Food allergy risks in catering

Transcription

1 Food allergy risks in catering CIEH Conference: October 31 st, 2018 Dr Hazel Gowland PGCE MSoFHT MREHIS FIFST FRSPH Food allergy advocacy, research and training

2 Hazel Gowland: Allergy Action Peanut and nut allergy as a baby Working with the Anaphylaxis Campaign since 1994 Develop and delivering effective allergy training since 1995 Work with food suppliers, regulators, caterers, schools, nurseries Consumer Research for FSA on food labelling and shopping Research into forensic aspects of food allergy deaths and near misses

3 What are the risks for people with allergies? Death Life-threatening symptoms Anaphylaxis Mild to moderate symptoms Very mild symptoms eg tingling, itch No symptoms (Allergen exposure below minimal eliciting dose) Sensitisation immune system set up for future allergy

4 Food allergy

5 Preventing sensitisation through early diet

6 Immunotherapy Milk ladder Egg ladder

7 Immunotherapy

8 Life stages

9 October 2017: Back-up AAIs in schools

10 Integrated allergy policies

11 What are the risks to businesses supplying food? Serious life-changing injury or death. Illness, maybe hospitalisation business responsible Risk of prosecution or civil claim Loss of reputation / brand damage Product complaint picked up by EHO / TSO / FSA Recall Complaint against caterer Social Media reputation damage Complaint during inspection Audit mark down Non Conformance Allergy Training needed Lesson learned In-house check - fixed

12 Severity of reactions Sensitivity Asthma history Age Metabolism Exercise / exertion Alcohol Medication + Recognised knowledge gaps Turner et al: Allergy 2015 Can we identify patients at risk from life-threatening reactions to foods?

13 Hospital admissions increase Turner, P.J., Gowland, M.H., Sharma, V., Ierodiakonou, D., Harper, N., Garcez, T., Pumphrey, R., Boyle, R.J. (2014). Increase in anaphylaxis-related hospitalization but no increase in fatalities: An analysis of United Kingdom national anaphylaxis data, Journal of Allergy and Clinical Immunology, 135 (4), pp

14 UK fatal reactions to food: Confirmed or reported likely trigger foods Data from Pumphrey& Gowland JACI 2007, Turner et al JACI 2014, inquest and media reports

15 ALLERGIC REACTION TO SUSPECTED FOOD Food not eaten? Consider other food exposure? Contact eg kissing, touch, inhalation, cosmetics, toiletries? Read labels (in Latin?) Symptoms observed. Resolve No treatment Report reaction: Pharmacist Family doctor Allergy clinic AIM TO AVOID IDENTIFIED ALLERGEN IN FUTURE What was in the food? Treat with medication carried / available Severe Following an allergic reaction suspected to have been caused by a food allergen Allergy Action 2018 Mild Food eaten? Symptoms Moderate TREATMENT Prepacked? Non prepacked? Call for emergency medical care / ambulance PATIENT STABILISED To the food business Retain packaging / food sample? Talk to staff No obvious trigger? Supplier unlikely to be responsible for reaction? Decide not to make complaint. (Future avoidance of product or business) To the official food control authority Consider whether the food sold had been: Misdescribed Mislabelled Supplied contrary to an understanding between the food business operator and the customer Aim to confirm culprit food, prevent reactions, protect others at risk, and more rarely to seek compensation? To a patient support organisation (Re-) Read packet Contact supplier? IDENTIFY LIKELY TRIGGER ALLERGEN DECIDE TO MAKE COMPLAINT Taking legal advice

16 Food Information Regulation Their website was helpful Look at other people s plates I hope the manager will check everything I might just taste a tiny bit and see what happens How busy are they? Is there a QR code? Hope they have wi fi so I can check the allergens online on my phone I hope they ve given me the right dish..?

17 Consumer protection

18 Recent allergy reports Gluten free version of dish requested but serving staff member picked up normal one instead on the pass as family wanted food more quickly Chain pub ingredients system not up to date and allergen column not ticked Message from group organiser for an event not passed on to kitchen Guest had ordered allergy meal and kitchen / service had food ready, but guest fancied the standard option instead and helped themselves Chain restaurant prepared allergy meal separately but allergic diner took food off another person s plate as well

19 Data from Pumphrey & Gowland JACI 2007, Turner et al JACI 2014, inquest and media reports Lessons from fatal allergic reactions Since January probable fatal reactions to foods in the UK Average age 20 (3y 55y) 20 Male: 24 Female Inquests delayed waiting for police / local authority action? Key evidence not always available

20 Data from Pumphrey & Gowland JACI 2007, Turner et al JACI 2014, inquest and media reports Lessons from fatal allergic reactions Possible factors Possible milk with meat eg buttermilk marinade, yogurt in kebab Misunderstanding about foods to be avoided Foods prepacked for direct sale with not all allergens labelled School recognition of symptoms Poor response eg symptoms, management, #AAI practice, posture Bullying?

21 Paul Wilson Paul Wilson s curry order January 30 th, 2014

22 R v Zaman May Offences Gross negligence manslaughter causing the death of Mr Wilson Placing food on the market that was unsafe and injurious to health (178/2002 EC and Food Hygiene (England) Regulations 2013) Selling food not of the substance demanded (Food Safety Act 1990) Falsely describing food as containing almonds when it contained peanuts (Food Safety Act 1990) Food offences 18 months (on their own) Sentenced to 6 years in jail in total (These offences took place before December 2014 when the Food Information Regulation 1169/2011 EC became enforceable.)

23 Appeal autumn 2017 Royal Courts of Justice Strand, London 08/11/17.. the Appellant's negligence in this case was not just gross; his behaviour, driven by money, was appalling. Given the very serious aggravating factors, even though the Appellant was a man of good character, we are wholly unpersuaded that a sentence of six years after a trial was manifestly excessive or, indeed, excessive at all. Conclusion The appeal in respect of both conviction and sentence is dismissed

24 1. History and diagnosis 2. Contract specifying avoidance 3. Reaction timing and symptoms (CCTV) 4. Food samples Eaten / PM 5. Investigation TSO/EHO, Police, Public Analyst and FSA Support 6. Analytical methods 7. Evidence from food suppliers & FBOs 8. Law to use Negligence?

25 Amy May Shead Dr Hazel Gowland CIEH Hazel Conference Gowland Allergy 2018 Action Allergy 2017 Action

26 January 2015: Manchester

27 January 2017: Lancashire Two men sent for trial October 2018

28 March 2017: Bath Failing to ensure that documents were up to date at all times in respect of food allergies Failing to identify the hazard of serving food to a customer with a particular food sensitivity in the absence of a notice reminding customers to ask about allergens in the food Failed to establish documents and records to demonstrate the effective application of the required measures such that food containing milk product was served to a customer with that particular health sensitivity; (Article 5 (1) EU Regulation 852/2004)

29 Unexpected allergens?

30 September 2018: West London Coroner s Court My conclusion is a narrative one. Natasha Ednan-Laperouse died of anaphylaxis in Nice on the 17 th July 2016 after eating a baguette, purchased from Pret-a-Manger at LHR T5. The baguette was manufactured to Pret specifications and contained sesame to which she was allergic. There was no specific allergen information on the baguette packaging or on the langar barker and Natasha was reassured by that. That concludes the Inquest into the death of Natasha Ednan-Laperouse.

31 September 2017: Table allergen detection

32 October 24 th, 2018

33 #Natashaslaw October 23rd, 2018

34 Guardians protecting those at risk

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36 ALLERGY ACTION allergytraining.com Dr Hazel Gowland PGCE, MSoFHT, MREHIS, FIFST, FRSPH