The data from the nation-wide Surveying Canadians to Assess the Prevalence of Common Food Allergies and Attitudes towards Food Labelling and Risk (SCAAALAR) telephone survey, sponsored by Health Canada and the AllerGen research network, was presented at the American Academy of Allergy, Asthma & Immunology’s conference in March, 2009.

While the information is not complete – it reflects about 90 per cent of the 9,000 individuals on whom data was collected: “We do find a greater prevalence of peanut allergy in Canadian children, and a greater prevalence of tree nut allergy overall, and in Canadian children,” says Dr. Ann Clarke, an allergist at the McGill University Health Centre, who discussed the results with Allergic Living.

In Canada, 1.52 per cent of children are allergic to peanuts, based on a history of allergic reaction. The comparable figure in the U.S., from a 2002 survey, is .83 per cent, representing an 83 per cent higher rate in Canada. Similarly, the rate of tree nut allergy is about 120 per cent higher for Canadian children: 1.13 per cent have a history of reaction here, compared to .51 per cent in the United States.

When Clarke and her team looked at the rates of shellfish allergy in both countries, they found a 50 per cent higher rate of the allergy in U.S. adults compared to Canadian adults.

Clarke cautions, however, that the differences come with a few caveats: the Canadian data was collected six years after the U.S. data, and some of the difference could be attributed to an increase in food allergies over that time. Also, the SCAAALAR team has not analyzed the demographics of the Canadian survey respondents yet, so it’s unclear if the studies represent the same socio-economic groups. This analysis will be done before the final results are published next year. (Updated U.S. statistics are also coming next year.)

While the rates of allergy that Clarke and her team used to compare to U.S. figures are based on having a history of food allergy reactions, they also collected data on those who have had a medical diagnosis of food allergy, without a previous reaction. “It might mean that the parent is going in with a child and saying, well, his brother has peanut allergies so I’m concerned he might be allergic, but he’s never eaten it,” says Clarke.

The physician then does a skin or blood test and makes a diagnosis based on the results. The SCAAALAR team is currently contacting all physicians who made the diagnoses in these cases to confirm that yes, that patient is deemed to have a true food allergy.

The final figures for food allergy prevalence in Canada for individual foods, as well as overall incidence figures, will be based on those who have had a history of allergic reaction, as well as those who have a confirmed physician diagnosis.
First published in the Summer 2009 issue of Allergic Living.

Click here for more food allergy articles.

Click here to visit the Talking Allergies Web Forum.

The news came as Health Canada outlined some significant changes to regulations governing food allergies, which should become law early next year. The new rules state that these priority allergens must be declared in plain language, and must be listed on an ingredient label, even when they are an ingredient of another ingredient. For example, under current rules, a label could simply say “spice” or “flavouring” instead of clearly specifying that sesame or perhaps mustard is in the product.

The changes follow a Health Canada review of comments that the public, medical professionals, the food industry and other stakeholders put forward about the proposed rules. In addition to mustard becoming the 11^thpriority allergen, the consultations led the department to remove allergy exemptions for fining agents and wax coatings.

Originally, a label on standardized alcohol (such as beer, wine, rum, gin and whiskey) was not going to have to state whether fining agents used in production were derived from eggs, milk or fish, three top allergens. Since the review, all alcoholic beverages will have to declare priority allergens that are present. As well, top allergens in wax coatings on pre-packaged vegetables and fruits, which can be made with milk, soy or other allergens and may contain gluten, must be declared. (This doesn’t apply to bulk produce.)

Health Canada also developed criteria with which it can assess new potential priority allergens in the future. “That is important because that now says there’s a standard to follow,” says Marilyn Allen, a food allergy consultant to Health Canada and Anaphylaxis Canada. The criteria say that when evaluating a potential priority allergen, Health Canada will examine the severity of reactions to a food, the data available on the prevalence of allergic reactions to it, as well as the level of exposure to the food in Canada. Staff will also research what other countries are including on their priority allergen lists.

The addition of mustard to the allergy list is a good example of the process. That allergy isn’t particularly widespread, but reactions that have occurred have been severe, and mustard is used in many products in Canada and is easily hidden behind words like “spice,” Allen says.

The move to include mustard on the priority list will help people with mustard allergy and their families identify what foods are safe to eat. “It will make our lives easier in terms of labeling,” says Julie Mototsune. She’s had to avoid everything from soups to potato chips to prepared meats because of her 7-year-old’s mustard allergy.

Health Canada expects the regulations to become final in Spring 2010, at which point food manufacturers will have an implementation period, which is currently set at a year.

HAVE YOUR SAY ON ‘MAY CONTAINS’

Health Canada is starting public consultations into “may contains” statements on packaged food labels. These are the words that manufacturers use on a label to warn consumers that a product could include trace amounts of one or more allergens.

Although these types of statements can be helpful, as it stands, they can be vague and confusing. Consumers are often left wondering if the allergen really is in the product, or if the company is simply reducing risk of liability.

Health Canada hopes to develop policy that will limit the variety of such statements that can be made, and to develop manufacturers’ guidelines for handling allergens and assessing the risk of cross-contamination. Public online consultations and meetings with consumers, industry, health professionals and allergy organizations across the country were set to begin in November. For more information, visit www.hc-sc.gc.ca, “food and nutrition”.

From the Winter 2010 issue of Allergic Living magazine.
To order that issue or to subscribe, click here.

© Copyright AGW Publishing Inc.

See Also: Food Labeling FAQ

Clarke revealed the new prevalence statistics at the Anaphylaxis Canada Spring Conference in Toronto in May. These figures are calculated from the nationwide SCAAALAR survey (which stands for Surveying Canadians to Assess the Prevalence of Common Food Allergies and Attitudes Towards Food Labelling and Risk), on which Clarke is a lead investigator. SCAAALAR is the first formal national tally of food allergies in Canada, with detailed information from 10,000 individuals.

A few days after Clarke’s Toronto speech, the Journal of Allergy and Clinical Immunology published a follow-up study on the prevalence of peanut and nut allergies in the United States.

In their phone survey of 13,500 individuals, Dr. Scott Sicherer and his colleagues at the Mount Sinai School of Medicine in New York determined that peanut and nut allergies in children more than tripled in 2008 from their comparable study in 1997.

In 2008, 1.4 per cent of American kids had peanut allergy and 1.1 per cent had nut allergy compared to 0.4 and 0.2 per cent respectively in 1997. (The combined rate of these two top allergies was 2.1 percent in 2008, compared to 0.6 percent in 1997.)

The SCAAALAR survey, funded by Health Canada and the AllerGen research network, and also published in JACI,  pegged the probable rate for peanut allergy in Canadian kids at 1.7 per cent in 2008, and 1.6 per cent for tree nuts.

Media Muddy Message

These new statistics arrived just as the question is again being raised in the media about how many people truly have food allergies, compared to how many think they have them. An article in The New York Times sparked the debate: it stated that “only” 8 per cent of children have food allergies and 5 per cent of adults have food allergies, then compared that to 30 per cent of the U.S. population who believe they have such allergies.

While these statistics appeared to come from a study published in the Journal of the American Medical Association (JAMA), Allergic Living obtained a copy of the study and those data are not in the report.

What the JAMA report provides is a review of 72 papers on food allergy diagnosis, management and prevention. In comparing available statistics, the medical article does say that more than 1 to 2 per cent, but fewer than 10 per cent of Americans have food allergies.

The report does not address the question of “perceived” versus true allergy at all, and one of the report’s authors told Allergic Living that the 30 per cent figure cited by The New York Times does not apply to the United States.

JAMA’s study was designed to provide guidance to the National Institute of Allergy and Infectious Diseases as its officials develop guidelines to define food allergies and give criteria for diagnosing and managing patients. The authors found that there isn’t a universally accepted definition of food allergy, and that there’s a lack of well-established guidelines for diagnosis.

“The systematic review of the food allergy literature published in JAMA is helpful in crystallizing the fact that food allergy is common, affecting millions of Americans, but also points out that we need much more research to better understand the exact prevalence, and how to prevent, more easily diagnose and treat this life-changing medical problem,” Sicherer noted.

First published in Allergic Living magazine, Summer 2010 edition.
To order that issue or to subscribe, click here.

© Copyright AGW Publishing Inc.