what their allergy is, then that’s obviously difficult,” she says.

“Communication is absolutely critical in terms of training people to ask the right questions and understand the information they’re being given by the consumer.”

A recent poll by Fourth found that 73% of people were not asked if they had allergies on their last trip to a restaurant, perhaps a consequence of the fact that one in four hospitality staff said they did not feel confident advising customers on allergens.

But clearly the hospitality industry is doing everything in its power to adhere to, and promulgate, a stringent food safety culture. New measures and procedures are being introduced, and it’s in the interest of the industry to ensure that the importance of allergens is ingrained in everybody from board room to dining room.

Ultimately there is a multifaceted chain of responsibility for mitigating the danger posed by allergens, and communication is key. Suppliers and operators need to be transparent, employees need to be informed and well trained, and consumers need to be willing to speak up. The responsibility is not singular. And neither is the solution.

 

*This article was originally published on Food Spark’s sister service MCA. For more information about MCA, please contact laura.tudor@mca-insight.com

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