Rare food allergies

Alex Gazzola looks at the many other foods which can cause allergic reactions and the difficulties faced by those who suffer from them.

The so-called top 14 food allergens, named on Annex II of Regulation 1169/2011 EC, are the ones with which most in the intolerance and allergy community are familiar – and they include cereals containing gluten, milk, egg, tree nuts, peanuts, soya and eight others.

The Regulation, which came into full effect in December 2014, impacted on how consumers should consult lists of ingredients – covered in detail in our article Food Allergen Labelling. In a nutshell, the law now requires food producers to emphasise every mention of any allergen in their lists of ingredients – be it via bold, underlining, CAPITALS, colour or any other method to make the allergen conspicuous.

The 14 were chosen as they were considered to be the most problematic within the EU, but this does not reflect the situation in the UK. According to the Anaphylaxis Campaign, around 300 of members are avoiding kiwi, which is not on Annex II, a figure greater than the number avoiding soya, which is. Similarly, 150 avoid banana, and around 100 both lentils and peas, none of which are on Annex II – considerably more than the few dozen avoiding celery, lupin and mustard, for example, which are. (See tables here for comparisons.)

Allergies to all foods are possible, and sufferers of rarer food allergies are presented with some unique problems …  

Non-Annex II allergens on food labels

The good news is that all ingredients must be named. If, for example, mushrooms have been added to a ready meal, ‘mushroom’ must duly be noted on the list of ingredients.

The bad is that this requirement only protects the consumer effectively when the ingredient is used in its original or natural form, leaving several potential stumbling blocks.

1. The derivation or source of any processed ingredients used in a food need only be declared when it is an Annex II allergen.

So, for example, take hydrolysed vegetable protein (HVP) – an ingredient derived from assorted vegetarian sources, used to boost ‘umami’ flavour in products such as stocks, bouillons, sauces and ready meals. You may see it on labels in a variety of configurations:

‘hydrolyzed vegetable protein (from wheat)’
‘hydrolyzed vegetable protein (from SOYA)’
‘hydrolyzed vegetable protein’

The sources of wheat and soya, as Annex II allergens, must be declared when the HVP is derived from them, as in the first and second examples. But if the HVP is derived from a non-Annex II allergen – such as corn, which is likely in the third example – then the source need not be declared, proving frustrating for the corn allergic consumer.

2. Potentially more obscure are terms such as ‘flavouring’ and ‘natural flavouring’.

A simple flavouring compound must be rendered as ‘barley malt flavouring’, for example, or ‘flavouring (from milk)’, if the ingredient is derived from an Annex II allergen.

However, the expression ‘natural flavouring’ or even just ‘flavouring’ – without further embellishment – is permitted if the derivation of that flavouring is onion, tomato, or mushroom, for example.

3. The ingredients of compound ingredients – such as mayonnaise in a tuna pate – must be declared if constituting over 2% of the final product.

So in the list of ingredients for that product, you may see something like this: tuna (fish), butter (milk), mayonnaise (rapeseed oil, egg, vinegar, salt), salt, sugar, lemon juice. 

But, if constituting under 2%, the compound ingredients need only be declared if one of the Annex II allergens.

If you have an allergy to a spice or a herb, typically used as mixtures or blends, and in relatively small amounts, you’ll commonly find terms such as ‘spices’ or ‘mixed herbs’ on ingredients, with no further elucidation offered in brackets – the only possible exception being in the case of spices, where mustard, an Annex II allergen, will need to be noted if present.

Precautions and Cross-contamination

There are two further concerns.

1. No precautionary allergy labelling (PAL).
‘May contain traces of [allergen]’ and ‘made in a factory where [allergen] is handled’ are terms which are voluntary and unregulated, but sadly common on many foods. However, allergens outside the top 14 are highly unlikely to be declared, should the risk of cross-contamination be present.

2. No product recalls. Whereas a costly recall will be instigated for wheat flour cross contamination, for example, it is unlikely to be done so for corn flour cross contamination. No product recall listed / archived on the Food Standards Agency website concerns a non Annex II allergen.

Problems for consumers

All the cases above illustrate how tough it can be for sufferers of unusual food allergies. All ingredients must be read individually, and highlighting of allergens is likely to be a hindrance not a help. Every vague or non-wholefood ingredient that could potentially be ‘concealing’ the trigger allergen needs to be assessed or further investigated with the manufacturer.

In practice, thoughtful or transparent food manufacturers may declare what the source of ingredients may be, but as they are under no obligation to do so, many will not, often for understandable reasons – such as to keep the ingredients list brief, or to maintain a recipe ‘trade secret’, such as with Marmite, whose precise ‘spice extracts’ are unknown. 

Individual Food Allergies

Some are harder to manage than others. For instance, a lettuce allergy may be simpler to cope with. Lettuce, a bland vegetable, is unlikely to be used to derive a ‘flavouring’ ingredient, and so will in all probability only appear in whole form – in a prepared salad or ready-made sandwich, for example. Others are more complex. Here are a few.

Corn allergy
This is particularly difficult, as corn is widely used in ‘free from’ products, and because corn is a source ingredient for many ingredients in general, such as vegetable gum, vegetable shortening, vegetable protein, vegetable starch, ‘thickener’, glucose or fructose syrup, and many more. See our Corn and Maize Allergy section for more information.

Onion/Garlic allergy
Also difficult. Garlic especially is used as a flavouring in many processed foods, and may ‘hide’ in a ‘spice’ mix. Anila’s Sauces is a brand of sauces which is free from onion and garlic (as well as gluten and milk).

Tomato Allergy
Found in all manner of processed foods – ready meals, condiments, sauces, soups and more. The much missed ‘Nomato’ range of tomato-free products has still not been replaced, but The Foraging Fox do a popular Beetroot Ketchup as an alternative to the usual variety.

Red pepper / chilli allergy
Peppers (ie capsicums) are related to chilli peppers / paprika, so if you are allergic to one, you may be allergic to all. Again, ‘spices’ are best avoided.

Potato allergy
May appear as ‘flour’ or ‘starch’ or in gluten-free flour mixes. It will usually be named when present in substantial quantities, and it is unlikely to ‘hide’ as ‘flavouring’ for example, though may feasibly appear as ‘vegetable thickener’ or similar. See our article on potato sensitivity here.

Fruit allergy
Severe allergies to kiwi, strawberry, peach and banana, for example, are well known. Any sweet products, desserts, fruit salads, confectionary are potential sources. Take care with ‘fruit flavour’ or ‘fruit flavouring’ – the first will be derived from real fruit (the name of which may not be declared), whereas the second may not be from fruit at all, and derived synthetically. Be also aware that, potentially, flavour derived from one fruit, such as kiwi, may be used in a product bearing the name of another, such as a strawberry yogurt.

In practice, many who react to fruit have Oral Allergy Syndrome – which is related to hay fever – and may only react to raw fruits. If this is the case, processed ‘flavouring’ ingredients, pasteurised juices and cooked desserts, for instance, will probably be safe.

Lentil / Pea / Bean allergy
These are all legumes – as are the most feared food allergen, peanut. Many with peanut allergy or soya bean allergy also react to one or more other legumes, but they can exist independently of these as well. Vegetarian or vegan foods, especially, are the ones to watch out for. Chickpea flour may also be used in gluten-free foods.

Meat allergy
Quite rare in the UK, but a minority of those effected by egg allergies are also allergic to chicken, and it’s a similar scenario between milk and beef. Vegetarian food will of course be safe, and any meat presence will in practice be clearly declared.

Eating Out

The rules for restaurants, pubs, food service providers and for foods sold loose (rather than pre-packed) are not as strict as labelling regulations for foods and drink you might find on your supermarket shelf.

In such cases, food service providers are under no obligation to give you the ingredients of the foods present – although they must give you the names of all Annex II allergens. In practice, they should be able to tell you most – such as if onion has gone into a stew – but where they may fall down is with processed ingredients. Chefs are unlikely to check whether there’s fenugreek in their spice mix, or chives in their dried herb mix – although may be able to investigate if you ask.

As with any allergy, calling in advance, explaining your situation, and reiterating the problem to waiting staff when you arrive, are all advisable.

Medicines / Supplements

Ask your doctor to check anything he or she prescribes you. Odd flavourings can be surprising additives. There is a case on record of a girl with banana allergy having an anaphylactic reaction to penicillin which had been flavoured with banana essence to make it more palatable for children to take.

Be wary of herbal supplements, which may contain various botanical or herbal extracts. Read labels carefully or call manufacturers.

Further information

Anaphylaxis Campaign – Onion and Garlic Allergy
Anaphylaxis Campaign – Kiwi Allergy
Anaphylaxis Campaign – Banana Allergy
Anaphylaxis Campaign – Tomato Allergy

March 2016

• If this article was of interest you will find many other articles on unlikely allergies and allergy connections here .

• For more on the more 'mainstream' allergies check in to our 'allergy and intolerance home page' – and for ideas on alternative foods go here and for hundreds of 'freefrom recipes, go here.

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