6   Managing the allergy

6.1.     Severe allergic reactions since allergy was first identified 
6.2.     Approach to eating foods containing substances of concern
6.3.     Ways in which food allergies are managed 
6.4.     Approach to broad product categories in screening for substances of concern

 

6.1 Severe allergic reactions since allergy was first identified (Q13a)

Respondents were asked whether the person with the most serious food allergy had had a severe allergic reaction since the allergy was first identified. The results are shown in Table 6.1a.

Table 6.1a   Occurrence of severe allergic reaction since the allergy was identified

Q13a   Has the person with the most serious food allergy had a severe allergic reaction since the allergy was identified?  

.	total sample	country		time since allergy identified
.		Australia (a)	New Zealand (b)	less than 1 year (c)	More than 1 year but less than 2 (d)	2 years or more (e)
base: all respondents ( n)	(n=510)	(n=413)	(n=97)	(n=70)	(n=78)	(n=360)
	%	%	%	%	%	%
Yes	42	40	a 52	e 26	e 33	cd 48
No	57	b 59	48	e 74	e 65	cd 52
Not answered	1	1	0	0	1	0
total	100	100	100	100	99*	100

^abcde    Indicates categories where there was a significant difference between the results in each column (significance at   the 95% confidence level )
*         Does not add to 100% due to rounding.

Just under half of those with a food allergy (42%) had had a severe allergic reaction since the allergy was first identified. The occurrence of severe allergic reaction was significantly higher in New Zealand   than inAustralia (52% versus 40% respectively).  

As indicated, the propensity to have had an adverse reaction increased along with the time since the allergy was first identified.

There was no significant difference by membership of an allergy support group.

By allergen, some with the most serious food allergy had been more susceptible to a severe allergic reaction than others. Those with the following allergies in the household had the highest occurrence of severe allergic reaction since the allergy was first identified:

• sulphites(65%);
• milk(56%);
• fish (54%);
• other allergies (50%);
• sesame seeds (47%); and
• egg  (47%).

The occurrence of adverse reaction for those with peanut and / or tree nut allergies were the two least reported, despite being the two highest reported allergies in the households of people with allergies (Table 3.4d):

• peanuts (41%); and
• tree nuts (42%).

The reasons for these differences were not further explored, though may be due to differences in the ease with which these allergies can be managed. Respondents who had a severe allergic reaction were then asked to describe the circumstances in which the reaction happened. The major responses are shown in Table 6.1b.

Table 6.1b  Description of severe allergic reaction, by country

Q13b If yes, can you please describe the circumstances in which this happened?

.	total sample	country
.		Australia (a)	New Zealand (b)
base: those who have had a severe allergic reaction since allergy was identified ( n)	(n=217)	(n=167)	(n=50)
	%*	%*	%*
Accidentally imbibed / drank / consumed	36	b 33	a 48
Came into contact with food substance – not consumed	21	23	16
Unlabelled food / incorrectly labelled	14	14	14
Offered offending food by unsuspecting person	14	14	16
Incorrectly advised of ingredients in pre-prepared food	8	7	12
Traces of substances in unexpected product (lollies)	6	6	6
Substance being present in unidentified food	4	b 5	a 0
Described symptoms (misunderstood question)	18	19	14

^ab        Indicates categories where there was a significant difference between the results in each column (significance at   the 95% confidence level )
*         Adds to more than 100% due to multiple responses.

After diagnosis, the most commonly given reason for having a repeat severe food allergic reaction was accidentally imbibed / drank / consumed (36%) followed by a fifth (21%) who came into contact with the food substance but had not consumed it.

Of some note for food labelling, 14% attributed their severe allergic reaction directly tounlabelled or incorrectly labelled food, and 6% attributed their severe allergic reaction totraces of substances in unexpected products.

The reason that the food was accidentally imbibed / drank / consumed was more likely to be given by respondents in New Zealand than those in Australia (48% versus 33%), whereas Australians were more likely than New Zealanders to say that it was caused by the  substance being present in unidentified food (5% versus 0% respectively.

Major responses are shown by membership of an allergy support group in Table 6.1c.

Table 6.1c  Description of severe allergic reaction, by membership of support group

Q13b  If yes, can you please describe the circumstances in which this happened?

.	total sample	Membership of ALLERGY SUPPORT GROUP
.		Yes (a)	No (b)
base: those who have had a severe allergic reaction since allergy was identified   ( n)	(n=217)	(n=114)	(n=101)
	%*	%*	%*
Accidentally imbibed / drank / consumed	36	34	40
Came into contact with food substance – not consumed	21	22	20
Unlabelled food / incorrectly labelled	14	18	10
Offered offending food by unsuspecting person	14	b 9	a 21
Incorrectly advised of ingredients in pre-prepared food	8	10	7
Traces of substances in unexpected product (lollies)	6	b 10	a 1
Substance being present in unidentified food	4	4	1
Described symptoms (misunderstood question)	18	17	19

^ab        Indicates categories where there was a significant difference between the results in each column (significance at   the 95% confidence level )
*         Adds to more than 100% due to multiple responses.

Members of a support group were significantly more likely than non-members to nominate the reason that there were traces of the substance in unexpected products (10% versus 1% respectively). In comparison, non-members were significantly more likely than  members to say that the cause was that the offending food was offered by an unsuspecting person (21% versus 9% respondents).

6.2  Approach to eating foods containing substances of concern (Q15)

Respondents were asked to indicate how the person(s) in their household would approach eating foods that contain specific ingredients of concern for the allergy they had. Results are shown in Table 6.2, arranged in descending order of propensity to avoid.  


Table 6.2   Approach to eating foods that contain the following…

Q16  Considering all the members of your household who have food allergies, as far as you know, how would each person(s) in your household with food allergy / allergies approach eating foods with the following ingredient(s)?
TICK ONE BOX FOR EACH OF THE PROBLEM INGREDIENTS FOR YOUR HOUSEHOLD

	Peanuts (ground nuts)	Tree nuts (eg. cashews walnuts)	Shell-fish	Fish	Egg	Sesame seeds	Milk	Wheat	Soy	Sulphites (food additives 220-225, 228)
BASE: respondents with that allergy in their household (n)	(n=399)	(n=279)	(n=109)	(n=83)	(n=272)	(n=72)	(n=200)	(n=66)	(n=78)	(n=51)
	%	%	%	%	%	%	%	%	%	%
They never eat it at all	80	72	72	66	62	61	60	42	27	22
They never eat it knowingly	16	22	19	19	20	26	20	18	26	18
They try, but can't avoid it completely	2	1	4	4	11	6	14	24	32	48

The foods that were easiest to avoid were nuts (peanuts and tree nuts) and seafood (fish and shellfish), with between two thirds and four fifths stating these foods were never eaten at all, and very low proportions (less than 5%) for they try, but can't avoid it completely.  

Egg, sesame seeds and milkrecord similar results, with three fifths stating they never eat it at all, a fifth to a quarter stating they never eat it knowingly and the rest (between 6% and 14%) stating they try, but can't avoid it completely.

It appeared that those with wheat,soy  andsulphitesallergies found it hardest to completely avoid (i.e.never eat it at all) the substances of concern. As can be seen from Table 6.2, only a quarter of respondents with an allergy to soy  or sulphites actually manage to avoid these ingredients completely (27% and 22% respectively). Those with a wheat allergy perform slightly better, with two in five (42%) being able to completely avoid the substance of concern. For the remaining allergies, between three in five (60%) and four in five (80%) managed to never eat the substance of concern.

6.3  Ways in which food allergies are managed (Q16)

Respondents were given a list of things they could do to help manage the food allergy or allergies of the 'at risk' person(s) in their household. They were asked to indicate how often they did each of the things on the list. Results are shown in the series of tables that follow.

It should be noted that the majority of households had multiple allergies, and hence, the results are not always clear by allergen.

 The first results shown, in Table 6.3a, are for buying unprocessed foods where possible.

Table 6.3a    Methods of managing the allergy - buying unprocessed foods where possible

Q16    As the person who mainly buys the groceries, how often do you do the following things to help manage the food allergy   / allergies of all the persons in your household? PLEASE TICK ONE BOX FOR EACH STATEMENT         

.	total sample	Membership of ALLERGY SUPPORT GROUP
.		Yes (a)	No (b)
base: ALL RESPONDENTS   ( n)	(n=510)	(n= 259)	(n= 247)
	%	%	%
Always	20	b 23	17
Often	52	b 57	47
Occasionally	18	14	a 21
Never	6	3	a 10
Don't know / not answered	4	3	a 6
Total	100	100	101*

^ab        Indicates categories where there was a significant difference between the results in each column (significance at   the 95% confidence level )
*         Does not add to 100% due to rounding.

A fifth (20%) always  reported buyingunprocessed foods where possible, with a further half (52%)often  buying unprocessed foods where possible. Only 6%never bought unprocessed foods where possible.

Members of allergy support groups were significantly more likely than non-members to buy unprocessed foods where possible (80% versus 64%always / oftenscores respectively).

When looking at the different allergies [1] , some respondents were more likelyt  o buyunprocessed foods where possible than others. The three allergies for which respondents were most likely toalwaysbuy unprocessed foods where possible were :

• wheat  (35%);
• soy (35%); and
• sulphites  (29%).

The results shown in Table 6.3b are for buying foods in sealed packages where possible.

Table 6.3b    Methods of managing the allergy - buying foods in sealed packages where possible

Q16  As the person who mainly buys the groceries, how often do you do the following things to help manage the food allergy   / allergies of all the persons in your household?  PLEASE TICK ONE BOX FOR EACH STATEMENT            

.	total sample	Membership of ALLERGY SUPPORT GROUP
.		Yes (a)	No (b)
base: ALL RESPONDENTS   ( n)	(n=510)	(n= 259)	(n= 247)
	%	%	%
Always	29	b 38	20
Often	44	46	42
Occasionally	16	10	a 23
Never	3	1	a 4
Don't know / not answered	7	4	a 11
Total	99*	99*	100

^ab        Indicates categories where there was a significant difference between the results in each column (significance at   the 95% confidence level )
*         Does not add to 100% due to rounding.

Just under a third (29%) always buy foods in sealed packages where possible, with a further 44% often buying foods in sealed packages where possible . Only 3% never buy foods in sealed packages where possible.  

Again,members of an allergy support group were significantly more likely than non-members toalways buy foods in sealed packages where possible (38% versus 20% respectively).

There were no notable differences by the different allergies [2] .

The results shown in Table 6.3c are for reading food labels carefully.

Table 6.3c   Methods of managing the allergy - reading food labels carefully

Q16 As the person who mainly buys the groceries, how often do you do the following things to help manage the food allergy   / allergies of all the persons in your household?  PLEASE TICK ONE BOX FOR EACH STATEMENT            

.	total sample	Membership of ALLERGY SUPPORT GROUP
.		Yes (a)	No (b)
base: ALL RESPONDENTS   ( n)	(n=510)	(n= 259)	(n= 247)
	%	%	%
Always	90	b 96	83
Often	8	3	a 13
Occasionally	1	-	a 3
Never	-	-	-
Don't know / not answered	1	1	1
Total	100	100	100

^ab        Indicates categories where there was a significant difference between the results in each column (significance at   the 95% confidence level )

Ninety percent respondents always read food labels carefully, with 8% often reading food labels carefully. No respondents stated theyneverread food labels carefully.  

Members of an allergy support group were significantly more likely than non-members toalways read food labels carefully (96% versus 83% respectively).

When looking at the different allergies [3] , some respondents were more likely to read food labels more carefully than others. The three allergies for which respondents were most likely toalwaysread food labels carefully were :

• milk(96%);
• sulphites  (94%); and
• sesame seeds  (94%).

The results shown in Table 6.3d are for contacting the food manufacturer about what was in the food.

Table 6.3d     Methods of managing the allergy - contacting the food manufacturer about what is in the food

Q16    As the person who mainly buys the groceries, how often do you do the following things to help manage the food allergy   / allergies of all the persons in your household? PLEASE TICK ONE BOX FOR EACH STATEMENT            

.	total sample	Membership of ALLERGY SUPPORT GROUP
.		Yes (a)	No (b)
base: ALL RESPONDENTS ( n)	(n=510)	(n= 259)	(n= 247)
.	%	%	%
Always	10	b 14	6
Often	20	b 30	10
Occasionally	37	40	34
Never	29	12	a 45
Don't know / not answered	4	3	6
Total	100	99*	101*

^ab        Indicates categories where there was a significant difference between the results in each column (significance at   the 95% confidence level )
*         Does not add to 100% due to rounding.

Ten percent respondents said theyalways contact the food manufacturer about what is in the food, with a further 20% often contacting the food manufacturer about what is in the food . However, the majority of respondents generally did not contact the food manufacturer about what was in the food, with just over a third (37%) stating they did this only occasionally and just under a third (29%) saying they had never contacted the food manufacturer about what was in the food.  

Again,members of an allergy support group were significantly more likely than non-members to contact the food manufacturer about what was in the food (44% versus 16% always / often).

When looking at the different allergies [4] , some respondents were more likely to contact the food manufacturer than others. The three allergies for which respondents were most likely toalwayscontact the manufacturer were :

• tree nuts (12%);
• shellfish (11%); and
• sesame seeds  (11%).

Those with wheat allergies were the least likely to contact (35% said they wouldnevercontact) the manufacturer.

The results shown in Table 6.3e are for buying loose or bulk foods.

Table 6.3e  Methods of managing the allergy - buying loose or bulk foods

Q16 As the person who mainly buys the groceries, how often do you do the following things to help manage the food allergy   / allergies of all the persons in your household? PLEASE TICK ONE BOX FOR EACH STATEMENT            

.	total sample	Membership of ALLERGY SUPPORT GROUP
.		Yes (a)	No (b)
base: ALL RESPONDENTS   ( n)	(n=510)	(n= 259)	(n= 247)
	%	%	%
Always	2	2	2
Often	10	7	a 13
Occasionally	38	38	38
Never	43	b 48	37
Don't know / not answered	7	5	10
Total	100	100	100

^ab        Indicates categories where there was a significant difference between the results in each column (significance at   the 95% confidence level )

Only 2% of respondents always buy loose or bulk foods, and 10% often buy loose or bulk foods. Just under half (43%) never buy loose or bulk foods.   

Members of an allergy support group were significantly more likely than non-members to never buy loose or bulk foods (48% versus 37%) [5] .

There was minimal variation overall. Those with fishand shellfish allergies were most likely to say they would never buy loose or bulk food (47% each) and those with sesame seeds and wheat allergies in the household least likely to say they would never buy loose or bulk food [6] ^, [7] .

The results shown in Table 6.3f are for checking food lists provided by allergy support group(s).

Table 6.3f   Methods of managing the allergy - checking food lists provided by allergy support group(s)

Q16  As the person who mainly buys the groceries, how often do you do the following things to help manage the food allergy   / allergies of all the persons in your household? PLEASE TICK ONE BOX FOR EACH STATEMENT            

.	total sample	Membership of ALLERGY SUPPORT GROUP
.		Yes (a)	No (b)
base: ALL RESPONDENTS ( n)	(n=510)	(n= 259)	(n= 247)
	%	%	%
Always	26	b 41	11
Often	24	b 32	16
Occasionally	23	18	a 28
Never	22	5	a 38
Don't know / not answered	5	3	a 7
Total	100	99*	100

^ab        Indicates categories where there was a significant difference between the results in each column (significance at   the 95% confidence level )
*         Does not add to 100% due to rounding.

A quarter (26%) of all respondents always check food lists provided by allergy support group(s), with a further 24% often checking food lists provided by allergy support group(s) . A fifth (22%) never check food lists provided by allergy support group(s), and they were mainly non-members. Members of an allergy support group were significantly more likely than non-members to check food lists provided by an allergy support group(s) (73% versus 27% always / oftenrespectively).

 

When looking at the different allergies, some respondents were more likely to check food lists provided by allergy support groups(s) than others. The three allergy types for which respondents were most likely to always check food lists provided by allergy support groups(s)  [8] were :

• sesame seeds  (33%);
• tree nuts  (29%); and
• fish  (29%).

The results shown in Table 6.3g are for buying same brand of product(s) shown from past experience to be allergen free.

Table 6.3g   Methods of managing the allergy - buying same brand of product(s) shown from past experience to be allergen free

Q16  As the person who mainly buys the groceries, how often do you do the following things to help manage the food allergy   / allergies of all the persons in your household? PLEASE TICK ONE BOX FOR EACH STATEMENT            

.	total sample	Membership of ALLERGY SUPPORT GROUP
.		Yes (a)	No (b)
base: all respondents ( n)	(n=510)	(n= 259)	(n= 247)
	%	%	%
Always	62	b 66	58
Often	32	30	34
Occasionally	2	1	3
Never	3	2	4
Don't know / not answered	1	1	2
total	100	100	101*

^ab        Indicates categories where there was a significant difference between the results in each column (significance at   the 95% confidence level )
*         Does not add to 100% due to rounding.

Two thirds (62%) of respondents always buy the same brands as in the past, with a third (32%) often buying the same brands as in the past. Very few did not do this, with only 3% stating they never did this.  

As seen consistently in this section,members of an allergy support group were significantly more likely than non-members to always buy the same brands as in the past (66% versus 58%) [9] .

Those with 'other allergies' [10] were most likely to follow past experience when purchasing products, with 76% always buying the same brands of products.   The next most likely to do this were those with the following allergies [11] :

• wheat  (73%);
• sulphites (72%);
• sesame seeds (71%);
• milk  71%); and
• soy  (70%).

Those least likely to rely on past experience were respondents with peanut (62%) and egg  allergies (63%) in their household.

The results shown in Table 6.3h are for checking food lists provided by the MFD. Note that this question was asked only of New Zealand respondents since it was only applicable to them; thus, analysis is of the New Zealand sample only.

Table 6.3h    Methods of managing the allergy - checking food lists provided by the Manufactured Food Database

Q16   As the person who mainly buys the groceries, how often do you do the following things to help manage the food allergy   / allergies of all the persons in your household? PLEASE TICK ONE BOX FOR EACH STATEMENT            

.	total New ZEALAND SAMPLE	Membership of ALLERGY SUPPORT GROUP
.		Yes (a)	No (b)
base: all respondents ( n)	(n=97)	65	32
	%	%	%
Always	27	b 37	6
Often	18	b 25	3
Occasionally	21	22	a 19
Never	26	12	a 53
Don't know	3	2	6
Not answered	6	3	a 12
total	101*	101*	100

^ab        Indicates categories where there was a significant difference between the results in each column (significance at   the 95% confidence level )
*         Does not add to 100% due to rounding.

Forty five percent of New Zealand respondents either always or often check food lists provided by the MFD, with a quarter never checking food lists provided by MFD .  

A significant difference in the behaviour of members and non-members of allergy support groups was seen. Members were significantly more likely to check food lists provided by MFD (62% versus 9% always / often). It is possible that the higher level of not answered scores to this question amongst non-members could indicate that there was a lack of awareness about the existence of the MFD [12] . This question did not investigate respondents' reasons for using / checking the MFD.

When looking at the different allergies, some respondents were more likely to check food lists provided by MFD than others [13] . The three allergies that prompted respondents to always check food lists provided by MFD were :

• milk(32%);
• wheat (32%); and
• other allergies (30%).
  

6.4   Approach to broad product categories in screening for substances of concern (Q17)

Respondents were asked if there were any broad product categories, e.g. sweet biscuits or frozen foods etc, for which they always needed to read the labels because the majority of them contained the substances of concern. The results are shown in Table 6.4a.

Table 6.4a     The need to check broad product categories

Q17a  Are there any broad product categories (eg dairy foods, bread, etc) for which you particularly need to read labels because the majority of them are likely to cause problems for the person(s) with the allergy / allergies?

.	total sample
.
base: all respondents ( n)	(n=510)
	%
Yes, I have to check some product categories	56
No, I have to check all product categories	41
Don’t know / can’t recall / not applicable	3
Total	100

Two in five respondents (41%) said they had to check all product categories and over half (56%) had to check some product categories.

This was reported most by those with sesame (56%),soy (56%) or milk(53%) allergies in their household, and least by those with shellfish(43%),peanut(44%),tree nut (45%) or sulphite(45%) allergies [14] ^{, [15]} .

Those shopping for children were more likely to report this than those shopping for themselves (44% versus 22% respectively) [16] .

Respondents who said they needed to check some product categories were given a list of 37 categories. They were then asked to indicate which of these categories they checked and the results are listed in Table 6.4b in descending order.

Table 6.4b  Broad product categories that need to be checked

Q17b If yes, please tick which of the following broad product categories you check for that reason

	total		total
base: THOSE WHO CHECK BROAD PRODUCT CATEGORIES ( n)	(n=285)	base: THOSE WHO CHECK BROAD PRODUCT CATEGORIES ( n)	(n=285)
	%		%
Sweet biscuits	87	Soups	42
Breakfast cereals	86	Noodles	39
Savoury biscuits / crackers	85	Dairy products	38
Cakes / muffins / pastries	85	Pasta	37
Confectionery	83	Margarines	36
Savoury snack foods	82	Dried fruit	36
Chocolates	77	Vegetable oils	33
Desserts	73	Butter / dairy spreads	32
Muesli	67	Egg and egg products	32
Spreads	67	Fish and fish products	31
Pre-prepared meals	64	Baby foods	27
Ice cream	62	Smoked / cured meats	26
Cook / simmer / pasta sauces	60	Infant formula	12
Sauces (eg. chilli, BBQ, Worcestershire)	58	Fruit juices	12
Canned foods	56	Soft drinks	10
Breads	53	Cordials	10
Frozen foods	52	Alcoholic drinks	6
Sausages	48	Rice	5
Mayonnaises	44	.	.

Notably, many of the items at the top of the list are non-essential food items for the household, such as biscuits, cakes, confectionery and snack foods.

By allergen [17] , t here were three for which respondents were significantly more likely to check all product categories:

• sesame seeds (56%);
• soy (56%); and
• milk  (53%).

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