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However, many consumers are unaware of the potential presence of allergens in medicines, particularly those associated with excipients, and even consumers that are more aware may struggle to identify the ingredients that pose a risk unless they are clearly indicated on external packaging.

True allergy represents less than 10% of all adverse drug reactions.¹ More common adverse reactions involve toxicity, drug–drug reactions and drug–food reactions. Reactions to aspirin and nonsteroidal anti-inflammatory agents, such as ibuprofen (Nurofen) and diclofenac (Voltarol) are also frequent causes of allergy-like reactions, but these are not true allergies as they occur when a drug interferes with the normal mechanisms of the immune system, causing the direct release of chemical mediators such as histamine.

Food industry experience

The food industries of all major developed countries have been obliged to face up to the allergen risk. Legislation in Europe,² the US,³ Australia and New Zealand⁴ dictates a list of allergens that must be specifically labelled if present in a packaged food item. While the requirements and lists differ between the jurisdictions, the essential point remains that consumers can expect specific allergen advice on the packaging of food.

However, the labelling of allergens has presented some food companies with difficulties. While the legislation was conceived with the intention of making life easier for consumers, it is not uncommon to find food items with apparently contradictory statements; for example, where the ingredient list makes no reference to nuts, and the packaging design and product name are also suggestive of a nut-free product, the allergen statement advises that the product may contain nuts.

The difficulty arises because there is no acceptable minimum limit that can be set for allergens. Even if the formulation contains no allergens, any ingredient that is processed in a facility where allergens might be present still constitutes a risk unless the facility practises strict procedures to avoid cross-contamination.

There is also room for debate as to whether labelling is really necessary with ingredients derived from known allergens. Certain exemptions already apply so that, whereas a glucosamine sulfate supplement might be labelled as 'containing shellfish', a beer brewed using isinglass, which is derived from fish, will not be expected to carry a 'contains fish' statement.

However, one positive consequence of the labelling requirement has been a much higher degree of cooperation and monitoring within the supply chain, particularly for those food manufacturers of 'free-from' products, who must fully understand exactly how their ingredients are sourced and produced.

A negative consequence is that the legislation has had a major impact on product recalls. In the first 6 months of 2008, 57% of all food and drink product recalls in the US, and 57% of all those in the UK, were caused by the apparent failure to correctly label foods that contained allergens.⁵ One example from the UK is a product, clearly described as a 'whole nut chocolate bar', that was recalled because the label failed to mention that the product might contain almonds as a specific allergen. In other cases, such as the presence of fish in a chicken pie, it was not clear whether the fish, or an ingredient derived from fish, had been used in the pie deliberately or whether there had been contamination.