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(If you're reading this, you've likely already read Part 1 of the "4 Things Counselors Should Know About Food Allergies" series. If not, I'd suggest you read that one first).
In Part 1, we explored some basic concepts about food allergy-related anxiety. We bridged the path between anxiety and its impact on quality of life. We touched on how anxiety is different than generalized anxiety, as it's clearly connected to continual perceived and actual health threats.
But wait!
There's something else that tends to cause an additional layer of anxiety for those managing food allergies: reading (and trusting) food labels.
Food Labeling Laws Often Create Additional Layers of Fear
It's often assumed that food products will have clear and consistent labeling, highlighting not only the ingredients but also whether the food was manufactured on the same line or in the same facility as allergens. Unfortunately, it's not that cut and dry, which often adds an additional layer of fear and anxiety for those managing food allergies.
"Labels on foods regulated by the FDA must list ingredients which contain one or more of the [8] major food allergens in one of two ways:
The common or usual name of the major food allergen must be followed by the food source in parentheses in the list of the ingredients. This will occur the first time the major food allergen is listed and does not have to be repeated each time the name of the specific food allergen appears. Examples: "lecithin (soy)," "flour (wheat)," and "whey (milk)"
There may be a section after or near the ingredient list called “Contains”. After the word “Contains”, there must be listed the name of the food source from which the major food allergen is derived. Example: "Contains Wheat, Milk, and Soy."
A "contains" statement is not required on a food label. Also, the common English name may only be listed in the contains statement and not in the list of ingredients. Therefore, you must read the list of ingredients and any "Contains statement" carefully.
As stated, thanks to the Food Allergen Labeling and Consumer Protection Act of 2004, there are some guidelines for food labeling, but there are still lots of grey areas for food-allergic people to navigate. To begin with, in the US, only the top eight major allergens are required to be clearly listed if they're an ingredient, leaving those with allergies to other foods potentially unsure if it's in that food item. Additionally, given the fact that there's no requirement or standard language to use when a company voluntarily chooses to disclose that an allergen was used in or near the preparation of the item, that uncertainty continues to grow.
Imagine if you already had fight-or-flight levels of stress due to day-to-day food allergy navigation, and then were tasked with trying to buy foods for your child that were deemed safe, despite the current labeling laws. It might feel like trying to solve a Rubix Cube without any directions - doable, but extremely challenging! With labeling laws that aren't required to be completely forthcoming, consistent, and transparent, those uncertainties just get piled on top of the already high levels of anxiety, and that's where the work is needed.
Here's what some people managing food allergies say on this topic:
"Food packages don’t tell you the whole story."
"It is absolutely imperative that you become the best label reader. I should have sought a degree in bio-engineering."
"Three times each we read those labels. Once at the store, again as we place it in the pantry, and the last time before it is served."
"Read EVERY label, EVERY time. Consistently. If you get comfortable with “X” product, because it is “safe”...and do not realize there are different types, sizes, etc...the results could be catastrophic."
Essentially, for those managing food allergies, buying food can feel a bit like playing Russian Roulette, especially for those who are newly diagnosed and may be feeling overwhelmed with most decisions.
Most people don't know how much of their allergen their body can handle before reacting (this is also known as their allergen threshold). For some, reactions start by just touching the allergen (especially if they then touch their eyes, nose, or mouth), or by ingesting even trace amounts.
It's important to know that all people with food allergies have varying degrees of comfort with their allergen. That comfort level is typically based on a combination of things - information from their allergist, any previous reaction experiences, and how much risk they're willing to take. Therefore, some of your clients may not pay much attention to the voluntary "may contain" labels and likely won't find food shopping as stressful.
But for those that do avoid items with a "may contain" warning, expect the stress levels to be higher. It will be essential to help these clients assess potential risk levels when buying foods (or eating out), learn to navigate the intrusive fearful thoughts surrounding food choices and establish their comfort zones with a variety of foods.
Additionally, as is the case in working with anyone with a food allergy, it will be crucial to help them learn to accept that no matter what, there will be a degree of uncertainty in all choices, but that it doesn't always mean something is unsafe.
FINAL THOUGHTS.....
It's important to understand how current food labeling laws impact those managing food allergies, how it may present an increased risk of reaction, and how this combination of factors often adds an additional layer of anxiety. Without understanding this aspect of the food allergy puzzle, you'll be putting it together without all of the pieces in play.
June 2020 Update:
Due to the COVID-19 pandemic, the U.S. Food & Drug Administration (FDA) issued an announcement in May 2020 that they were allowing temporary flexibility in food labeling requirements to decrease supply chain disruptions. To learn more about these temporary changes and how they may impact those managing food allergies, the resources below may be helpful:
FDA Temporary Flexibility Announcement (5/22/20)
12 Nonprofits' Letter to the FDA (5/28/20)
Lawyer Homa Woodrum's tweet thread on new FDA policy (5/24/20)
"FDA's New Label Policy Sparks Outpouring of Allergy Concerns" (Allergic Living Magazine, 6/1/20)
If you're working with a client who has food allergies and feel you need more information to educate yourself, check out the following resources, in addition to the links within this post:
Challenges of Food Allergies Connected to Personality Traits for the First Time (Science Daily, March 2018)
Managing Food Allergies in Schools: Guidance for Parents (FARE)