How do you manage “may contain” foods for patients or residents with food allergies?

This is one of those tricky areas of food allergen management that organisations may struggle with. “May contain” or “may be present” statements are called Precautionary Allergen Labelling (PAL) statements.

PAL statements are a warning from manufacturers that the food may have been contaminated with, or come into contact with, an allergen - even though it is not an intentional ingredient of the food. Allergen cross contamination can happen at any stage in food production - while the ingredient or food is growing, harvested, transported, stored, prepared (made into a final product) or packaged.

In the past, many people ignored these statements – in fact, some health professionals still tell their patients with food allergies to ignore them!

Thanks to the efforts of the Allergen Bureau, in recent years more food manufacturers are now using scientifically based risk assessments to determine if the cross-contamination level of allergen in the final food product is a risk to someone with an allergy to that food should they eat it.

If the risk assessment shows there is a real risk to people with an allergy to that food, the product will have a PAL statement. If the risk assessment shows that there is no risk to the majority of people with an allergy to that food, no PAL statement will be added to the product’s label.  

This means PAL statements are more likely to mean what they say, more so than they did in the past. You still can’t tell by looking at a label whether a risk assessment process has been used, but companies who are members of the Allergen Bureau are more likely to use PAL statements appropriately - you can see which companies are Allergen Bureau members here.

What does this mean for food service in hospitals, aged care and other food service settings?

Part of best practice food allergen management means not serving foods or ingredients with PAL statements to patients or residents with an allergy to that food, because there is a risk the person could react.

For example, if a food says ‘may contain wheat’, you should not serve that food to someone with a wheat allergy.

This can make menu choices more restrictive for patients and residents, which can put long stay patients or residents at risk. So having dietitians involved in food selection and menu planning as well as foodservice staff who are well trained in food allergen management is important to make sure patients and residents with food allergies are given a variety of appropriate foods and adequate nutrition.

At the IHHC conference in Perth last month, we held a workshop and explored this topic with participants from a variety of backgrounds – urban, rural, large and small hospitals, aged care facilities, industry colleagues. Here is what participants shared about how their organisations manage PAL statements for patients and residents with food allergies:

·       Find out if the patient or resident has a true allergy or if it is an intolerance or a preference – you may need a dietitian or nutrition assistant to do this. If it is not an allergy, they may not need the same level of restrictions as those with food allergies.

·       Make meals from scratch whenever possible as it limits the number of packaged foods you need to use. Of course this is not possible if your food is pre-prepared offsite.

·       Pre-prepared meals or meals prepared offsite should be assessed for food allergen management processes. Organisations need to be aware of the risk of cross-contamination of food allergens in products prepared offsite so they can provide appropriate food and drinks to patients and residents with food allergies. This information could be requested as part of the tender or contract process.

·       If patients or residents complain about the restricted choices, discuss with patients which ingredients have PAL statements and explain the risks. Some facilities allow patients to accept the risk of eating certain products with PAL statements and document the conversation in the medical or care notes. Remember that some products are riskier than others because of the way they are processed; for example, if there are many products made using the same equipment. An example of this is snack foods and biscuits.

·       Some facilities assess products with PAL statements by contacting the manufacturer to check if they use a risk assessment process to determine how to code that product for allergens in the system. This can be useful if you can’t find an alternative product without a PAL statement.

·       Products need to be checked regularly for allergens as ingredients and for allergens in PAL statements when they are ordered and delivered. PAL statements can change if the manufacturer’s supplier changes or if the manufacturing process changes, as this can change the cross-contamination risk.

·       Check any product substitutes for products with PAL statements if the product you usually use is not available.

by Ingrid Roche, Senior Project Officer, National Allergy Council and Accredited Practising Dietitian (Allergy)

For further information see the National Allergy Council’s food labelling information which includes two videos about PAL statements, and complete an All about Allergens free online training course – there are courses for hospitals and residential care.

You can contact us directly at info@nationalallergycouncil.org.au.

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