Food Labels: Reading Between the Lines for Cross-Contamination

I simply adore sesame oil.  I love the flavor it brings to Asian cooking, and the nuttiness it adds to other dishes.  For the last few years though, I have essentially stopped using it, because of my difficulty finding a brand that wasn't at risk of cross-contamination.  It seems every distributor of sesame oil that I've contacted is also bottling peanut oil in the same facility.

(By the way, an easy way to spot another allergy mom at the grocery store is to look for a woman squinting at an ingredient label with a cell phone pressed to her ear and a look of extreme frustration on her face.)

So imagine my excitement when my husband proudly brought home a bottle of Sun Luck Pure Sesame Oil.  "All Natural" the label exclaimed.  "No gluten" was featured in a little symbol on the side.  And the ingredients?  "Pure sesame seed oil" followed by "NO ALLERGENS, NO PRESERVATIVES ADDED."

It seemed like my lucky day.

Being fairly untrusting, especially when it comes to glib assurances regarding allergens with the potential to threaten my child's life, I still pulled up the web site to do some checking before cracking open the bottle.  There I found another item in the Sun Luck product line, Thai Peanut Sauce.  I immediately tried calling the company's phone number to find out if the items are manufactured in the same facility.  Unfortunately, it was after business hours and I wasn't able to get an answer.  Needless to say, I didn't use the sesame oil with our salmon that night.

The next morning I gave them another call, only to have my suspicions confirmed.  The sesame oil is indeed being processed on the same line as the peanut sauce.  The person I spoke to initially defended the label, saying that it only had to include the ingredients inside the bottle, not ingredients from other items in the facility, but became very sympathetic when I explained the severity of The Kid's peanut allergy.  Although I take corporate assurances that feedback is being passed up the food chain with a grain of salt, the woman I spoke to seemed genuinely concerned.  I explained that those of us managing food allergies read labels extremely closely and look for facilities and equipment warnings, so that the way that the label was worded was, well, somewhat misleading.

It's hard enough reading every label without having to suspiciously search for inaccuracies or unlabeled cross-contamination.  One of these days I'm going to put Mad Eye Moody's words, "Constant Vigilance!" up on my kitchen wall.  In the meantime, I'll be squinting at labels and gritting my teeth at my cell phone in the grocery store.

This post was written as part of NHBPM – 30 health posts in 30 days.

At Least It's Listed on the Label

As if I didn't have enough reasons for paranoia, here's what I stumbled across in the hand soap aisle.  That's right, "Milk Protein & Honey" Softsoap in the refill size.  (Apologies for the camera phone pic.)  So now I have no way of knowing if the liquid soap in the dispenser next to every single public sink might contain food allergens.  You may wish to buy stock in baby wipes, because I will personally be increasing the market demand for them.  It just never ends....

What's Wrong with this Picture?

Look what I found nestled among the bulk food bins at my (usually wonderful) local health food store: one of my favorite allergen free products, Enjoy Life Chocolate Chips.

Someone may have missed the point. Let's just hope no one misses the fine print. And, yes, I did already speak to the manager, whose only response was to simply point out the allergy warning.

Hurricane Season

It's here again, the season when we make a list, check it twice, shop like maniacs, and make sure we don't forget the batteries. (Really, why do I live in Florida?) It's time to stock up on medications and allergen free food supplies if you haven't already. Here's my long winded post on hurricane prep from last year and here's a follow up post when I discovered that the meds that I had made a great deal of effort to obtain as substitutes for the ones my son usually takes with his nebulizer (in case of power outage) contained milk protein. It still makes me want to bang my head against a wall!

Contact Reaction to Hair Conditioner

I want to scream right now. I want to tear my hair out and gnash my teeth. I really, really want to punch somebody. Maybe somebody in the FDA. Then maybe someone in one of the industry groups that lobby for less regulation. I want to throw genetically engineered tomatoes in the face of every business owner who thinks it is remotely acceptable to sell a single product without every damn ingredient clearly listed in plain language on every damn label.

Today my little boy came home from Kindergarten with a letter explaining that one of the other children in his class had been found to have head lice, and listed a few precautions we were to take. My mom, who has taken the baton for the last leg of our houseguest marathon, mentioned that nits are not big fans of hair conditioner. So as she bathed my my child, I grabbed my own conditioner from my bathroom, and we applied it to my son's already silky soft hair and let it sit on his head for a while as he blew bubbles in the bathtub.

After rinsing the conditioner off, mom noticed some hives on his back. She soaped up a washcloth and washed his torso, but they continued to get worse after the bath. We didn't know what they were from, and we all wracked our brains trying to figure out if any of us had been in contact with any unsafe foods. Finally I gave him some Benadryl, wrapped him up in a blanket, and let him go to sleep on the sofa in the living room, so we could keep an eye on him in case of a secondary reaction.

The only thing in my child's routine or on his menu that was the least bit different was using the conditioner. So I grabbed the bottle of Equate Pro Vitamin Conditioner ("Compare to Pantene Pro-V Classic Care!") and started searching for names of chemicals on Google.

INGREDIENTS: Water, Cyclopentasiloxane, Stearamidopropyl, Dimethylamine, Cetyl Alcohol, Quaternium-18, Panthenol, Panthenyl Ethyl Ether, Stearyl Alcohol, Dimethicone, Polysorbate 60, Cetearyl Alcohol, Benzyl Alcohol, Oleyl Alcohol, Glyceryl Stearate, Hydroxyethylcellulose, Fragrance, Citric Acid, EDTA, Methylchloroisothiazolinone, Methylisothiazolinone

Just as a comparison, let me list the foods that my child is allergic to:

Peanuts, Shellfish, Eggs, Cows Milk, Goats Milk, Beef, Lamb

You wouldn't think there would be any intersection between the list of ingredients in my conditioner and my son's allergies, would you? You would be wrong.

Quaternium-18 is derived "from fatty acids of tallow," i.e., beef or mutton fat.

Panthenol is derived from Pantothenic Acid, of which some of the best sources are "liver, kidneys, fresh green vegetables, and egg yolks."

Panthenyl Ethyl Ether can be produced from "corn oil, sunflower oil, peanut oil, and caster oil."

Stearyl Alcohol is made from Stearic Acid, which can be made from any number of animal fats or vegetable oils.

Cetearyl Alcohol is "made by combining fatty alcohols from vegetable sources, such as coconut alcohol."

Oleyl Alcohol is derived from beef fat.

Glyceryl Stearate has a multitude of sources, such as "animal fats and plant oils including soya bean, palm kernel and corn oil."

I do realize that my child, like other individuals with food allergies, has an immune system that responds innapropriately to the proteins in specific foods. Derivatives from a specific food do not necessarily contain that protein, which is why those with peanut allergies may supposedly be able to consume peanut oil safely. (Even if true, I wouldn't want to trust my son's life to the the risk of of any contamination.)

What I do not understand is why is any manufacturer is allowed to put nonsense such as "fragrances" on a label instead of an actual ingredient. I also do not understand why we do not require plain language labeling which reveals an ingredient's source, such as "Oleyl Alcohol from beef fat." I highly doubt that was kosher beef, and I'm sure my vegetarian and vegan friends would also like that tidbit of information.

Even more frustrating is that FALCPA, the law which requires food labels to list in plain English the eight major allergens, "milk; eggs; fish such as bass, flounder, and cod; crustacean shellfish such as crab, lobster, and shrimp; tree nuts such as almonds, walnuts, and pecans; peanuts; wheat; and soybeans," as well as proteins derived from them, does not apply to medicines or health and beauty products. (The vast numbers of people allergic to corn or sesame, or like my son animal proteins like beef or lamb, are just up a creek.)

So if the Panthenol is derived from egg yolk or the Stearyl Alcohol is made from peanut oil, which are both Big Eight Allergens, they are still not required to be listed in plain English on the label, since hair conditioner is not a food. They might not have been covered anyway, if no proteins are technically included in them.

To top off the obfuscation, the manufacturer is under no obligation to give me, the consumer, any information on the components of the "fragrances" listed casually on the bottle. I can spend my money any way I please and refrain from purchasing any product that fails to meet my expectations, but I should be able to get the facts to base my decision from a label without a degree in chemistry and detective agency at my disposal!

The same problem plagues food labels that list "flavors" and "spices" as if the words revealed information about the product rather than concealed it. If you are allergic to cinnamon or garlic, best of luck to you. You will need it and the patience I have all but lost when you call the manufacturer.

No business should be able to claim any kind of proprietary secrets when it comes to ingredients that are meant to be consumed or applied to the bodies of the consumer. I've got a suggestion for The Colonel as far as what he can do with his eleven herbs and spices.

List them on the label.

Walk a Mile with Me

Right now, parents are scanning ingredient labels on familiar foods, squinting at the astoundingly long list in miniscule script, trying to determine if a dangerous peanut product is contained within.

And their children aren't even allergic to peanuts.

Saturday, the FDA issued a warning that the recent salmonella outbreak had been traced to Peanut Corporation, a supplier of peanut paste and peanut butter to institutions and manufacturers. The federal agency recommends that consumers "avoid eating cookies, cakes, ice cream and other foods that contain peanut butter" until the whole mess is sorted out.

That's a scary and overwhelming prescription. It's also an opportunity for those of us in the allergy community to reach out and both share our expertise and create more understanding of the daily obstacles we face in trying to keep our children safe. So to those of you who have never dealt with food allergies and are on peanut watch for the first time, let me give you an introduction:

• First, this really is manageable.
• Fortunately, the ingredient in question is one of the "big eight," the foods most likely to cause an allergic reaction, and which are required to be highlighted on the label. Consider for a moment those of us who deal with food allergies not on that list, which are often obscured with words like "spices" and "flavors." If the salmonella had been sourced to a tomato processor, it could easily be hiding in tomato paste listed as "natural flavors."
• You must read every label every time. It's both that hard and that simple. If you see peanuts listed, put that product aside until the FDA determines what's safe and what isn't. When in doubt, don't eat it.
• This is the point when you get to tell your child that s/he may not have the cookie or snack they want. If you have the time to do so, it's much easier if you involve your child in the label reading, even if you still need to read it for them. (I skip the chemicals.) It's sort of a reverse treasure hunt.
• Another constant source of worry for parents of children with food allergies, is their safety when we are not present to supervise. Will their daycare or school be responsible for reading labels? How do we teach our children never to accept food from someone else that we haven't approved? You may wish to have a talk with your child and your child's school.

It's just a glimpse into our world, but maybe this can help you navigate through the salmonella scare. Hopefully, my son will outgrow his food allergies, or even better, researchers may find a cure, and this lifestyle can become a thing of the past. Until then, I'll keep squinting at labels.

FDA Seeks Food Allergen Labeling Comments

The Food and Drug Administration is holding an advisory hearing on how food allergens are labeled:

FDA is developing a long-term strategy to assist manufacturers in using allergen advisory labeling that is truthful and not misleading, conveys a clear and uniform message, and adequately informs food-allergic consumers and their caregivers. To that end, FDA is soliciting comments and information to assist the agency in determining how manufacturers currently use advisory labeling, how consumers interpret different advisory labeling statements, and what wording is likely to be most effective in communicating to consumers the likelihood that an allergen may be present in a food. The agency is also interested in receiving comments about whether consumers find advisory labeling helpful for making food purchasing decisions.

You may submit electronic comments here. Let 'em have it!

Update: Here's a more direct link to the comment submission form for this hearing.

Allergic Reaction at School

Yesterday, after two full school years of pre-school minus one week, I finally got the phone call I'd been dreading since the first day: my son had had an allergic reaction immediately after eating his snack. Until now, every aspect of his schooling had far exceeded my expectations. His teacher has taken him from learning his alphabet to beginning to read short words. His therapists are top notch, much better than I had thought I'd find in the public school system. The Kid has thrived in this environment, and both his teacher and the two aides she's had have been extremely vigilant in protecting him from food allergens.

On the phone, his teacher said that The Kid had broken out in hives on his face and neck. She described them as "really horrible" with white spots in the center like blisters. They had given him Benadryl and the hives were starting to fade. At that point, they weren't sure if he had eaten something or if it was a contact allergy, since he was scratching and rubbing his neck when they noticed the reaction.

By the time I reached the school, the hives were much more faded, but still visible, and my little boy was pretty drunk on the Benadryl. The teacher and aide had searched the room and rechecked the snack and discovered that the pretzels he had eaten were "manufactured in a facility that also processes peanuts." They had read the label, but had stopped after reading the major allergen labeling about wheat and soy ingredients. (I have mixed feelings about the labeling requirements for the eight major allergens, but I'll save that for a different post.) I took him home, fed him lunch, and watched him like a hawk for the next four hours in case of a secondary reaction.

I didn't realize how much the day had stressed me until my husband came home and I promptly took a nap/fell into a coma. After dinner last night when the Benadryl had worn off, The Kid and I talked about the reaction. This is the first one he's had in about a year and a half, so his language skills have advanced enough for me to get more of his perspective. He described the hives as "buggy bites," which surprised me. (We usually say either bugs or insects, so I'm not sure where he got the phrase.) He also said that they hurt, rather than itched. Then we talked about what he has to do if it happens again.

I got out the Epi-Pen trainer and we practiced using it and I explained how it works. In case of a reaction, his job is to find a grown up and ask for help as fast as he can. If the grown up doesn't understand or listen, he is to point to his medic alert bracelet and just ask for help and not to take no for an answer. (The Kid's language skills are excellent, but he has articulation problems that sometimes make his speech difficult to understand.) I am terrified that a teacher might just tell him to sit down and be quiet when his life is literally on the line.

After talking with his allergist's office, I've decided to make some changes in his medical instructions for next year. We've controlled all of his reactions with Benadryl until now, so I had given the school instructions to use that unless his breathing was affected, in which case they were to give the Epi and call 911. Next year I'm going to have them immediately use the Epi-Pen in case of reaction, rather than the approach we use at home. The location of the hives on the neck and face especially worries me, since I suspect that if The Kid is exposed to even a slightly larger amount of peanut, he could have a reaction that might stop his breathing. (Just typing those words makes me shake.) I'm also only going to allow food that has been brought from home or had the label checked by my husband or me.

I was already worried about beginning Kindergarten. Now I'm terrified. It's been long enough since The Kid had a reaction, that I was starting to relax. Not anymore. I'm just hoping that yesterday's reaction will at least help us prevent another one.

Supplies from Whole Foods

There isn't a Whole Foods near us, but I was able to stop at one last week and picked up a couple items I haven't seen at stores closer to home. I planned to get some Agar, but the rest were impulse purchases. These will keep me experimenting for a while, but I'm still in sticker shock. (That's half a tank of gas you're looking at!)

Take a close look at the label on the kosher, egg free marshmallows. I never would have thought of fish gelatin as a binder, which may be reassuring to those of you who sometimes come over for dinner!

I'll post more about these as I use them.

Update: Well, I tried making a fake Mac & Cheese from the "Follow Your Heart Vegan Gourmet Cheese Alternative." It was so nasty it doesn't even rate its own post. Yuck. The stuff was beyond awful. Save your money.

No More Secret Ingredients

While grocery shopping, I picked up a frozen tube of Louis Rich Ground Turkey Sausage. As I did my scan of the ingredient list, I noticed two of my pet peeves: spices and flavors. What spice? What flavor? What is the point in listing ingredients if all of them are not listed? In irritation, I grabbed my cellphone, and dialed the 800 number listed on the package. It was promptly answered by an efficient sounding female voice, "Kraft Foods."

I told the voice from Kraft Foods, that my son has multiple, severe food allergies, and that I had questions about the ingredients in the Turkey Sausage. She immediately replied that all of the allergens are printed on the label. I explained that the foods required to be listed are only the the eight most common allergens, and that my son has multiple, severe food allergies, not all of which are on the list of the most common allergens. She again replied that all of the allergens are printed on the label.

I took a deep breath.

I repeated again that my son has multiple, severe food allergies. Only four (!) of the foods to which he has an allergy are included in the list of the eight most common allergens, which are required to be shown on the label. He is also allergic to beef and lamb, and would she be so kind as to verify that the mysterious flavors on the ingredient label do not include any beef or lamb ingredients? There was a pause. She said she would check and put me on hold.

While waiting, I fumed about regulations that allow secret ingredients and proprietary formulas. I didn't have long to fume. The voice returned promptly and replied that no, there were no beef or lamb ingredients. Then it finally occurred to me that there are no reporting requirements for cross-contamination, either, and I asked if she could verify that the turkey was not processed on equipment that also processed beef or lamb. She put me back on hold.

This time when she came back, the voice informed me that the equipment did process other meats, but that they had very stringent cleaning requirements. I thanked the voice for her help and hung up.

Ground turkey and turkey sausage are staple items for us. I've purchased both many times, and possibly the only reason I noticed the dreaded flavors today is that I'd managed to go grocery shopping without The Kid in tow. Now I have another fear: beef cross-contamination. How paranoid do I need to be to keep my child safe?

We have already experienced an allergic reaction when I prepared pasta for my son without noticing the warning about shared equipment with milk products. (I don't have an excuse. I just assumed that because it was in my cupboard it was safe. Now I reread every label while I'm cooking.)

My local grocery store has a very nice pamphlet about food allergies, a summary of which would read: "If you have food allergies, don't consume anything prepared in our bakery, deli, etc., because we have no way of preventing cross-contamination. Purchase only prepackaged food and check the label for allergens." Of course, those labels are not completely forthcoming. So I make judgment calls. I don't buy sliced turkey at the deli counter, because it may share a slicer with the cheese. I buy the nasty processed sliced turkey instead. I do buy fresh fish at the seafood counter, despite its proximity to the shellfish.

Do we need to give up ground meat? That would make cooking a whole lot harder. Do I need to get a meat grinder and grind my own turkey? Is there a Kitchen Aid attachment for that? Just the fact that I am seriously asking these questions makes me wonder if I've gone too far, but then I visualize The Kid having another allergic reaction.

Now I worry if I'm paranoid enough. No wonder secret ingredients make me crazy.

First Sign of a Happy New Year

I was very impressed when I saw this sign today at the Lowry Park Zoo, although I hoped it hadn't been posted as the result of a child's allergic reaction! We didn't get to feed the fish, but the epi-pen stayed in its bag.

Whenever I hear complaints about how essential safeguards for children with food allergies are an "inconvenience", I want to remind that person that none of us would survive our first day of life without the intervention of adults and that raising any child is both the biggest inconvenience and most important job many of us will ever have.

Corporate responsibility, common decency, and safety for our children is not too much to ask.