Understanding Precautionary Allergen Labeling (PAL) Preferences Among Food Allergy Stakeholders

Abstract

The United States does not have clear requirements for the use of food precautionary allergen labeling (PAL). The Food Allergen Labeling and Consumer Protection Act requires the names of 8 allergens (peanut, tree nuts, milk, egg, wheat, soy, fish, and shellfish), if present, to be listed in English on ingredient labels. Additional PAL, such as “may contain” or “made on shared equipment,” is voluntarily placed on products. In the current study, researchers aimed to understand patient and family knowledge of and preferences for PAL statements.Individuals with a personal history of food allergy (FA) or those with a relationship with a patient with FA (including caregivers, partners, and teachers) were invited to participate in the current study through a survey delivered through the Food Allergy Research and Education’s membership listserv. Researchers initially conducted a focus group to understand shopping experiences, understanding of PAL, and preferences for labeling language, format, and placement. A survey draft was sent to 9 additional stakeholders to refine survey reliability and comprehension. Of the ultimate recipients, 25 208 opened the e-mail, 3541 began the survey, and data from 3008 respondents were analyzed. Respondents were primarily female (84.7%), caregivers of a patient with FA (77%), non-Hispanic White (78.4%), had a graduate degree (40.6%), and had an annual household income >$100 000 (48.5%).Queried demographics included sex, race/ethnicity, education, household income, living location, relationship to FA, type of FA, number of FAs, severe adverse reaction history, and PAL knowledge. Survey domain outcomes included shopping habits, frequency of purchasing products with PAL, PAL preferences, confidence when purchasing PAL products, and PAL discussions with health care providers. Logistic regression analysis evaluated associations between respondent characteristics and PAL outcomes.Of respondents, 24.2% correctly answered 4 knowledge questions surrounding PAL. The majority of respondents never purchase products labeled “may contain traces of allergen” (85.5%), in comparison with never purchasing products labeled “good manufacturing practices used to segregate ingredients in a facility that also processes allergen” (35%). The top preferences for desired PAL statements were “not suitable for people with [blank] allergy” (29.3%) and “may contain” (22.1%). Respondents favor labeling with specific allergens versus a category of allergens. Most respondents favored PAL immediately after the ingredient list. Of individuals with FA, 32% were instructed to avoid foods with PAL, whereas 44.5% did not discuss PAL with their health care provider. Respondents who were told to avoid all PAL were 59% less likely to purchase products with PAL than patients who did not discuss PAL with their provider were.Responses revealed lack of awareness of PAL policies and suggest that consumers purchase products with PAL on the basis of specific language used. Consumers desire clarity, specificity, and consistency in labeling. Provider discussions influence purchasing.The authors acknowledge limitations of the current study to include potential bias in a sample of patients and caregivers from an advocacy group, which may not accurately represent all patients with FA. Inconsistent labeling practices currently cause confusion and may increase risk for patients with FA. Physician advocacy for improved labeling requirements may benefit patients and families.