Growing adoption of plant-based diets helps explain why more people are suffering serious reactions to non-regulated allergens. Nick Hughes reports.
Is allergens regulation keeping pace with our changing diets, and in particular the rise of plant-based eating?
That was the subtext behind a recent study that concluded there is a strong case for adding buckwheat, peas and lentils, pine nuts, and goat’s and sheep’s milk to the list of food allergens that require mandatory labelling.
It follows in-depth analysis of 20 years of data reported to the Europe-wide Allergy Vigilance Network, published in the journal Clinical and Experimental Allergy. Researchers identified eight allergenic foods that are not currently regulated that each contributed to more than 1% of reported cases of food-induced anaphylaxis (FIA), the most serious level of food allergic reaction that can sometimes lead to death.
The study is based on analysis of almost 3,000 cases collected by allergy experts and hospitals, mostly in France, Belgium, and Luxembourg, between 2002 and 2023. Researchers focused on foods that don’t currently feature on the list of 14 allergens that have to be labelled under EU and UK law, but which triggered at least 1% of the reactions reported during the period. For each case, they assessed the food involved, the age of the person affected, how serious the reaction was, whether it happened more than once, and whether the allergen was hidden in the food. They also studied trends over time to see if certain allergens were becoming more common, more serious, or harder to avoid.
They concluded that four of those foods – kiwi, beehive products (like honey), apples and alpha-gal (a sugar molecule found in some meat products) – do not merit inclusion on the list of 14, however the remaining four should be considered for inclusion due to the frequency and severity of reactions to them and the potential for hidden exposure.
Changing diets
The findings are significant not just for what they tell us about emerging allergenic risks but for how food trends are shaping people’s exposure to these ingredients. Researchers said growing cases of FIA linked to these emerging allergens can in part be explained by changing dietary habits over the past decade often motivated by health and sustainability.
Those following gluten- or dairy-free, vegetarian or vegan diets, for example, are encouraged to consume a wide variety of plant-based foods to meet their nutritional needs. By eating more legumes like peas and lentils, seeds including pine nuts, and buckwheat (in a gluten-free diet) people are being exposed to new risks of allergy and anaphylaxis, the study suggested.
It’s important to state that the researchers do not make the case for reducing consumption of these foods, only for regulators to be proactive in recognising the risk they pose. The current list of 14 regulated allergens is set out in 2011 EU legislation on food information to consumers. It includes foods like nuts, fish, mustard, eggs and cereals containing gluten. Yet despite the legal text providing for the possibility of revision “in the case of the emergence of a risk to consumers’ health”, the list has not been updated since 2011, nor has the UK deviated from it since Brexit.
In that period our food consumption habits have changed significantly. Consider the example of peas – grouped together with lentils in the research due to their frequent cross-reactivity (when the proteins in one food are similar to those in another, leading the immune system to mistakenly identify them as the same allergen). Around half of the FIA cases in the study associated with peas were linked not to those consumed in their natural form but to extracts found in ultra-processed food products.
Peas are increasingly used by the food industry to produce meat and dairy substitutes due to their favourable textural and flavour profile. The likes of Pizza Hut, Ben & Jerry’s and Beyond Burger have all used peas in plant-based products, which often appear in ingredient lists in the form of extracts such as pea protein isolate, pea fibre or pea flour. The charity Allergy UK has warned that peas may also be hidden within more generic descriptions like vegetable protein or vegetable fibre. That’s permitted under the current regulatory framework, however should peas be added to the list of 14 allergens businesses would be required to declare their presence in a formal way, by highlighting them in bold on pre-packaged foods and communicating their presence at the point of sale in out-of-home settings.
Buckle up
Buckwheat is another up-and-coming ingredient gaining popularity with chefs and foodies. French artisan patisserie Orée Boulangeries, which operates sites across central London, produces a buckwheat bread within its artisan range. Retail brands have also sprung up such as Grechka, which means buckwheat in Russian.
Buckwheat was identified as one of 50 future foods we should eat more of due to their nutritional and sustainability qualities by WWF and Knorr in a 2019 report. The grain is described in the report as “one of the healthiest, nuttiest and most versatile grains”; is considered “an ideal higher protein swap for flour in pastas and breads”; and can also be “a great alternative to rice”.
It’s also a growing allergen risk – and not just among consumers. Occupational exposure was mentioned in 15% of cases involving buckwheat in the study including six bakers, three crepe makers and two warehouse workers, while one case occurred in a 15-year-old girl working as a bakery student.
Policy change
Updating food law, especially at EU level, is a notoriously slow process and there seems no immediate prospect of buckwheat, and peas and lentils, along with pine nuts, and goat’s and sheep’s milk, being added to the list of 14. The Food Standards Agency (FSA) told BBC News it recognises that there are a significant number of foods that can cause allergies or intolerances. “This is why pre-packed foods must list all ingredients, why food businesses must provide clear information about allergens and why we encourage consumers to speak up about their allergies,” said deputy director of food policy, James Cooper.
Yet it’s also true that allergens is one of the most dynamic areas of food policy in the both the UK, EU and globally. In March this year, the FSA published new best practice guidance which states out-of-home businesses should provide written allergen information to customers when serving non-prepacked food. Written information should be available alongside a conversation between servers and customers about their allergen requirements in settings like cafés, pubs and restaurants.
Moves have also been made to tighten guidelines around the use of a precautionary allergen label (PAL), often described informally as a ‘may contain’ label. Updated guidance published by the FSA in 2023 states that a PAL should only be applied to food where there is an unavoidable risk of cross-contamination.
Meanwhile, institutions like the World Health Organisation and Food and Agriculture Organisation continue to weigh up whether it’s time to bring PAL into the regulatory sphere by developing thresholds for when a PAL statement should be used and standards for how the risk to the public should be communicated.
Extending the list of 14 regulated allergens would add complexity and cost to businesses but could ultimately save people’s lives. It’s another balance regulators will need to strike in this most delicate of policy areas.
