1 Background
1.1. Introduction
1.2. Research objectives
1.3. Target groups
1.1 Introduction
1.1.1 The new food regulations
The Australia New Zealand Food Standards Code (‘the Code’) that became fully enforceable from December 2002 included several changes to the labelling provisions for Australia and New Zealand. Food labels are now required to provide three levels of advice for consumers;mandatory warning statements;mandatory advisory statements;and mandatory declarations of certain substances in foods. These provisions apply when any of the substances listed in Standard 1.2.3 Mandatory Warning and Advisory Statements and Declarations are present in food as an ingredient; an ingredient of a compound ingredient; a food additive or component of a food additive; or a processing aid or a component of a processing aid (FSANZ 20021).
The mandatory declarations, warning statements and advisory statements are intended to provide consumers with sufficient information such that they and / or their carers can avoid potentially life-threatening adverse reactions to food or an ingredient in food.
Allergens that must be declared on food labels include gluten containing cereals and their products (e.g. wheat, rye, barley, oats); crustacea and crustacea products; eggs and egg products; fish and fish products; milk and milk products; nuts and sesame seeds (including their products); peanuts and soybeans (including their products) and added sulphites (in concentrations of 10 mg/kg or more) (FSANZ 20021). This means that the Code now requires the declaration of specific substances in a food product. For example, wheat, rye, barley, oats, spelt etc have to be declared on the food label instead of cereals; peanuts, soybean or sesame instead of vegetable oil and specific name of crustacea used instead of using the generic label of fish or crustacea. Furthermore, where starch is derived from wheat, rye, barley, oats or spelt, the specific source of the cereal must be declared
Previously, not all foods were labelled for the presence of food ingredients that may affect people with allergies or food intolerances. The intent of the Code is to ensure all of the main foods that may cause allergic reactions (as indicated above) will be declared on the label of packaged foods. Under the old Code only peanuts in packaged foods were required to be labelled, and added sulphites if present in concentrations greater then 25 mg/kg.
Sulphites, a group of related food additives, were included in the Quantitative Consumer Survey on Allergen Labelling because in a small number of people it causes symptoms that are identical to that of allergy (Jackson 2003). It must be noted that while sulphites may not be considered an allergen, in this survey it has been reported together with the other allergens, such as eggs and peanuts.
Food Standards Australia New Zealand (FSANZ), through its established Evaluation Strategy 2001-03, will assess through this survey, how well the regulatory arrangements of the Code are working in terms of the allergen labelling requirements(ANZFA 2001). The Quantitative Consumer Survey on Allergen Labelling was conducted in Australia and New Zealand to collect baseline data on knowledge and awareness of the allergen labelling provisions by those ‘at risk’ of allergic reactions to foods, and their current behaviours in food selection. It is intended that a follow-up survey would be conducted at a later time to assess the effects of the introduction, in the Code, of the labelling changes for allergens.
1.1.2 Food Allergies
A food allergy may be defined as an adverse reaction to food proteins due to an immune hypersensitivity, that is, an interaction between at least one food protein with one or more immune responses (Hill, Hoskings & Heine 1999). For sensitive individuals, the presence of allergens in food is potentially life threatening. Currently, there is no cure for food allergy, and the only successful method to manage food allergy is avoidance of foods containing the allergen. Fortunately, most consumers are aware of their specific sensitivities and can avoid foods that might result in a life-threatening situation. For example, while a person with a peanut allergy may find it easy to avoid whole peanuts, formulated foods present a separate challenge. In such cases, the individual relies on accurate ingredient labelling (Cohen 1999).
An adverse reaction to allergens in food products is a serious health issue that affects around 1% of adults and less than 10% of young children (Cohen 1999; Swain, Soutter, Loblay 1996). Evidence suggests that infants with allergies, such as egg or milk, may ‘grow out of it’ but some allergies, such as peanut, may persist into adult life (Jackson 2003; Al-Muhsen, Clarke & Kagan 2003).
With respect to adverse reactions, a single food may cause different symptoms in different people or even in the same person at different times. The same symptoms may also be caused by different foods in the same person (Jackson 2003). Food allergy symptoms affect many parts of the body including the gastrointestinal tract (nausea, vomiting, abdominal cramps), the respiratory tract (sneezing, asthma), the skin (eczema, urticaria) or the cardiovascular system (hypotension, cardiac arrest) (Jackson 2003; Al-Muhsen, Clarke & Kagan 2003; FSANZ 20022).
A broader definition of food allergies was adopted by FSANZ for the purposes of this survey. This was done to attain a wider cross-section of participants who may be assessing food labels critically because of concerns about the presence of allergens; it is not canvassing a truly anaphylactic population (see section 1.3) [1] .
It should be noted that this survey was not intended to measure the prevalence of food allergies in Australia or New Zealand, or to assess the consistency of food labels with the allergen labelling requirements in the Code.
1.2 Research objectives
The evaluation described herein is the first part of what is intended to be a two-part process to measure the impact of the new allergen labelling requirements.
The research aims were to:
1. assess the level of awareness and knowledge of consumers ‘at risk’ of an adverse reaction, and their carers (if relevant), of the labelling provisions that cover allergens;
2. assess the ability of those ‘at risk’, or their carers (if relevant) to successfully identify those foods that contain the pertinent allergens;
3. understand the existing behaviours of ‘at risk’ consumers or their carers (where relevant) in regard to food selection; and
4. identify whether a lack of understanding of the allergen labelling of foods contributes to the occurrence of adverse reaction in those affected, and if so to what degree (FSANZ 2002 2 ).
The definition of consumers 'at risk' was widened in the survey to include all those who have had or are 'at risk' of an adverse (allergic) reaction to food (see section 1.3).
This first phase of the evaluation is described as the benchmark survey . The survey is therefore, referred to throughout as the Quantitative Consumer Survey on Allergen Labelling: Benchmark 2003.
It is planned to conduct a second phase of research at some time in the future to track changes in awareness, knowledge and behaviours when compared to the measures that are established by the benchmark survey based on the aims listed above.
This has an implication for the methodology selected in that it must be able to be replicated, a key requirement for ensuring reliability.
As many food manufacturers had been in the process of bringing their food labels into alignment with the Code since it was first introduced in December 2000, these baseline data do not provide a 'true' measure of the situation with regard to allergen labelling ‘before’ the implementation of changes to the Code.
1.3 Target groups
A targeted sample was obtained that was not intended to be necessarily representative of gender, age, education, or ethnicity of the general populations of Australia and New Zealand, or the 'at risk' population themselves. It was considered unlikely that sufficient participants would have been recruited using random sampling of the general population due to the low proportion of consumers 'at risk' in the population.
The target groups for the proposed survey were originally identified as:
- those ‘at risk’ of anaphylactic reaction to certain foods or food ingredients; and
- their carers.
Food-induced anaphylactic reaction was defined as a ‘reaction that involves one or more of the following symptoms: difficulty breathing or throat swelling, generalised urticaria (hives) and/or faintness or collapse ( FSANZ 2002 2 ).
Originally, participants to be included in the research were those who had already had an anaphylactic reaction, or had been identified as 'at risk' of food allergies by medical specialists. If the 'at risk' participant was under 14 years of age, then their carers would have been invited to participate.
However, during the development of the questionnaire, the defined target group was broadened to the following definition:
By serious food allergy, we mean a reaction that involves one or more of the following symptoms due to exposure to a particular food or food ingredient:
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The questionnaire was designed to be answered by the main grocery buyer, as it was deemed that they would be the most knowledgeable and appropriate member in the household to answer questions about food labels and food selection decisions. For clarity, throughout this report participants are referred to as 'respondents' whether they were the ‘main grocery buyer’ or ‘the person with an allergy’.
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