5 Knowledge and information about the allergy
5.1. Respondents’ ability to identify food ingredients of concern
5.2. Sources of information
5.3. Ease with which information about what ingredients to avoid was originally found
5.4. Type and source of instruction on how to identify ingredients of concern on food labels
5.5. Membership of a support group
5 .1 Respondents’ ability to identify food ingredients of concern (Q14)
Respondents were presented with a list of words that are used to designate substances that can be of concern to persons with various food allergies. Not all food allergies were tested at question 14 – alternative names for shellfish and sulphites ingredients not being included in the list.
Results are shown in the series of tables (a to g) that follow for total household allergies (i.e. any household that had a person with an allergy of the type concerned) for each of the substances associated with a particular food allergy.
Note: the food allergy types are not mutually exclusive, that is, many households had multiple allergies and were included in numerous calculations against each allergen. Thus, the results for each allergen may be affected by the presence of allergies other than the one under discussion.
Thirty one respondents (6%) did not answer this question.
In each table, the 'average' or score for the total sample is presented in the column on the left side of the table. Comparisons are then made to the total or average for those with each particular food allergy.
In general, levels of awareness of a food as containing a substance of concern were higher for those with an allergy to that particular substance, compared to the total sample. However, the somewhat low levels of recognition of substances of concern appear to indicate a gap in awareness about the potential of many substances to be an issue for the person with the allergy, as can be seen in the tables that follow (5.1a-g).
The first results shown, in Table 5.1a, are for those with nut allergies (peanut and tree nuts).
Table 5.1a Awareness of substances of concern for those with nut allergies
Q14 Which of the following words tell you that the ingredients that the person with the most serious food allergy needs to avoid, may be present in the food product? PLEASE TICK ALL THAT APPLY
| . | Percent correct | ||
| . | total sample | total allergies | |
| . | Peanut (a) | Tree nuts (b) | |
base: all respondents ( n) | (n=510) | (n=399) | (n=279) |
Peanuts | % | % | % |
Praline* | 34 | 41 | 46 |
Vegetable oil s | 16 | 20 | 21 |
Tree nuts |
|
|
|
Marzipan | 44 | b 52 | a 60 |
Praline* | 34 | 41 | 46 |
ab Indicates categories where there was a significant difference between the results in each column (significance at the 95% confidence level )
* Praline, a nut confection, is presented twice because it can be an issue for those with either a peanut or a tree nut allergy[1] .
s Vegetable oil can include peanut oil. Most peanut oils are not allergenic as they are protein free – only those that are unrefined (cold pressed) may be problematic as they may still contain traces of proteins. However, mixed vegetable oils are very unlikely to be cold pressed. Peanut, sesame or soy components of vegetable oil are now required by the Code (Standard 1.2.4) to be declared on the food label.
For each of the substances listed, there was a higher than average recognition that praline and marzipan were substances of concern for both of the nut allergies, significantly so for marzipan. However, very few of those with peanut allergies in the household indicated thatvegetable oilcould be an issue, with only one in five respondents with peanut allergies (20%) in their household identifying this ingredient. It is not known whether this was because they had already found vegetable oil to be a minimal or no risk, or whether respondents were not aware that some vegetable oils may potentially contain cold pressed peanut oil, or whether the labelling was adequate (as mentioned previously, ingredients of vegetable oils that are potential allergens are now required under the provisions of the Code, to be declared) [2] .
The results are shown for milk allergies in Table 5.1b.
Table 5.1b Awareness of substances of concern for those with a milk allergy
Q14 Which of the following words tell you that the ingredients that the person with the most serious food allergy needs to avoid, may be present in the food product? PLEASE TICK ALL THAT APPLY
| . | PERCENT correct | |
| . | total sample | total allergies |
| . | Milk | |
base: all respondents ( n) | (n=510) | (n=200) |
Milk | % | % |
Whey | 29 | 72 |
Butterfat | 29 | 72 |
Lactose | 28 | 68 |
Casein | 26 | 64 |
Lactalbumin | 23 | 42 |
Between a quarter (23% for lactalbumin) and three in ten respondents (29% for both whey and butterfat ) on average identified the milk derivatives as substances of concern.
Between two thirds (64% for casein) to three quarters of respondents (72% for both whey and butterfat) identified the substance of concern for milk allergens. The lowest awareness amongst respondents who had a milk allergy in the household was recorded for lactalbumin, with only 42% identifying this substance.
Compared to the data shown in Table 5.1a for those with nut allergies, recognition of most substances of concern for those who have a milk allergy in the household was much higher (64%-72%, compared to 20%-60% for nut allergies).
The results are shown for those with a soy allergy in Table 5.1c.
Table 5.1c Awareness of substances of concern for those with a soy allergy
Q14 Which of the following words tell you that the ingredients that the person with the most serious food allergy needs to avoid, may be present in the food product? PLEASE TICK ALL THAT APPLY
| . | Percent correct | |
| . | total sample | total allergies |
| . | Soy | |
base: all respondents ( n) | (n=510) | (n=78) |
Soy | % | % |
Tofu | 8 | 46 |
Textured vegetable protein | 18 | 36 |
Tempeh | 5 | 13 |
Tamari | 4 | 10 |
Almost a half of respondents (46%) recognised tofu as containing a substance of concern, and around a third recognised that there could be an issue with textured vegetable protein (36%). However, there were low levels of recognition for both tamari (10%) and tempeh (13%), which may in part be due to a lack of recognition that the ingredients or products listed (tempeh, tamari) contain soy.
The results are shown for those with a wheat allergy in Table 5.1d.
Table 5.1d Awareness of substances of concern for those with a wheat allergy
Q14 Which of the following words tell you that the ingredients that the person with the most serious food allergy needs to avoid, may be present in the food product? PLEASE TICK ALL THAT APPLY
| . | PERCENT correct | |
| . | total sample | total allergies |
| . | Wheat | |
base: all respondents ( n) | (n=510) | (n=66) |
Wheat | % | % |
Baker's flour | 9 | 56 |
Thickener* | 14 | 50 |
Semolina | 7 | 38 |
Couscous | 6 | 32 |
Cornflour s | 5 | 29 |
Starch | 5 | 29 |
Icing sugar mix | 5 | 27 |
Textured vegetable protein | 18 | 27 |
Maltodextrin u | 5 | 18 |
s Cornflour could be derived from maize or wheat.
u Maltodextrin could be derived either from wheat or maize.
* Some thickeners are wheat derived.
A half or more of those respondents where a wheat allergy was present in the household were aware that baker's flour and thickenerwere substances of concern, with 56% and 50% respectively identifying these substances. Around a third were aware that semolina (38%) and couscous (32%) were of concern.
Maltodextrin was the least likely ingredient to be identified, with only 18% nominating this as a substance of concern.
It should be noted that in the Code, where a cereal or source of starch is wheat, rye, barley, oats or spelt then the specific name of the cereal must be declared (Standard 1.2.4).
The results are shown for those with an egg allergy in Table 5.1e.
Table 5.1e Awareness of substances of concern for those with an egg allergy
Q14 Which of the following words tell you that the ingredients that the person with the most serious food allergy needs to avoid, may be present in the food product? PLEASE TICK ALL THAT APPLY
| . | PERCENT correct | |
| . | total sample | total allergies |
| . | Egg | |
base: all respondents ( n) | (n=510) | (n=272) |
Egg | % | % |
Albumin | 37 | 67 |
Ovalbumin | 25 | 45 |
Around two-thirds of respondents with an egg allergy in the household (67%) were aware that albumin was a substance of concern, however less than half (45%) identified ovalbumin as being of concern.
The results are shown for those with fish allergies in Table 5.1f.
Table 5.1f Awareness of substances of concern for those with fish allergies
Q14 Which of the following words tell you that the ingredients that the person with the most serious food allergy needs to avoid, may be present in the food product? PLEASE TICK ALL THAT APPLY
| . | PERCENT correct | |
| . | total sample | total allergies |
Fish | ||
base: all respondents ( n) | (n=510) | (n=83) |
Fish | % | % |
Anchovies | 13 | 59 |
Surimi* | 6 | 18 |
* Depending on the manufacturers formulation, surimi could also contain eggs, wheat, and shellfish
Over half of those with a fish allergy in their household (59%) recognised that anchovies were a substance of concern.
Of some concern was that the level of recognition of surimi was very low. Only 6% of the total sample identified it and only around one in five of those had a fish in the household (18%). However, this could also indicate that many consumers did not know that ‘surimi’ was the more technical name for 'imitation crab stick' or ‘seafood extenders’.
The results are shown for those with a sesame seed allergy in Table 5.1g.
Table 5.1g Awareness of substances of concern for those with a sesame seed allergy
Q14 Which of the following words tell you that the ingredients that the person with the most serious food allergy needs to avoid, may be present in the food product? PLEASE TICK ALL THAT APPLY
| . | PERCENT correct | |
| . | total sample | total allergies |
Sesame seeds | ||
base: all respondents ( n) | (n=510) | (n=72) |
Sesame seeds | % | % |
Tahini | 15 | 62 |
Three in five of the respondents with a sesame seed allergy (62%) recognised thattahiniwas a substance of concern.
Summary
The results suggest that while there was a reasonable level of recognition of common ingredient names for potential allergens, this was not universal. It decreased markedly with less common names and/or more ‘scientific’ terminology.
Across the different sample sources, those derived from the support group sample were consistently more proficient at identifying many of the substances of concern, than were those from the two medical groups. The next most proficient was the hospital or institutional sample and the least proficient was the private clinicians [3] sample. These results suggest that respondents who belonged to a support group were better informed about substances of potential concern.
5.2 Sources of information (Q18)
Respondents were asked where they had obtained relevant information about the foods to avoid when the food allergy first became an issue for their household. The sources indicated are shown in Table 5.2.
Table 5.2 Information sources for the allergy
Q18 When a serious food allergy first became an issue in your household, where did you get the relevant information about what food(s) and food ingredients(s) needed to be avoided? PLEASE TICK ALL THAT APPLY
| . | total sample | country | |
Information obtained from. … | Australia | New Zealand (b) | |
base: all respondents ( n) | (n=510) | (n=413) | (n=97) |
| %* | %* | %* |
A doctor specialising in allergies | 78 | b 81 | a 66 |
An allergy support group | 39 | 38 | 46 |
A dietitian | 36 | 37 | 34 |
Books | 36 | 37 | 31 |
A GP / doctor / medical practitioner | 32 | 32 | 33 |
The web / Internet | 31 | 32 | 29 |
A friend / acquaintance | 13 | 14 | 10 |
Parents | 8 | 8 | 10 |
The Manufactured Food Database s | 7 | b <1 | a 35 |
An alternative health practitioner | 6 | b 4 | a 12 |
Trial and error | 3 | 4 | 2 |
Pharmacist | 1 | 2 | 0 |
Food manufacturer | 1 | 1 | 0 |
ab Indicates categories where there was a significant difference between the results in each column (significance at the 95% confidence level)
* Adds to more than 100% due to multiple responses (i.e. people may have obtained information from more than one source).
s The Manufactured Food Database was not an option provided for in the Australian questionnaire but it was added by several Australian respondents as another source of information.
Three quarters of respondents (78%) said their major source of information was a doctor who specialises in allergies. The level recorded in Australia was significantly higher than that in New Zealand(81% versus 66% respectively).
The next major sources of information for around a third of respondents were:
- an allergy support group (39%);
- a dietitian (36%);
- books (36%);
- a GP / doctor / medical practitioner (32%); and
- the web or Internet (31%).
A third of New Zealand respondents (35%) identified the MFD as a source of information [4] . Even though this was a New Zealand initiative, a very small number of Australian respondents(<1%) also identified this source via free text option given in this question.
New Zealanders were significantly more likely than Australians to nominate an alternative health practitioner as a source of information (12% versus 4% respectively).
5 .3 Ease with which information about what ingredients to avoid was originally found (Q19)
Respondents were asked whether they had found it easy or difficult to get the information they needed to help them avoid the foods of concern, when the allergy was first diagnosed. The results are shown in Table 5.3a.
Table 5.3a Ease of getting information when allergy first identified
Q19 When a serious allergy was first identified, was it easy or difficult to get the information you needed to help you avoid the foods of concern?
| . | total sample | sample source | time since allergy identified | ||||
| . | Hospital (a) | Private (b) | Support Groups | Less than 1 year | More than 1 year but less than 2 (e) | 2 years or more | |
base: all respondents ( n) | (n=510) | (n=162) | (n=174) | (n=174) | (n=70) | (n=78) | (n=360) |
| % | % | % | % | % | % | % |
It was easy | 46 | c 54 | c 54 | ab 32 | ef 64 | d 47 | d 42 |
It was difficult | 49 | c 40 | c 41 | ab 66 | ef 34 | d 50 | d 52 |
Don't know | 4 | 5 | 5 | 2 | 1 | 1 | 5 |
Not answered | 1 | 1 | 1 | 0 | 0 | 1 | 1 |
Total | 100 | 100 | 101* | 100 | 99* | 99* | 100 |
* Does not add to 100% due to rounding.
ab Indicates categories where there was a significant difference between the results in each column (significance at the 95% confidence level )
About the same proportion of respondents found it difficult (49%) as found it easy (46%) to find the information they needed when the food allergy was first diagnosed. Four percent said they could not remember how easy or difficult it had been.
Respondents from the support group sample wer