Dealing with food allergies is a daily fact of life for millions of people in the UK, but the topic has been brought into sharp focus in recent months as details of two recent deaths came to light.
The coroner in the recent inquest into the death of 15-year-old Natasha Ednan-Laperouse found allergy labelling by sandwich chain Pret A Manger had been inadequate. Natasha, who had a number of severe allergies, had checked the ingredients on the packaging of an artichoke, olive and tapenade baguette she had purchased from the company at Heathrow Airport in 2016 but they made no mention of sesame seeds contained in the bread. She collapsed on her flight from London to Nice and died later the same day.
The court heard Pret did not label “artisan” baguettes as containing sesame seeds, despite there being six allergic reaction cases in the year before Natasha died.
Following the conclusion of the case, Natasha’s father Nadim Ednan-Laperouse said the inquest should “serve as a watershed moment to make meaningful change and save lives” and Pret subsequently agreed to list all ingredients in its freshly-made products.
Under current guidelines, food packaged on-site before sale do not require a specific allergen label.
A second case came light days later involving the death of 42-year-old Celia Marsh, who died last December after eating a flatbread from Pret that was supposed to be dairy-free but was found to be contaminated with dairy.
An inquest into her death is yet to take place, with Pret and one of its former supplier contesting who was culpable.
A statement from Celia’s family said: “ “She was a much-loved mother, daughter, sister and wife. We miss her greatly and we just want the answers to why she died after eating lunch with her family.”
The two tragic cases have shone a spotlight on the potentially-deadly effects of food allergies, which are very common in this country.
According to Allergy UK, such conditions affect between six and eight per cent of children. For children with severe allergies, everyday tasks can be challenging, from eating lunch to travelling on public transport.
Gemma Swales, 30, and four-year-old daughter Poppy live in Sutton-on-Craven in North Yorkshire.
Poppy has severe allergies to egg and peanuts, which she has to carry EpiPens for, and she also has a lesser allergy to milk.
“She had terrible reactions in the beginning, sickness, stomach upset, blistering eczema, so bad she couldn’t lay on her back at one point,” Swales says. “We check packaging and labelling for everything she eats and eating out can be a minefield – especially when people don’t actually understand what I’m trying to get across. You’d be surprised how many people think dairy is an allergy to milk and eggs and how many people think that she would be OK to eat baked eggs.”
Swales says she worries all the time that Poppy may accidentally eat something she is allergic to. “Accidents happen and at the end of the day although she is very much aware of her allergies, she is only four years old and doesn’t understand the severity of her allergens,” she says.
“We have a plan in place at school where not just food items need to be checked but play items too, such as messy play things, packaging for craft work like egg boxes.
“Even where her drinks bottle is kept in class is key to keeping her safe. Imagine a kid has eaten peanut butter for breakfast and mistakenly drinks her water.”
Allergies occur when the body’s immune system reacts to a particular substance as though it is harmful. This begins when the allergen enters the body, triggering an antibody response.
When the allergen comes into contact with the antibodies, these cells release certain substances including histamine, which cause swelling, inflammation and other problems.
People with severe allergies may be at risk of anaphylactic shock, a drop in blood pressure which can lead to loss of consciousness and sometimes death. It can be treated with an adrenaline auto-injector, otherwise known as an EpiPen.
In the two decades up to 2012, the number of hospital admissions in the UK for anaphylaxis rose by 615 per cent.
“Allergies have been increasing for more than a century, they are still increasing in some places and seem to have reached their plateau in other,” says Nikos Papadopoulos, professor of allergy and paediatric allergy at the University of Manchester.
“It is also important to note that many children have allergies that are mild and therefore not paying so much attention to them. For example, a bit of dry skin, or occasional wheeze episodes or mild hayfever.”
Nobody knows exactly why we are becoming more allergic, but there are several theories. In 2015, a US study suggested that delaying the introduction of allergenic foods to babies – such as eggs and nuts – could have an impact.
Low levels of vitamin D, rising pollution and decreased exposure to infections or microbes in early life may also lead to an increased risk of allergies, experts have suggested.
“We have evidence suggesting that our modern lifestyle attracts lots of allergies. But modern lifestyle is many things: what we eat, breathe or are exposed to is much different to what it was one to two centuries ago,” Papadopoulos says.
“Many factors contribute to allergies, including diet, pollution, stress, the way houses are built, global warming and more. What however stands out is our distance from the microbes, bacteria and viruses, that would be the norm in an agricultural society but have been obliterated in modern environments: we are almost ‘sterile’ and while this protects us from many lethal diseases, it makes us more vulnerable towards allergies.”
So what is the best way to cope with allergies? “Currently there is no cure for food allergy so avoidance is important to prevent accidental exposure and the possibility of an allergic reaction,” says Holly Shaw, a nurse advisor for Allergy UK.
“Being able to identify from a food label whether that item contains the food/foods that need to be avoided – in the case where people have multiple food allergies – is an important part of making safe food choices when shopping and eating out.”
Food allergies are more common among children who come from families where other members have allergies, according to the charity. Babies who have eczema are also at a higher risk of having food allergies.
Allergy UK advises a three-step process to managing food allergies in children: identifying and avoiding the cause if possible, recognising the symptoms of an allergic reaction, and knowing what to do if it happens again. Keeping a food and symptom diary can help to identify food that cause reactions.
It is essential to be careful when eating out in a restaurant and to ask whether food contains certain foods. Some food types contain other foods that can trigger allergies, which restaurant staff may have overlooked.
The NHS advises to prepare for the worst and to take anti-allergy medication with you when eating out, particularly an adrenaline auto-injector.
“Cafes and food places need to label everything so much more clearly,” Swales says.
“Unfortunately we have come across so many places that don’t offer any allergy advice. We do not buy from these places.
“Most of the time we take her a pack up out but occasionally she will have a meal out with us after everything has been talked over with the chef.
“We stick to places we know mainly but even then it can be scary for us. Cross-contamination is so inevitable in some busy poorly-managed kitchens juggling so many different meals.”
Pret ‘determined to drive meaningful change’
Pret chief executive Clive Schlee has said the company is determined to “drive change in the industry” to better protect customers with allergies.
The company is trialling new labels which show full ingredients, including allergens, on packaging from next month, while prominent allergen warning stickers are being placed on all freshly-made products.
He said: “Pret is also committed to working with others, including the government, regulatory authorities, charity groups and industry peers to secure legislative changes to better protect people with allergies. I hope this sets us on course to drive change in the industry and ensure customers with allergies are as protected and informed as possible. Nothing is more important to Pret right now.”