7 The use of food labels to manage the allergy - Part B
7.5. Action taken when unsure of an ingredient or a product label
7.6. Attitudes towards and utility of disclaimers
7.7. Overall ability to recognise substances of concern
7.8. Ability to recognise substances of concern on actual food labels
7.5 Action taken when unsure of an ingredient or a product label (Q26)
Respondents were then asked what they did if they were unsure about what was written in the ingredient list of a food label. The results are shown in Table 7.5 below.
Table 7.5 Action taken when unsure of an ingredient
Q26 If you are unsure about what is written in the ingredient list, which of the following do you do? PLEASE TICK ALL BOXES THAT APPLY
| . | total sample | Membership of ALLERGY SUPPORT GROUP | |
| . | Yes | No | |
base: THOSE UNSURE ABOUT ingredients IN FOOD LABELS because of allergens ( n) | (n=495) | (n=253) | (n=238) |
| %* | %* | %* |
Avoid using / eating the food | 88 | 90 | 86 |
Ring the manufacturer and ask | 46 | b 64 | 29 |
Try a small amount / give a small amount to the person with the allergy | 17 | 14 | a 20 |
Ring your dietitian or doctor | 7 | 7 | 7 |
Ring a support group | 5 | b 9 | 0 |
Ring a friend | 4 | 5 | 3 |
Eat the food anyway / give the food to the person with the allergy | 1 | 0 | 1 |
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.
Avoidance of the food was the most common action if the respondent was unsure of an ingredient on a food label, with nine in ten (88%) saying this. The next most common response was to ring the manufacturer, which almost half (46%), indicated they would do.
Members of allergy support groups were significantly more likely to contact the manufacturerthannon-members (64% versus 29% respectively), and to contact an allergy support group (9% members versus 0% non-members respectively).
Non-members of an allergy support group were significantly more likely to trial the food by trying a small amount or giving a small amount to the person with the food allergy than were members of support groups (20% versus 14% respectively).
7.6 Attitudes towards and utility of disclaimers (Q27, Q28, Q29)
Respondents were asked about their attitudes to the series of disclaimers currently appearing on food labels:
- ‘may contain traces of …’;
- ‘made in the same premises as products containing …’;and
- ‘made on the same equipment as products containing …’.
The response options given were:
- not very useful because it doesn’t say whether the ingredient I am allergic to is definitely in the product or not;
- quite useful because it reminds me I may be eating a product containing the ingredient I am allergic to;
- very useful because I am told that there is a chance that the ingredient I am allergic to is present; and
- not sure / don’t know.
Results for each disclaimer are shown in Table 7.6a.
Table 7.6a Attitude to disclaimers …
Q27/28/29 If you had an allergy to the particular ingredient mentioned, how useful is this statement to you? PLEASE TICK one box only
| . | May contain traces of … | Made in the same premises as products containing … | Made on the same equipment as products containing … |
base: all respondents ( n) | (n=510) | (n=510) | (n=510) |
| % | % | % |
Not very useful | 54 | 54 | 37 |
Quite useful | 11 | 13 | 14 |
Very useful | 33 | 31 | 46 |
Not sure /don’t know | <1 | 1 | 3 |
Not answered | 1 | <1 | 0 |
Total | 99* | 99* | 100 |
* Does not add to 100% due to rounding.
The first two disclaimers:‘may contain traces of …’, and ‘made in the same premises as products containing …’ were each seen by over half (54%) of the respondents as not very useful. The third statement, ‘made on the same equipment as products containing …’ was seen by respondents more as being very useful (46%).
It was reported in a general consumer labelling survey that was conducted in 2002 [7] that a large proportion of consumers (53%) said that the 'may contain nuts' statement would be very useful – for those with an allergy to nuts. However, fewer consumers with an allergy in the general survey said this statement was very useful (42% of those with a peanut allergy). In comparison, this survey recorded a lower proportion of respondents saying the 'may contain …' disclaimer was very useful (33%). However, it should be noted that the general consumer survey was asking about nuts in particular whereas, in the allergen survey, the question was worded more generally (see question 27a).
Members of an allergy support group were significantly more likely than non-members to say that the disclaimers were useful:
- ‘may contain traces of …’(37% versus 29% respectively);
- ‘made in the same premises as products containing …’ (35% versus 27% respectively); and
- ‘made on the same equipment as products containing …’(55% versus 38% respectively) [8] .
Respondents were then asked what action they would take if they saw that a label displayed one of these disclaimers. Results for each disclaimer are shown in Table 7.6b.
Table 7.6b Attitude to disclaimers …
Q27/28/29 What would you do if a label on a product said …? PLEASE TICK one box only
| . | May contain traces of … | Made in the same premises as products containing … | Made on the same equipment as products containing … |
base: all respondents ( n) | (n=510) | (n=510) | (n=510) |
| % | % | % |
Always avoid | 51 | 41 | 66 |
Sometimes / usually avoid | 40 | 43 | 25 |
Always use | 8 | 10 | 3 |
Not sure/ don’t know | 1 | 6 | 5 |
Total | 100 | 100 | 99* |
* Does not add to 100% due to rounding.
For the first two disclaimers: ‘may contain traces of …’ and ‘made in the same premises as products containing …’ - the same proportion of respondents said they usually or sometimes avoid the product (40% and 43% respectively). However, a half (51%) said they would always avoid the product with the may contain traces of …’ statement.
Of note, two-thirds (66%) respondents said they would always avoid the product with the statement‘made on the same equipment as products containing …’on the label.
Members of an allergy support group [9] were significantly more likely than non-members to say they would always avoid the product when the label contained a statement to the effect:
- ‘may contain traces of …’(61% versus 41% respectively);
- ‘made in the same premises as products containing …’(48% versus 35% respectively); and
- ‘made on the same equipment as products containing …’(78% versus 53% respectively).
7.7 Overall ability to recognise substances of concern (Q14, Q30)
A composite measure of knowledge was constructed, which was a combination of the answers at both Q14 (alternative words for substances) and Q30 (simulated food labels – see section 7.8 for more detailed discussion). The total number of substances of concern for each of the food allergies was calculated, and then respondents' recognition of each of the substances was measured against this maximum score. Results are shown for each allergen in Table 7.7a, arranged in descending order of ability to recognise the substances of concern.
Table 7.7a Ability to recognise substances of concern. Performance against maximum scores
. | ALLERGEN | |||||||
. | Tree nuts (eg. cashews walnuts) | Milk | Egg | Soy | Fish | Sesame seeds | Wheat | Peanuts (ground nuts) |
BASE: respondents with that allergy in their household ( n ) | (n=279) | (n=200) | (n=272) | (n=78) | (n=83) | (n=72) | (n=66) | (n=399) |
Maximum score 5 | 7.0 | 13.0 | 4.0 | 12.0 | 3.0 | 2.0 | 22.0 | 15.0 |
Average score for those managing the allergy | 5.2 | 9.2 | 2.8 | 6.4 | 1.5 | 1.0 | 9.1 | 6.0 |
Ratio of average: maximum scores as a percentage | 74% | 71% | 70% | 53% | 50% | 50% | 41% | 40% |
5 This number is a count of the number of substances of concern at Q14 and Q30 for this allergy type.
Note that sulphites did not feature on the simulated labels, so no calculation is included for sulphites.
Averages are rounded to one decimal place.
As can be seen, tree nuts, milk and egg allergens were the easiest to identify, with between seven in ten (70%) and three quarters (74%) of the substances of concern being identified by those with the allergy.
Around half of the substances of concern for those with a soy,fish or sesame allergy in their household were correctly identified (53%, 50% and 50% respectively).
However, only two in five of the possible substances of concern for those with wheat or peanut allergies in their household (41% and 40%) were identified [10] .
The levels of identification evident suggest that many people with food allergies did not recognise all products containing the particular substances that could trigger an adverse reaction.
Results are shown for all allergens by whether the respondent was a member of an allergy support group in Table 7.7b.
Table 7.7b Ratio of ability to recognise substances of concern, by membership of allergy support group
. | ALLERGEN | |||||||
. | Tree nuts (eg. cashews walnuts) | Milk | Egg | Soy | Fish | Sesame seeds | Wheat | Peanuts (ground nuts) |
BASE: respondents with that allergy in their household ( n) | (n=279) | (n=200) | (n=272) | (n=78) | (n=83) | (n=72) | (n=66) | (n=399) |
Members of an allergy support group | s 80% | s 77% | s 75% | 56% | 50% | 50% | 43% | s 47% |
Not members of an allergy support group | 67% | 65% | 62% | 52% | 47% | 50% | 40% | 32% |
s Indicates significance to the line below, i.e. not members of an allergy support group.
Note that sulphites did not feature on the simulated labels, so no calculation is included for sulphites.
Averages are rounded to one decimal place.
As indicated by the table above, being a member of a support group means that respondents were significantly more likely to identify substances of concern for the following allergies:
- tree nuts;
- milk;
- egg; and
- peanuts.
Respondents' capacity to recognise the individual food substances of concern listed on the labels is discussed in the following section.
7.8 Ability to recognise substances of concern on actual food labels (Q30)
Respondents were presented with 14 simulated food labels to test their ability to recognise suitable products for their household. The labels are displayed in Figure 7.8.
Note that many respondents had multiple allergies in their household and accordingly, the presence of multiple allergies may result in the rejection of a particular product based on potential reactions to allergens other than the one for which results are shown.
Thus, in the following tables (7.8a-h) the percentage of respondents who highlighted the substances of concern is shown. However, some did not 'correctly' identify the substance of concern to their household, but rejected the product. This suggests that respondents may have been rejecting products for reasons other than the food allergy being discussed.
Results are shown in the series of tables that follow. Table 7.8a below, displays the answers for those with a tree nut allergy in their household.
Table 7.8a Awareness of substances of concern for those with a tree nut allergy
Q30 Circle any ingredients you think might be unsuitable for any person(s) in your household with an allergy? PLEASE TICK ALL THAT APPLY. Then indicate your assessment of the product.
Awareness was high amongst those with a tree nut allergy, with almost all correctly recognising the substance of concern. Results suggest that levels of awareness were higher where there was a direct reference to 'nuts' in the ingredient list, rather than the 'may contain' statements, as indicated by the results for Labels 5 and 9. However, it could also be the case that the 'may contain' statement acts as a default, as was indicated by the results for Label 13 where the only reference to nuts was in the 'may contain' statement.
Between 3% to 8% of respondents highlighted the product type as being unsuitable rather than highlighting a particular ingredient in the product.
Amongst those with a tree nut allergy, high levels of rejection of the products were recorded (93% to 99%).
Table 7.8b displays the answers for those with a milk allergy in their household.
Table 7.8b Awareness of substances of concern for those with milk allergy
Awareness was generally high for those with a milk allergy, with 86-88% correctly identifying the substances of concern (milk solids,full / skim milk powder, etc). Awareness for casein [Label 3] was slightly lower with 79% identifying that substance, however, only two in five (39%) identifiedshortening[Label 14] as a source of potential reaction. There was a slightly higher proportion of respondents (10%) who highlighted Label 14 product type as the cause of concern.
In terms of respondents' assessments of the products, very high levels of rejection were indicated. Even in the case of Label 14, where correct identification of the substance of concern was low, 93% of respondents with a milk allergy in the household still said they wouldrejectthe product. It is probable therefore, that in households where there were multiple allergies, some of these products had been rejected for reasons other than their potential to cause a reaction amongst those with a milk allergy. It is possible that respondents were aware that there was potential for those types of products to contain other allergens.
Table 7.8c shows the answers for those with an egg allergy in their household.
Table 7.8c Awareness of substances of concern for those with an egg allergy
Q30 Circle any ingredients you think might be unsuitable for any person(s) in your household with an allergy? PLEASE TICK ALL THAT APPLY
% of those with an egg allergy in household who …. | ||||
Identified substance | Would reject the product | |||
base: those with an egg allergy who responded ( n) |
| |||
Label # | Ingredient | |||
Label 4[n=265] | Egg | 90 | 98% Reject | |
Mayonnaise | Highlighted entire label / product | 5 | 1% Suitable | |
|
| 1% Don't know | ||
Label 13[n=261] | 'May contain' statement | 80 | 95% Reject | |
Confectionery | Highlighted entire label / product | 6 | 2% Suitable | |
|
| 3% Don't know | ||
Where the substance was included as part of the ingredients, identification was higher (i.e. 90% identified egg in Label 4 compared to 80% who highlighted the' may contain' statement in Label 13). Similar percentages highlighted the product type as the cause of concern for both products (5% and 6% respectively).
The level of overall rejection of the product was high (95%), even where there was a lower level of acknowledgment that the product could contain the allergen (Label 13).
The answers for those with a fish allergy in their household are shown in Table 7.8d.
Table 7.8d Awareness of substances of concern for those with a fish allergy
% of those with fish allergy in household who …. | ||||
Identified substance | Would reject the product | |||
base: those with a fish allergy who responded ( n) |
| |||
Label # | Ingredient | |||
Label 10[n=74] | Anchovies | 78 | 96% Reject | |
Sauce | Highlighted entire label / product | 12 | 1% Suitable | |
|
| 3% Don't know | ||
One in ten (12%) of the respondents highlighted the product type as the cause of concern, and 78% correctly identified thatanchovieswas a substance of concern for those with a fish allergy.
Ninety six percent of the respondents then rejected the product, with a further 3% saying theydid not know whether the product was suitable.
The answers for respondents with a soy allergy in their household are shown in Table 7.8e.
Table 7.8e Awareness of substances of concern for those with soy allergies
Levels of recognition of the substances of concern were higher where the allergen was clearly stated (i.e. the word ‘soy’or ‘soya’was part of the ingredient name), with between 73% and 90% respondents correctly identifying the substances of concern. Where the substance of concern was also part of the product name as in Label 6, i.e.soy milk, recognition was total (99%).
Recognition was lower where substances that could be problematic were not clearly designated as containing the allergen, i.e.hydrolysed vegetable protein, where less than half of respondents identified this substance as being a potential issue (44% for Label 11 and 45% for Label 14). Up to 9% highlighted the product type as the cause of concern.
In terms of each product's perceived suitability, around four in five went on to reject each of the bakery or pastry items (82% - 84%), whereas almost all rejected the cheese, soy milk and sauce.
Table 7.8f displays the answers for respondents with a sesame allergy in their household.
Table 7.8f Awareness of substances of concern for those with a sesame seed allergy
% of those with sesame seed allergy in household who …. | ||||
Identified substance | Would reject the product | |||
base: those with a sesame allergy who responded ( n) |
| |||
Label # | Ingredient |
|
|
|
Label 13[n=68] | 'May contain' statement | 81 | 93% Reject | |
Confectionery | Highlighted entire label / product | NUTTAB: What's in your food? | ||