Current approaches in diagnosing and managing food allergy among Queensland Public Health settings Michael Sheridan BSc., BEd., DipFinPl., GradDipEnvHth., MBiotech. PhD RESEARCH CANDIDATE SUPERVISOR: A/PROF ANDREAS LOPATA CO-SUPERVISOR: PROF NORELLE DALY ADVISOR: DR FIONA BAIRD FACULTY: MEDICINE, HEALTH AND MOLECULAR SCIENCES SCHOOL: PHARMACY AND MOLECULAR SCIENCES
Study Chapters Chapter 1 Health Professional Survey Questionnaires Doctors, Nurses, Paramedics, Kitchen Staff Chapter 2 Data Coder Survey & Scenarios Questionnaires, Case Scenarios to be individually coded via ICD-10-AM. Data Coders Chapter 3 Mortality & Morbidity Data Analysis Nth QLD Hospital mortality and morbidity data analysis 10yrs, Time Trends. Chapter 4 Food Labelling ELISA of imported foods. Chapter 5 Development of Models & Tools Systematic publication review of diagnostics & Treatments, Web and App platforms, Health Professional Training packages, Recommendations. 2
Chapter 4 - Food Labelling 3
Legislation Food Act 2006 37 Food Standards Code 38 (FSANZ) Food Recalls Food Safety Programs 4
Mandatory Labelling Mandatory Food Labelling Food Act 2006 37, Chapter 2, Part 2, s39(3) A person must not sell or advertise food that is packaged or labelled in a way that contravenes a provision of the food standards code. Maximum penalty 500 penalty units. Food Standards Code 38 PART 1.2 Labelling and other Information Requirements Standard 1.2.1 Application of Labelling and Other Information Requirements Standard 1.2.2 Food Identification Requirements Standard 1.2.3 Mandatory Warning and Advisory Statements and Declarations Standard 1.2.4 Labelling of Ingredients Problems Hidden allergens in the wording e.g. Glucose syrup (wheat), Lecithin (soy), Casein (milk). Listing the allergenic food in ingredients list satisfies Mandatory Labelling Requirement. Many exemptions e.g. made and packed on the permises from which it is sold, sold at fundraising events, packaged in the presence of the purchaser etc 5
Voluntary Labelling Precautionary Food Labelling may be present, may contain traces of Allergen Bureau - Voluntary Incident Trace Allergen Labelling (VITAL) via ED (Eliciting Dose) Thresholds: VITAL1.0 39 (egg, peanut, hazelnut, cow s milk, wheat, lupin, cashew, shrimp, sesame seed, mustard, soybean) VITAL 2.0 40 - egg (0.03mg), peanut (0.2mg), hazelnut (0.1mg), cow s milk (0.1mg) - allergic rxn estimate to 1% population. Problems Overuse or underuse of voluntary labelling. Not uniform across industry. 6
HYPOTHESIS & AIM Preliminary Data 2012 TPHU & QHFSS study found tested products with undeclared allergens. Hypothesis Current food product labelling of allergen mandatory warnings, advisory statements and declarations, of imported packaged foods sold in North QLD are inadequately communicated. Aim Determine the extent of undeclared food allergens in select imported packaged foods sold in North QLD. 7
FOOD LABELLING METHODOLOGY Perform a quantitative single-case design ELISA study in triplicate: 24 imported packaged foods from retailers. Significant differences between means to be determined. Results compared with product label and the Food Standards Code - PART 1.2 Labelling and other Information Requirements 38 Compare ELISA results for major undeclared allergens with VITAL 2.0 tested foods and Voluntray Labelling. Review of Food Labelling Standards e.g. labelling exemptions, FSP s & Recalls. 8
FOOD LABELLING METHODOLOGY Allergens to be tested: - Depends on selected foods Egg Peanut Hazelnut Sesame seed Lupin Cow s milk Wheat Cashew Soybean Shrimp 9
http://www.oxoid.com/pdf/elisa/peanut-flyer-april-2009-uk.pdf (06.06.2013) 10
Food Labelling OUTCOMES Published Journal Articles. This study will be performed in collaboration with FSANZ and the National Measurement Institute. Share Findings & Recommendations - FSANZ and Food Safety Standards and Regulation QLD Health regarding food labelling results. E.g. Food Compliance Committee Working Group. Review and Recommendations - QLD Health and HHS s regarding FSP s and patient policies and procedures. 11
Acknowledgements Townsville Public Health Unit (TPHU) Dr Steven Donohue Damien Farrington Greg Bennett Collaborations National Measurement Institute Maria Toressan Sheena Hickey FSANZ James Cook University (JCU) A/Prof Andreas Lopata Kari Arbouin Dr Fiona Beard EMProf Rhondda Jones (Stats) Funding Source A/Prof Andreas Lopata - ARC Future Fellowship 12
References 31. The Food Act 2006, Federal Government of Australia. 32. The Food Standards Code, Food Standards Australia and New Zealand (FSANZ), Federal Government of Australia. 33. Taylor SL, Baumert JL, Kruizinga AG, Remington BC, Crevel RW, Brooke-Taylor S, et al. Establishment of Reference Doses for residues of allergenic foods: report of the VITAL Expert Panel. Food & Chemical Toxicology. 2014;63:9-17. PubMed PMID: 24184597. 34. Allen KJMDPFabc, Remington BCBSd, Baumert JLPd, Crevel RWRDe, Houben GFPf, Brooke-Taylor SPg, et al. Allergen reference doses for precautionary labeling (VITAL 2.0): Clinical implications. J Allergy Clin Immunol. 2014;133(1):156-64. 13