Currently affecting over four million Australians, allergic diseases are an important chronic disease and public health issue in Australia, and, according to experts it’s a problem that keeps getting worse.

“The prevalence in Australia is the highest documented in the world and there is very good evidence to suggest we have an increasing level of food allergy in the community,” says Robin Sherlock, Vice President of the Allergen Bureau. “It’s difficult to know whether this is because we’re diagnosing it better, but it’s certainly considered a hotspot, particularly for children up to the age of five where 10 per cent are diagnosed with a food allergy.”

Sherlock, who is also Technical Manager at DTS Food Assurance, a laboratory that provides analytical services for the food industry, says that although food-allergic individuals will not always have a severe, life-threatening reaction, studies have shown that the feeling that you might have one still has a significant impact on a food-allergic person’s quality of life, as well as their families or carers.

Most food allergies are caused by peanuts, tree nuts, milk, eggs, sesame seeds, fish and shellfish, lupin, soy and wheat. Exposure to these allergens causes anything from mild discomfort to potentially life-threatening anaphylaxis. To protect sufferers, Food Standards Australia and New Zealand (FSANZ) states that these ingredients must be declared on the food label. That’s straightforward enough. So far so good.

Where it gets murky is that in manufacturing facilities, most of the time allergenic ingredients cannot be kept separate from non-allergenic ingredients. “It is possible to separate them, but does require time, effort and good processes,” says Sherlock.

“In today’s food manufacturing environment, it is virtually impossible to ensure zero chance of cross-contamination. This obviously has important implications for people with severe allergies, where even a minute amount of a peanut can cause severe allergic reaction or anaphylaxis,” says allergen expert Associate Professor Alice Lee from UNSW Chemical Engineering.

Associate Professor Lee, who also is a Co-director of the ARC Training Centre for Advanced Technologies in Food Manufacture (ATFM), says this has led to many food producers, the majority of which in Australia are small to medium sized enterprises (SMEs), opting for the most conservative route of over-labelling their products with allergen warnings to protect themselves against potential litigation, even if the chance of contamination is tiny.

This might seem a sensible thing to do, but according to Associate Professor Lee, it is dramatically reducing the safe product choices for allergy sufferers and is incredibly misleading. “The real problem with the precautionary allergen labelling, or PAL, statement today is that there is absolutely no way of knowing whether it has or doesn’t have allergen residue from cross-contamination,” she says. “The premise of PAL statements is that if the product lists an allergen to which you are allergic, then do not consume the product.”

James Roberts is an Honorary Fellow for the National Measurement Institute (NMI), which is part of the Department of Industry, Innovation and Science. But until recently he was the General Manager of the Analytical Services branch of NMI and primarily concerned with metrology, specifically in terms of allergens and food safety and making sure new testing methods are validated, scientifically rigorously and appropriately. He agrees that one of the biggest problems in Australia is making SMEs aware of the issues.

“If I were talking to a large multinational food producer, they would absolutely understand the reputational and technical issues associated with allergen management,” he says. “The problem is, however, this is not always well understood in SMEs where the impact of a death from their products or a food recall could be substantial.”

Roberts says he believes Australia is progressing well in terms of developing analytical testing and allergen testing kits and he is seeing a growing number of laboratories aspiring towards attaining ISO 17025, an internationally recognised accreditation that sets out the requirements for the competence of testing and inspection laboratories.

As President of the Allergen Bureau and Regulatory & Scientific Affairs Manager for Oceania for food giant Nestlé, Kirsten Grinter says it is important that industry has confidence in the tools they use. “The Allergen Bureau is primarily concerned with finding out what industry needs, and building a pathway to develop allergen management procedures and tools to ensure a consistent and transparent approach to risk review and assessment is applied. Strong robust allergen science that underpins quantitative risk assessment enables the industry in its goal of protecting the allergic consumer. Of course, by doing that we are also protecting the Australian and New Zealand food industry,” she says.

With growing confusion and frustration among suffers with allergies, the Allergy and Anaphylaxis Association (A&AA), a patient support organisation, is pushing for risk-based assessment and labelling. This is also at the heart of Associate Professor Lee’s ongoing research and activities. “I believe the next step is to use PAL to effectively communicate the risk.

This can be done by setting reference doses for each of the major allergens (ie the maximum dose that patients can consume without it causing an allergenic reaction) and the action levels (the maximum amount of an allergen that can exist in a product) accordingly,” she says.

“The Allergen Bureau [which advises the food industry on the management of food allergens through the Voluntary Incidental Trace Allergen Labelling, or VITAL, program], has worked hard to set the action levels based on the reference doses scientifically established by the VSEP [VITAL Scientific Expert Panel], to which FARRP (Food Allergy Research and Resource Program and a partner of ATFM), was a significant contributor. But in my opinion, we are currently at an impasse because FSANZ has not endorsed them,” explains Associate Professor Lee. “FSANZ are concerned about the uncertainty and accuracy of the analytical techniques used to measure allergenic residues in food, particularly in processed food.”

Grinter acknowledges these issues. “We’re not there yet and it is constantly evolving, but good, quantitative risk assessment is accepted by the industry and the Allergen Bureau’s aim is to really embed that.

One key initiative in this space is the National Allergy Strategy which was launched in 2015 by the Australian Society of Clinical Immunology and Allergy (ASCIA) and A&AA. Sherlock says the Strategy is a world-leading program which is pulling all the strands together by recognising that allergen management is a significant issue and developing tools to help people. The latest development is a free online training course that provides information and interactive videos relevant to people in the food service industry.

Another important initiative is the Food Allergen Management Symposium (FAMS), which is being championed by Associate Professor Lee. “In 2017, the Symposium attracted 165 delegates from 102 organisations across 10 countries. Most of our delegates were from the food industry, but we also had clinicians, dieticians, food scientists, regulatory bodies, biomedical researchers, and analysts,” says Associate Professor Lee.

The Symposium was all about improving communications between all the different stakeholder groups and Roberts, Sherlock and Grinter, who co-chaired FAMS2017, unanimously agree the event was hugely valuable. “The Symposium was about ‘remove the disconnects’ and getting everybody on the same page in terms of what’s happening,” says Roberts.

Grinter continues: “There is real power in all working together on this. One of the best parts of the three-day event was having multiple stakeholders in the room: dietitians, nutritionists, clinicians, industry, regulators and ‘enforcers’, all hearing the individual and collective viewpoints – that’s critical.”

Having brought the stakeholders together, the next steps will be to keep the momentum going. “There is still so much to do, and much we don’t understand, but we’re in a great position to be able to continue to effectively address existing and emerging problems of this number one food safety issue in the future,” says Associate Professor Lee.

Words by Penny Jones