For the many consumers with a peanut allergy, going to a baseball game or getting aboard an airplane may be dangerous outings. So much so the Minnesota Twins Major League Baseball team designated several peanut-free skybox games this season for the comfort of those with peanut allergies and their families. In addition, Continental Airlines announced it is phasing out serving peanuts on flights.
Such actions are not surprising considering peanut allergies doubled in children during the five-year period between 1997 and 2002, according to the Food Allergy and Anaphylaxis Network (FAAN). And it’s not just peanut allergies, as the other seven common allergens — milk, eggs, tree nuts, wheat, soy, fish and shellfish — also are increasing in prevalence. Overall, 12 million Americans, or 4% of the population, have food allergies, according to the FAAN, and about three million children have food allergies. In addition, one in 17 children under the age of three has a food allergy.
"We know that we are becoming more allergic as a population in general, so all allergies are increasing, and food allergy sits under that allergy umbrella," said Anne Munoz-Furlong, chief executive officer of the FAAN. "We also know that other countries — other industrialized countries — are reporting an increase in allergies, specifically food allergies. So it’s not something we are only seeing in the U.S., we are seeing it around the world."
Getting to the root of the problem
Why have food allergies become this prevalent?
Researchers don’t know the primary cause, but several theories exist about why the increase is occurring, especially in industrialized countries. The main theories center around the concept that perhaps society has cleaned up the environment too much, and the immune system is looking for something to do. In addition, with so many vaccines and the eradication of various diseases, the immune system simply doesn’t have as many pathogens to fight as it did historically. The possibility exists that as a result, the immune system is creating problems where there are none.
This theory is called the hygiene hypothesis, said Scott Sicherer, associate professor of pediatric allergy and immunology at the Mount Sinai School of Medicine in New York. He said evidence backing this theory includes indications there seems to be more allergies in those who do not live a farming lifestyle and less allergies among those who have fewer siblings and those who attend daycare. All of these situations would represent the increased presence of bacteria and pathogens leading to fewer allergies.
Ms. Munoz-Furlong said increases in allergies also may be related to the way children are being introduced to foods.
"We are introducing foods at a much younger age to children than ever before," Ms. Munoz-Furlong said. "And perhaps for some of these kids the immune system is immature and doesn’t know what to do with these proteins. When in doubt, the immune system will fight."
She said the concept of home-cooked meals and introducing foods slowly is going away. In addition, she noted the whole food supply has become more diverse, with a lot of that having to do with adding nuts.
"It’s probably a combination of factors that all together are leading to an increase in food allergies," Ms. Munoz-Furlong said. "But we’ve clearly done something to our environment because allergies in general are increasing as well."
Mr. Sicherer rejected the idea that perhaps it’s just food allergies are more diagnosed today than previously. He said while there my not be good studies tracking allergy rates in previous decades, he said interviews with school nurses reveal they simply didn’t see as many allergies in previous decades. In addition, the FAAN said research suggests food-related anaphylaxis might be underdiagnosed.
Mr. Sicherer also pointed to the rise in food allergies as being tied to the rising rates of all types of allergies.
Not only are allergies more prevalent than before, but some allergies are persisting longer in life than originally thought. The FAAN said according to a 2007 study, of 800 children with a milk allergy, only 19% had outgrown their allergy by the age of four and only 79% had outgrown their allergy by 16. In general, Ms. Munoz-Furlong said most children will outgrow their allergy to milk, egg, wheat and soy. She said peanut and tree nut allergies are not outgrown as commonly.
"We are seeing that kids are hanging onto their allergy longer, which again speaks to something has changed and we are becoming more allergic," Ms. Munoz-Furlong said.
Impact on the industry
Mr. Sicherer said in some quality of life studies that have been conducted, those living with allergies reported going to a restaurant had the biggest impact on their quality of life because finding allergen-free foods may be difficult.
He also said label reading for those with allergies may be confusing. While the eight major allergens are required to be labeled clearly under the Food Allergen Labeling and Consumer Protection Act, there are many food products at risk of containing allergens that are labeled with advisory labeling not covered under the act.
While families of children with food allergies commonly refrain from buying products with cautionary labeling, these families sometimes are less strict when a cautionary statement reads "made in a facility with an allergen" as opposed to "may contain an allergen" because they perceived those words to mean there was less of a risk. Referencing an earlier study, Mr. Sicherer said the products labeled "made in a facility with an allergen" were actually more likely to be contained with higher levels of the allergen than those labeled "may contain an allergen."
"You can’t really go by the way they are saying it on the label," Mr. Sicherer said.
Currently, there simply isn’t regulation of this cautionary area.
"That is creating a lot of confusion and concern for our patients who are reading the labels and wondering, ‘What do they mean by this,’" Mr. Sicherer said.
He said it would be helpful if there would be more guidance to companies on what words to use and when to use them.
"The food industry is getting more and more pressure to provide allergen-free foods," Ms. Munoz-Furlong said. "Specialty food companies are springing up to address those needs."
She also emphasized the impact of increasing rates of allergies on restaurants and how there is a need for restaurants to provide accurate ingredient information. That also speaks to a need for further training of restaurant employees.
She also said the market for allergen-free foods is growing exponentially due to the need and interest. She said not only do 12 million Americans have a food allergy, but families of those with allergies often change their eating and dining habits to support that person. As a result, she said the impact on the market is three to four times the size of the affected population, resulting in significant buying power for this market.
According to the Global New Products Database from Mintel, Chicago, there were 887 food and beverage products introduced in 2007 claiming low, no or reduced allergens, up from 663 in 2006 and 426 in 2005. So far in 2008 there have been 754 products introduced making allergen-friendly claims. The top categories for these claims in 2008 include snacks, beverages, dairy, bakery, and sauces and seasonings, Mintel said.
Hope for a cure
Currently, the only true cure for food allergies is strict avoidance. But Ms. Munoz-Furlong said avoiding problem foods is harder than it seems. She said even with great care the average person with an allergy will have a reaction once every five years. She said the issue is not people trying to take risks to see how much of the food they can handle, but they eat foods they think are safe and end up with a reaction. Specific problems include ordering fried food in restaurants as other food with allergens may have been fried in that oil.
"I’m more encouraged now than I was five years ago that we are going to be seeing some dramatic increase in the treatment of food allergy," Ms. Munoz-Furlong said. "We’re not quite there for a cure, but if we can move people away from significant life-threatening reactions upon accidental ingestion and they would only have mild reactions, we are protecting them. I think that’s a great first step."
Currently, the National Institute of Health is sponsoring a consortium of food allergy research involving five different sites in the United States undertaking projects for the treatment of food allergies, especially egg and peanut allergies.
"There is definitely more in the pipeline now than ever before, and there are a variety of different approaches," Mr. Sicherer said.
Mr. Sicherer added that some of the methods being studied include herbal remedies, oral immune therapy and vaccines.
"What we know is the tip of the iceberg," Ms. Munoz-Furlong said. "Everyone for so long was looking at the tip of the iceberg and thinking that’s all there was. We are now learning the problem is much bigger than anyone imagined."
This article can also be found in the digital edition of Food Business News, July 8, 2008, starting on Page 29. Click