Consumer preferences for food allergen labeling

Cell-based, cell-cultured, cell-cultivated, cultured, or cultivated. What is the best name for meat, poultry, and seafood made directly from the cells of animals?

To be sold in the United States, meat, poultry, and seafood products made from cultured cells must be labeled with a "common or usual name" to help consumers understand what they are purchasing. The terms "Cultured," "Cultivated," "Cell-Cultured," "Cell-Cultivated," "Cell-Based" and a control (without a common or usual name) were tested using an online experiment. Two regulatory criteria were assessed: that the term distinguishes the novel products from conventional products, and appropriately signals allergenicity. Three consumer acceptance criteria were assessed: that the term is seen as appropriate, does not disparage the novel or conventional products, nor elicit perceptions that the products are unsafe, unhealthy, or not nutritious. Each term was shown on packages of frozen Beef Filets, Beef Burgers, Chicken Breasts, Chicken Burgers, Atlantic Salmon Fillets, and Salmon Burgers. A representative sample of 4385 Americans (18 + ) were randomly assigned to view a single product with a single term or the control. Consumers' ability to distinguish tested terms from conventional products differed by product category. "Cultured" and "Cultivated" failed to adequately differentiate the novel products from "Wild-Caught and Farm-Raised" salmon products. "Cultivated" failed to differentiate the novel Beef Filet product from "Grass-Fed" Beef Filets. "Cell-Cultured," "Cell-Cultivated," and "Cell-Based" each signaled that the products were different from conventional products across the proteins, and signaled allergenicity, meeting the two key regulatory criteria. They were not significantly different on most consumer perception measures. However, "Cell-Cultured" may have slightly better consumer acceptance across the novel beef, chicken, and salmon products, recommending its universal adoption.

Knowledge, Attitudes, and Practices of Consumers on Food Allergy and Food Allergen Labeling: A Case of Lebanon

The epidemiology of food allergies is increasing worldwide. International labeling standards were developed to enhance consumers' awareness of allergen-free foods. The main objective of the present study is to assess the characteristics of allergen labeling and consumers' knowledge, attitudes, and purchasing habits of food products with allergens in Lebanon. We evaluated the allergen labeling of 1000 food products form Lebanese supermarkets. A random sample of 541 consumers was recruited through an online survey (November 2020-February 2021). Descriptives and regression analysis were conducted. Results showed that wheat represents the largest group of food allergens on food labels, followed by milk and soybean. Furthermore, 42.9% of supermarket food products had a precautionary allergen labeling with "may contain traces of allergens". The majority of food products complied with local regulations for locally manufactured and imported products. One-quarter of survey respondents had a food allergy or were caregivers of food-allergic individuals. Regression analyses showed that "previous experience of a severe reaction" was negatively associated with food allergy-related knowledge and attitude scores respectively (β = -1.394, 95% CI: (-1.827, -1.034) and β = -1.432, 95% CI: (-2.798, -0.067)). The findings of this study provide practical insights on food allergy labeling issues for stakeholders and policymakers in the food supply chain.

Pharmacokinetic Comparison of Chitosan-Derived and Biofermentation-Derived Glucosamine in Nutritional Supplement for Bone Health

Glucosamine and chondroitin sulfate have been used as nutritional supplementation for joint tissues and osteoarthritis (OA). Biofermented glucosamine is of great interest in the supplement industry as an alternative source of glucosamine. The purpose of this study is to compare the pharmacokinetics of chitosan-derived glucosamine and biofermentation-derived glucosamine as nutritional supplementation. In a randomized, double-blind and cross-over study design, we recruited subjects of healthy men and women. The pharmacokinetics of glucosamine were examined after a single dose of glucosamine sulfate 2KCl (1500 mg) with two different sources of glucosamine (chitosan-derived glucosamine and biofermentation-derived glucosamine) to male and female subjects fitted with intravenous (iv) catheters for repeated blood sampling up to 8 h. According to plasma concentration-time curve of glucosamine after an oral administration of 1500 mg of glucosamine sulfate 2KCl, AUC_0-8h and AUC_0-∞ values of glucosamine following oral administration of chitosan-derived and biofermentation-derived glucosamine formulations were within the bioequivalence criteria (90% CI of ratios are within 0.8-1.25). The mean Cmax ratios for these two formulations (90% CI of 0.892-1.342) did not meet bioequivalence criteria due to high within-subject variability. There were no statistically significant effects of sequence, period, origin of glucosamine on pharmacokinetic parameters of glucosamine such as AUC_0-8h, AUC_0-∞, Cmax. Our findings suggest that biofermentation-derived glucosamine could be a sustainable source of raw materials for glucosamine supplement.

The Economic Burden of Food Allergy: What We Know and What We Need to Learn

Purpose of Review

Food allergy management and treatment require dietary modification, are associated with significant burdens, and affect food choices and behaviours. Emerging therapies, such as oral immunotherapy (OIT), provide a glimmer of hope for those living with the condition. Some burdens have received substantial focus, whereas many knowledge gaps on the significance of other impacts, including economic burden, remain.

Recent Findings

Evidence from many countries, but disproportionately from the United States, supports that food allergy carries significant healthcare and societal costs. Early introduction for the prevention of food allergies is theoretically cost-effective, but remains largely undescribed. Unique considerations, such as those to cow’s milk protein allergy, which affects a substantial proportion of infants, and adrenaline autoinjectors, which have a high cost-per-use, require a balance between cost-effectiveness to the healthcare system and adverse outcomes. Household costs have largely been explored in two countries, but owing to different healthcare structures and costs of living, comparisons are difficult, as are generalisations to other countries. Stock epinephrine in schools may present a cost-effective strategy, particularly in economically disadvantaged areas. Costs relating to OIT must be examined within both immediate benefits, such as protection from anaphylaxis, and long-term benefits, such as sustained unresponsiveness.

Summary

Although the absolute costs differ by region/country and type of food allergy, a consistent pattern persists: food allergy is a costly condition, to those who live with it, and the multiple stakeholders with which they interact.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40521-022-00306-5.

Responses of consumers with food allergy to the new allergen-labelling legislation in Saudi Arabia: a preliminary survey

OBJECTIVE

Preventing a food allergy reaction depends primarily on eliminating allergens from the diet. In October 2019, the Saudi Food and Drug Authority (SFDA) introduced new legislation requiring food establishments providing and selling non-prepacked foods to state the presence of the top fourteen food allergens on their menus. The current study aimed to assess the allergen-labelling knowledge, practices, preferences and perceptions towards the new SFDA allergen-labelling legislation among consumers with food allergy in Saudi Arabia.

DESIGN

Observational cross-sectional study using an online questionnaire.

SETTING

Saudi Arabia; February - March 2020.

PARTICIPANTS

Residents of Saudi Arabia with food allergy (n 427), aged 18-70 years.

RESULTS

Among participants, only 28·1 % knew that there were governmental regulations in Saudi Arabia regarding food-allergen labelling and approximately two-thirds (67 %) check labels on prepacked food products for allergens. The majority of the participants preferred food products carrying safety statements (84·1 %) and symbols (80·1 %). A total of 47·1 % were aware that regulations in Saudi Arabia require allergens to be declared in ingredient lists, while 51·3 % were aware that advisory allergen labelling is not required by law. Only 26·2 % were aware of the new SFDA legislation regarding provision of allergen information by food establishments. However, the majority (94·4 %) were supportive of the new legislation, and most of them were more likely to eat at restaurants that reported allergen information for food items on the menu.

CONCLUSIONS

The new SFDA food allergen-labelling legislation needs to be more widely and effectively disseminated to increase the level of awareness among adults with food allergy in Saudi Arabia.

Poor understanding of allergen labelling by allergic and non-allergic consumers

Background

Understanding consumers’ interpretation of allergy information is crucial for effective food safety policies. We evaluated consumer understanding of allergy information on foods in controlled, experimental studies.

Method

Using 18 packaged foods, we evaluated consumer understanding of information about allergens in two experiments: First, a comparison of foods with no stated allergen versus allergen as a stated ingredient versus a precautionary allergen label (PAL); second, a comparison of three common variants of PAL. In each experiment, consumers with and without self‐reported food allergy were asked to estimate the risk of allergic reaction and to rate the comprehensibility of the allergen information. In the second experiment, consumers were also asked which form of PAL they preferred.

Results

Risk of reaction was assessed as high and low for foods with the allergen stated as ingredient, or without any mention of allergen. However, risk assessment for PAL varied and was judged as higher by non‐allergic than allergic participants (82% vs. 58%, p < .001). Understanding of risk associated with PAL also varied by health literacy (p < .001). Both allergic and non‐allergic consumers judged all forms of allergy information to be unclear, especially products with no allergy information for non‐allergic consumers. Products with a ‘Produced in a Factory’ PAL were perceived as less risky than ‘May contain’ or ‘Traces of’ PALs (p < .001), less than 40% of participants judged PAL information to be comprehensible, and participants preferred ‘May contain’ over the other PALs.

Conclusion

Both allergic and non‐allergic consumers find allergen information difficult to interpret on packaged foods and misunderstand PAL, incorrectly distinguishing different risk levels for different PAL wording. Clearer allergy information guidelines are called for, and the use of only one PAL wording is recommended.

Allergen labelling: Current practice and improvement from a communication perspective

BACKGROUND

Allergen information on product labels is crucial in food allergy management, though inadequacy in current labelling practices is one of the major causes for accidental reactions upon consuming prepacked food products.

OBJECTIVE

This study analyses current status of communicating allergen information on food labels and provides practical recommendations for improving the label format based on communication theory.

METHODS

Product labels (N 288) of seven food categories from private label products and brands were obtained at three retailers in the Netherlands. Information regarding the 14 EU-regulated allergens was evaluated by the frequency of emphasizing allergens in the ingredient list, use of precautionary allergen labelling (PAL), icons and an allergen information section. Effectiveness of communication was assessed evaluating readability and findability of information on allergens using principles of Gestalt and Cognitive Load theories.

RESULTS

As requested by EU regulation 1169/2011, emphasizing allergens in the ingredient list was almost 100%, all other presentations of information on allergens on labels was highly diverse. A separate allergen information section was present on most private label products. This section could, but not necessarily did, repeat allergens from the ingredient list and/or give a PAL. Brands often provided a PAL at the end of the ingredient list. Part of the products displayed an icon at different locations of the label. Label background, a lack of cohesion and variation in location of topics hamper the identification of relevant information on allergens by (allergic) consumers. Recommendations include a standardized order for mandatory and voluntary topics on the label and a separate allergen information section.

CONCLUSION AND CLINICAL RELEVANCE

Overall, consumers encounter a wide and inconsistent range in ways of presentation of allergen information on labels. Standardization according to basic design principles can improve usability and support safe food purchases for allergic consumers.

Characteristics of Allergen Labelling and Precautionary Allergen Labelling in Packaged Food Products Available in Latin America

The characteristics of food allergen labelling are relevant for avoiding accidental exposure to the allergens of interest but no Latin American country has evaluated these characteristics. Our aim was to evaluate the characteristics of food allergen labelling and precautionary allergen labelling (PAL) in six Latin American countries. All data were collected directly from the supermarkets surveyed. A total of 10,254 packaged food products were analyzed, of which 63.3% (n = 6494) and 33.2% (n = 3405) featured allergen labelling and/or PAL, respectively. Most products complied with local regulations (≥87.4% for both locally produced and imported). Thirty-three types of PAL statements were detected; the most frequent was “may contain traces of…” (35.1%). Countries without regulations on the characteristics of allergen labelling had two-fold more products that contained allergens in their ingredients lists but no food allergen labelling. The use of PAL in countries that regulate it (38.2%) was as high as that in countries without PAL regulations (19.2%–44.7%). The findings suggest that the lack of regulations for the characteristics of allergen labeling increases the risk of accidental exposure to allergens of interest. Our findings also suggest that beyond regulations, a scientific approach is required for minimizing and standardizing the use of PAL.

Which snack factors and nutritional ingredients influence college students' snack choices? Evidence from discrete choice experiments

Objective: The study examined which snack factors and nutritional ingredients influence college students' snack choices using a discrete choice experiment (DCE). Participants: In November 2016, a total of 1,624 undergraduate students participated in the study. Methods: Two DCEs were constructed using a unique approach of block fractional factorial designs. The first DCE examined four three-level snack factors: healthiness, taste, convenience, and price. The second DCE focused on six two-level nutritional ingredients: sugar, salt, calories, fat, all natural, and fiber. Results: Students preferred quick and cheap snacks, but higher prices on healthy snacks did not affect their decision significantly. Healthiness and sugar had the highest relative importance of snack factors and nutritional ingredients, respectively. High-sugar snacks were less favored if students considered themselves educated in nutrition. Conclusion: Thus, potential ways to improve the snack choices for college students are to offer healthier snacks on college campuses and to promote nutrition education.

Soy Preparations Are Potentially Dangerous Factors in the Course of a Food Allergy

The special properties of soy preparations make them common additives for food production and can be dangerous for sensitive individuals. Our aim was to check consumers’ awareness of potential risks of soy preparations added to numerous food products, depending on respondents’ education, and to evaluate immunoreactive properties of chosen soy preparations. A personal questionnaire was used. Respondents (n = 251) were aged 23–28 years old, lived in Poland, and were graduates or students in their last year of food technology, medicine, and university of technology. The slot blot and Western blotting methods were used to mark immunoreactivity of soy preparations. It was shown that most respondents often or usually read labels of food products they buy. The surveyed indicated protein is the allergenic component in soy. Almost half of them were of the opinion that hydrolysis removes the allergenic properties of soy. Most of the medical students surveyed thought that people allergic to soy may consume products that contain soy preparations. The analytical results indicated that soy preparation contained protein fractions that were immunoreactive with sera of allergenic patients. It was proven that preparations, even hydrolysates, contain immunoreactive proteins that may be the source of hidden allergens, even though they are not recognized as dangerous by well-educated respondents.

Understanding how consumers with food allergies make decisions based on precautionary labelling

BACKGROUND

Understanding consumer perceptions is crucial if effective food safety policy and risk communication are to be developed and implemented. We sought to understand how those living with food allergy assess risk with precautionary allergen labelling (PAL) and their preference in how risks are communicated within a quantitative risk assessment (QRA) framework.

METHODS

The Integrated Approaches to Food Allergen and Allergy Risk Management (iFAAM) labelling online survey was developed for adults and parents of children with food allergy and distributed across Germany, Ireland, Netherlands, Spain and UK via patient support groups.

RESULTS

There were 1560 complete responses. 'This product is not suitable for' was selected as first choice for PAL by 46% overall and 'May contain' was selected as the first choice by 44%. Seventy-three percent reported that it would improve their trust in a product if a QRA process had been used to make a decision about whether to include 'may contain'. Overall, 66% reported that a 'statement + symbol' on the label indicating a QRA, would help them to understand the risk assessment process that had been used by the food manufacturer.

CONCLUSIONS

Consumers want to know what process has actually taken place for the placing of a PAL and/or risk assessment statement on a particular food product. Our findings provide a basis for the development of more informative communication around food allergen risk and safety and support evidence-based policy-making in the context of the legislative requirements of the European Union's Food Information for Consumers Regulation.

Estimation of acrylamide exposure in Italian schoolchildren consuming a canteen menu: health concern in three age groups

Acrylamide (AA) is a food process contaminant with carcinogenic and genotoxic properties that is formed in thermally treated foods, especially carbohydrate-rich. Dietary exposure to AA, due to school canteen foods, was estimated in schoolchildren aged 3-13 years by combining the AA concentration in foods with the amount and frequency of food consumption. Potato products and bakery products presented the highest mean levels of AA (841 and 244 µg/kg, respectively) followed by meat (222 µg/kg) and egg products (151 µg/kg). The mean total AA intake was estimated at 2.16 µg/kg bw/d, with the highest percentages provided by potato products (34.5%), meat products (26.1%) and bread (24.5%). The calculated margins of exposure (MOEs) for the average AA exposure (84 and 212 for the benchmark dose lower confidence limits (BMDL) of 0.17 and 0.43 mg/kg bw/d) suggest that there is a health concern with respect to students eating in school canteens.

Food allergen labelling: "May contain" evidence from Malaysia

Food allergen labelling is mandatory and regulated whilst precautionary allergen labelling (PAL) remains voluntary in most countries. It is the aim of this study to identify the food allergens declared in food products sold in a developing country and to what extent food allergens and PAL are emphasised in the products. A total of 505 food and beverages (snacks, baked goods, confectionary, baby food, condiments & jams, beverages, powder & paste, instant food, chilled & frozen food and canned food) were evaluated in Malaysia. Soybean represents the largest group of food allergen declared in labels, followed by wheat and milk products. Thirteen variations of contains statement were found with "Contains [allergen(s)]" being the most common (55.02%). There were 22 different types of "may contain" statements with 'May contain traces of [allergen(s)]' being the most common advice labelling used (55.41%). Different font type or emphasis such as brackets (51.57%) and bold font (33.86%) were used to inform consumers about presence of allergens. The national regulations on food allergen labelling are then critically contrasted with other Asian countries and the EU Regulation No. 1169/2011, which represents one of the most stringent food regulations in the world. Improving current allergen labelling limitations and practices would be of great benefit to consumers to prevent risk of food hypersensitivity.