Research

2024 Decoding Food Allergies: Insights from NHS data

A new study funded by the Food Standards Agency (FSA) alongside Food Standards Scotland, and carried out by researchers from Imperial College London used NHS Data to examine trends in food allergy epidemiology, including severe, food-induced allergic reactions.

Background

People with food allergies may experience reactions that are often categorised as non-severe, near-fatal food anaphylaxis and fatal food anaphylaxis. While non-severe allergic reactions to food are up to 1,000 times more common than fatal food-related anaphylaxis, obtaining data relating to the circumstances under which these reactions occurred is challenging under the current diagnosis coding system used in the National Health Service (NHS).

The project analysed NHS data in relation to hospitalisations, primary care visits and Accidents & Emergency (A&E) department visits from 1998 to 2018 and considered two key questions:
– What are the trends in the occurrence of food hypersensitivity reactions and their consequences in terms of healthcare encounters (both to hospital and primary care)?
– What are the circumstances surrounding severe, life-threatening reactions to food?

Key findings

– Food-induced anaphylaxis represented 29.4% of reported anaphylaxis admissions from 1998 to 2018
– Since 1998, the rate of hospital admissions for food-induced anaphylaxis has increased year-on-year by an average of 5.7%
– Despite increased admissions, the case fatality rate (proportion of hospital admissions associated with a fatal outcome) more than halved, from 0.7% in 1998 to less than 0.3% in 2018
– 152 deaths were identified during the study period where the cause was likely to have been food-induced anaphylaxis
– Overall, At least 86 (46%) of total fatalities were triggered by peanut or tree nuts
– The most common cause of fatal anaphylaxis in children aged under 16 years was cow’s milk; responsible for 26% of fatalities in this age group

The FSA noted that advancements in identifying and managing anaphylaxis may have contributed to the decrease in case fatality rates. However, the study also noted ‘significant under-prescribing’ of adrenaline auto-injector devices (AAI). Data showed that 40% of individuals with prior food-induced anaphylaxis were not prescribed AAI and at least 59% did not have AAI on repeat prescription.

Researchers at Imperial College London, who conducted the study, also found from their data analysis that the total estimated prevalence of food allergy in the UK increased from 0.4% to 1.1% from 2008 and 2018, with the highest prevalence in young children. Read their news report.

Read the FSA’s blog, the research report and the project paper

Next Steps
The FSA is currently creating best practice guidance for food businesses in the non-prepacked sector (such as restaurants and cafes) on how to provide allergen information to consumers. This guidance will help businesses to improve the availability of allergen information, and support individuals with food allergies or food hypersensitivities in making better, more informed food choices when eating out.

2024 Patterns and Prevalence of Adult Food Allergy (PAFA)

New research funded by the Food Standards Agency and carried out by the University of Manchester, in conjunction with Manchester University NHS Foundation, Amsterdam University Medical Centre, University of Southampton and the Isle of Wight NHS Trust has found that around 6% of the UK adult population are estimated to have a clinically confirmed food allergy. This equates to around 2.4 million people.

The project found that more than 30% of adults report living with symptoms of food hypersensitivity; an unpleasant reaction as a result of consuming a particular food. There are different types of food hypersensitivity including a food allergy, food intolerance and coeliac disease. When this was investigated further through a clinical assessment, it was found that around 6% of the UK adult population (2.4 million people) are estimated to have a clinically confirmed food allergy.

Key findings

– Foods such as peanuts and tree nuts like hazelnuts, walnuts and almonds, are most likely to cause an allergic reaction.
– Many individuals also had allergies to fresh fruits like apple, peach and kiwi fruit. These were associated with allergies to birch pollen, also known as pollen-food allergy syndrome or oral allergy syndrome.
– Allergies to foods like milk, fish, shrimp and mussels were uncommon
– Childhood food allergies persist into early adulthood, and then further increase with around half of food allergies developing in later adulthood. Key risk factors for childhood onset food allergy were early onset eczema, co-existing asthma or hayfever.
– Many of the individuals were found to have food allergies that were caused by several different foods.

Read the FSA’s news release and the full report [pdf]

2021 Provision of Allergen Information Study

New research for the Food Standards Agency and Food Standards Scotland finds allergen management by food businesses has significantly improved since new regulations came into force in 2014, but ‘there is still much to do’.

The findings of the study show a dramatic improvement in the provision of allergen information and better food safety for consumers. In summary, the research showed:

– Better provision of allergen information: the vast majority of the 2,303 food business operators surveyed said that they provide written or verbal information about each of the 14 allergens they sell.
– Improved allergen labelling policies: 95% of food businesses said they have a written (83%) or informal policy (12%) on allergen labelling – up from 60% in 2012. Of 55 market traders surveyed, 93% had written (78%) or informal (15%) policies.
– Better checking of allergenic ingredients: almost all (99.9%) of food businesses had processes in place to check if a product contains allergenic ingredients – up from 92% in 2012. Nearly nine in ten food businesses (86%) check or audit the ingredients they obtain from suppliers and wholesalers (71% in 2012).
– More training for staff: half (49%) of food businesses had undertaken formal training on food allergens, up from a third (34%) reporting this in 2012. Almost all food business operators provided staff with allergen information (99%), most commonly through verbal training (90%).

The study, carried out by IFF Research on behalf of the Food Standards Agency and Food Standards Scotland, also provided a new baseline of understanding for food prepacked for direct sale (PPDS). This includes exploring food business operators’ (FBOs) awareness and intentions in the light of new legislation coming into effect on 1 October 2021, which requires them to provide full ingredients labelling for PPDS food.

Visit the Food Standards Agency website to read their news release and the full research report.

2020 Food Allergies Survey

A survey has highlighted the challenges facing young people with food allergies and intolerances.

The research was undertaken by Food Standards Scotland (FSS) in partnership with Young Scot between 15 January and 10 February 2020.

Of the 570 responses, 28% (160 people) reported having a food allergy, most commonly to peanuts, cereals (including gluten), tree nuts, milk and eggs.

The survey also found that:

– 44% of respondents with a food allergy wouldn’t always mention it to the person they’re buying food from in a restaurant or café
– The main reasons given for this were because they don’t want to make a fuss, don’t think it’s important to tell staff or are embarrassed to say
– 34% of respondents aged 12 to 18 who wouldn’t always mention their food allergy stated that they use the menu to check whether the food they are ordering contains allergens
– 40% of respondents don’t always check the ingredients labelled on the food they buy or order to make sure it’s safe
– Only around half (49%) of those who need to carry an allergy pen or auto-injector always carry one with them
– Around one in 10 respondents worry about it a lot, and the same number have been teased or bullied because of it
– A new campaign from FSS, supported by Allergy UK and Young Scot, aims to encourage young people with food allergies across Scotland to discuss their food allergies with friends, and when they’re eating out and about, and to remember their allergy pen if they need one.

Visit the Food Standards Scotland website for more information about the survey and their campaign.

2018 Food Allergies Survey

A bespoke online survey of 16- to 24-year-olds revealed that over half of young people with a food allergy or intolerance had avoided eating out in the previous six months due to their condition.

The research was undertaken by the Food Standards Agency in partnership with Allergy UK (AUK) and the Anaphylaxis Campaign (AC) between July and September 2018.

Of the 2,599 respondents who participated, 49% reported having a food allergy, 33% had a food intolerance and 18% reported both a food allergy and intolerance.

The survey also found that:

– 88% of respondents reported eating out or ordering takeaways/ food online without support.
– Before eating out without support, 55% of respondents reported always researching the menu, and 49% said that they always pack their medication.
– When eating out, 59% of respondents said they often tend to visit the same places.
– When ordering a takeaway/food online without support, 51% of respondents stated that they always check an online menu’s allergen information before choosing what to eat. 39% said they always only order dishes that they know are safe.
– Overall, 60% of respondents said they had avoided eating out in the last six months because of their condition.
– 67% of respondents said that they were aware of the legal requirement of food businesses to provide customers with information on the top 14 allergens when used as ingredients in the food they serve.
– 53% of all eligible respondents stated that they felt extremely, very or quite confident that food businesses are able to provide correct information regarding allergens in food they serve.
– 14% reported feeling extremely confident asking for allergen information when eating out or ordering a takeaway/ food online, while 14% reported feeling not at all confident.

Visit the Food Standards Agency website for more information about their Food Allergy and Intolerance Research Programme.