By Kelly Thomas
Even though food is an essential part of life, it can be life threatening for those who have food allergies. Dining out, traveling, eating at the school cafeteria or attending a friend’s birthday can be a challenge. Society’s awareness of food allergies improved considerably in the past 10 years, and the state of Massachusetts has been way ahead of the game. Indeed, Massachusetts was the first state in the US to enact food allergy legislation.
MA: the first state with a food allergen law
The Food Allergy Awareness Act was signed into law by then-Gov. Deval Patrick in 2009. The goal of this act is to reduce risk of illness and death due to accidental consumption of allergens “by increasing restaurant industry and consumer awareness of regulations and best practices with respect to major food allergens.”
On Oct. 1, 2010, the food allergy awareness regulation went into effect, requiring all food establishments that “cook, prepare or serve food intended for immediate consumption either on or off the premises” to have on staff a certified food protection manager. To earn their certificate, a restaurant manager must watch an online video created by the non-profit FARE (Food Allergy Research and Education), available on the National Restaurant Association website ServSafe. It provides information about the different kinds of food allergies, and the consequences of cross-contaminations but also the importance of food labeling. Once this video training is completed the manager would receive a printed certificate from the National Restaurant Association.
“All food establishments must have on staff a certified food protection manager who has been issued a certificate of allergy awareness, and that is valid for five years,” said Steve Clark, director of Government Affairs for the Massachusetts Restaurant Association. “And in Massachusetts, you are required to display educational posters in your work area that highlight the recognized allergens. And every food service establishment has the same requirement, from a cafeteria in a nursing home to a bakery,” he said.
One should notice the difference between food allergies and food intolerances. Food allergies cause immune reactions that affect different organs in the body. Food intolerances or food sensitivities symptoms, however, are often limited to digestive problems.
On its website the Centers for Diseases Control and Prevention defines food allergies as “an adverse immune system reaction that happens after exposure to a certain food. The body’s immune response can be severe and life threatening, such as anaphylaxis.”
For instance if someone has an allergy to cow’s milk his or her immune system will overreact and will produce antibodies called Immunoglobulin E (IgE) because the immune system identifies cow’s milk as an invader.
It is also essential to distinguish celiac disease from gluten intolerance or sensitivity. While people who have celiac experience the damage of their small intestine or develop a tissue of antibodies called transglutaminase, people who only have gluten intolerance or sensitivity don’t experience this damage. Besides, people who have celiac and keep eating gluten will potentially experience weight loss, bone loss and even infertility, according to the Celiac Disease Foundation’s website.
Cynthia Bancale, a marketing manager, has a gluten sensitivity. She said she was impressed about how gluten-friendly Boston is when she moved from the West Coast in 2012.
“There is a place in Boston called Flour. I went there because they have gluten-free bread. They asked me: ‘Are you gluten sensitive or do you have celiac?’ and I said ‘I’m highly sensitive.’ And the waiter said, ‘we ask because if you have celiac we have to put special gloves, and we prepare the sandwich somewhere else so that there is no cross contamination.’ I was very impressed that a sandwich place will do that,” Bancale said.
The Food Allergy Awareness Act also requires a food establishment to have a consumer notice for customers with food allergies. It can be a posted sign or a section on a menu.
“The bottom of the menu in Massachusetts says, ‘Before placing your order please notify your server if a person in your party has a food allergy’ so that the certified food protection manager makes sure to take good care of you,” said Clark.
Read the label
Even though in Massachusetts people with food allergies can technically dine out without being afraid of getting sick thanks to the Food Allergy Awareness Act, a lot of work still needs to be done.
For instance, people with food allergies should also pay attention to food labels when doing their grocery shopping to make sure a product doesn’t contain hidden allergens. Indeed, even though the Food Allergen Labeling and Consumer Protection Act (FALCPA) was passed by Congress in 2004, it only requires that food labels declare the presence of a “major food allergen” but it doesn’t say anything about what is called a precautionary or advisory label.
“In the United States the advisory labels that say, ‘May contain gluten, milk, nut ’ or ‘Processed in a facility that also processes nuts, milk etc,’ are not currently regulated under any federal rules, so some manufacturers use them, others don’t. Because they are completely voluntary, you really can’t count on them. And this is a bit of a problem,” said Tricia Thompson, dietician, and author of the website Gluten free watchdog.
A report titled “Guidelines for the diagnosis and management of food allergy in the United States,” underlines the importance of training on how to interpret food labels and how to recognize labeling of food allergens. The expert panel who did the report also suggests to avoid “products with precautionary labeling, such as this product may have a trace of allergen.”
Marie Malloy is in charge of public relations for the non-profit FARE (Food Allergy Research and Education). She confirmed that advisory labels are currently not regulated.
“There are no laws governing or requiring the advisory labels, so they may or may not indicate if a product contains a specific allergen. This may or may not truly indicate if a product is at risk for cross-contact. FARE’s recommendation is to contact a manufacturer directly if you are considering consuming a product and want to know about their manufacturing practices and risk of cross-contact,” Malloy said.
A study from 2009 titled, “Audit of manufactured products advisory labels and identification of labeling ambiguities” shows that after having performed a supermarket survey of 20,241 manufactured food products for use of advisory labels, 17 percent of the products surveyed contained advisory labels with many ambiguities that present a challenge to consumers with food allergies.
In her book “Food Allergies: Enjoying Life with a Severe Allergy,” Tanya Wright, a dietician specializing in the diagnosis and management of food allergies, notes that an increasing number of food manufacturers are adding to their packaging the declaration, “This product may contain nuts/gluten/milk” or “Made in a factory handling nuts/gluten/milk.” Wright explained that this label can be put on a product even if the chance of cross-contamination is minuscule.
“This has resulted in many products that do not contain nuts, and were possibly suitable for someone allergic to nuts, now becoming out of bounds… it has reduced the food choices available to anyone with that food allergy,” Wright wrote in her book.
Food allergies: a disability?
A food allergy also impacts the quality of life and can cause more stress and anxiety, as well as isolation.
Danya Goodman, an Emerson College therapist explained why food allergies can cause anxiety for people who have them. “The problem with what we called invisible illnesses, is that even if people have chronic pain or disease they look totally normal and we kind of live in this society where if you don’t look sick then somehow it doesn’t count. And you don’t really receive the same care and concern that you really deserve. And there is kind of disbelief where people have to prove themselves,” explained Goodman.
Celiac disease is a case in point, since among the symptoms listed by the National Institute of Diabetes and Digestive and Kidney Diseases are depression, anxiety or fatigue, but also abdominal bloating, chronic diarrhea, stomach pain, vomiting, anemia, weight loss, dermatitis, itchy skin rash, and infertility. On its website, the National Institute of Diabetes and Digestive and Kidney Diseases describes celiac disease as an “immune disorder in which people cannot tolerate gluten because it damages the inner lining of their small intestines and prevent it from absorbing nutrients.”
The U.S Department of Justice website’s questions-and-answers page addressed food allergies and the Americans with Disabilities Act, noting, “It depends. A disability as defined by the ADA is a mental or physical impairment that substantially limits a major life activity, such as eating. Major life activities also include major bodily functions, such as the functions of the gastrointestinal system. Some individuals with food allergies have a disability as defined by the ADA – particularly those with more significant or severe responses to certain foods. This would include individuals with celiac disease and others who have autoimmune responses to certain foods, the symptoms of which may include difficulty swallowing and breathing, asthma, or anaphylactic shock.”
Malloy is in charge of public relations for the non-profit organization FARE. She explained that a food allergy may be considered a disability under the Americans Disabilities Act and also under other federal laws, such as section 504 of the Rehabilitation Act of 1973. On its website the non-profit defines a disability as “a physical or mental issue that seriously limits one or more major life activities. Life activities include things like your heart and circulatory system, eating and your digestive system, breathing and your respiratory system, and more. All of these life activities are at risk for a person with a life-threatening food allergy.”
Goodman explained that allergies and diseases like celiac may have serious psychological effects, and can be considered a disability.
“Celiac is a very serious chronic long-term illness so I think that it definitely has severe psychological effects and can be considered under disabilities but people who are allergic to shellfish for instance it’s not necessarily a disability. It’s inconvenient, and frustrated but there are not the same psychological effects than for people with celiac, “ said Goodman.