Whether your child has received a new food allergy diagnosis, or you are a seasoned food allergy parent, reading food labels has its challenges.
Classically when we think of food allergies, we think of reactions like hives, swelling, vomiting, difficulty breathing, and changes in blood pressure shortly after ingestion of a food. But there are also lesser-known types of food allergies that are hallmarked by different symptoms. Those can include food protein-induced enterocolitis syndrome (FPIES) and eosinophilic disorders. In other words, every child with food allergies is different. Some need to avoid even the most minuscule amounts of an allergen. Others may be tolerant of those very small amounts.
As with any food-allergy-related diagnosis, it is important to be vigilant about food avoidance . This is because an accidental exposure can cause an adverse reaction – ranging from mild to very severe.
Avoidance is our first-line of defense in management of food allergies. Because of this, I’d like to share a process of reading food labels so that families can learn how to avoid those allergens.
How to Read a Label for Food Allergies:
1. Understand the law
First, it’s important to understand what manufacturers are required to report. Labeling laws are different all across the world, so keep this in mind if you travel internationally. For the purposes of this post, we’ll stay focused on the United States.
In 2004, the U.S. passed a food allergen labeling and consumer protection act. This mandates that for packaged food products sold in the U.S. containing any of the eight major food allergens, the allergen has to be listed on the label. The eight major food allergens are milk, egg, wheat, soy, peanut, tree nut, fish and crustacean shellfish. This law, however, does not include foods that “may contain” an allergen. It is only included if the food is part of the ingredients list. Read more about that in #3 below.
2. Know what to look for on the label
The ways that manufacturers list any of the eight major allergens is not always obvious or consistent. For instance, they can specifically call out the allergen underneath the ingredients list with a statement: “Contains wheat.” Or, if flour is the listed ingredient, it could call out the allergen by putting “wheat” in parenthesis like this: Flour (wheat). The allergen can also be bolded within the ingredients list. Again, this means that the allergen is present in the food.
3. Recognize that “trace” foods are not required to be listed
Manufacturers are not required to list the presence of an unintended allergen, or “trace” allergens. We also call this precautionary allergen labeling. This means that cross-contamination could have occurred during the manufacturing process. This would include using shared equipment of an allergen or within close proximity to an allergen during the manufacturing process. Terms you may see on a label that identify this could include: “may contain”, “might contain”, “may contain traces”, “ may be present”, “produced in a factory with”, “produced on the same line”, “manufactured on shared equipment with”, “packaged in a shared facility with,” etc.
These terms are not required and a manufacturer can choose whether or not to include this labeling.
4. Know where to look for precautionary allergen labeling
Often the precautionary allergen labeling is under the ingredient list. However, it could be located anywhere on the package. Be sure to read the entire package to make sure that you don’t miss it. Sometimes it’s on the opposite side of the ingredients list. Sometimes it’s below the ingredients list, but underneath some other type of marketing wording.
5. Realize that manufacturers can change their process at any time
Because manufacturers can change their production processes at any time, it’s important to read food labels every single time kids eat something. Parents and caregivers need to do this even for known and trusted foods they’ve been eating for years. This may sound exhausting, and it is, but it will get easier with time as you make it part of your routine.
6. Be aware that allergens can have different names
Further complicating things is that allergens can be referred to by different names. Or they’re called different things when they are a derivative of a particular food. For example, “whey” is the watery part of milk after the formation of curds. “Marzipan” is made of almond meal. However, if a food contains one of the 8 major food allergens, it must be identified under the food allergen labeling and consumer protection act of 2004.
The Food Allergy Research & Education (FARE) web site is a great resource to learn all of the allergens and their varying names.
If you are concerned about a particular packaged product, know that it is completely acceptable to call the manufacturer and ask about their ingredients and production processes. The risk of cross contamination depends on a lot of different things. For instance, the type of food it is can make a difference. Going directly to the source is sometimes the best way to decide if a food is safe for your child.
Because food allergies are different for every kid, families should be having conversations with their providers about label reading and food avoidance for their particular allergies.
If you would like to learn more about the Food Allergy Program at Cincinnati Children’s, please call 513-636-2601 or fill out an online form for more information.
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