Consumer Perception of Thresholds

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Consumer Perception of Thresholds IFST Spring Conference 2015 Lynne Regent Anaphylaxis Campaign CEO @LynneRegentAC

What I will cover Who we are Background to a global survey on consumer perception of thresholds Headline results of the survey Focus on the results from the UK What the findings tell us

Who we are The only UK-wide charity solely supporting people at risk from severe allergic reactions For 20 years we`ve provided information/ support to patients and carers We work with healthcare professionals, the food industry/ pharmaceutical companies for better understanding of severe allergies We empower patients, carers and healthcare professionals through our Allergy Wise online training We actively campaign for better allergy care

Global Survey on Thresholds Objectives Gather information on consumer perspective of food allergen thresholds from many countries Use results to advance the dialogue amongst key stakeholders (i.e. food industry, clinicians, regulators and patient groups) Help identify ways to effectively communicate threshold concepts to consumers and get their feedback Results helpful to inform discussions Not a scientific research study

Survey: Process Coordinated by Anaphylaxis Canada Committee Canada, US, UK, Australia, Belgium, Italy Local medical advisors reviewed questions. Recruitment: patient organisation members, websites, social media, 1 group placed a newspaper ad Most used Survey Monkey Survey open for a two week period

Respondents from each country that took part in the survey 1% 0% 0% 1% 1% 0% USA Canada 2% 2% 2% 2% Spain Germany 4% Austrailia 4% Israel Chile 5% New Zealand 6% 58% The Nederlands UK France Ireland 13% Italy South Africa India EFA: Denmark/Norway

Respondents - Total: 9,689 Parents: 81% Food allergic individuals: 24% Had an allergic reactions: 94% Symptoms ranged from mild to moderate. Had a severe allergic reaction: 68% - Such as anaphylaxis; difficulty breathing, swelling of the tongue, lips, face or throat.

Peanut Top food allergies No.1: US, Canada, Germany, Australia, New Zealand, Netherlands, UK, Ireland, South Africa Tree Nuts No.1: Netherlands, France Milk No.1: Spain, Israel, Chile, Italy Wheat No.1: India Eggs and fish also high in most countries

International Results

Countries No. adults in the household with food allergies EFA India South Africa 4 adults Italy Ireland France UK The Nederlands Chile 3 adults 2 adults New Zealand Israel Australia Germany Spain 1 adult 0 adults Canada USA 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Number of children (< 18 yrs) in the household with food allergies EFA India 5 children South Africa Italy 4 children Ireland France UK 3 children The Nederlands Chile 2 children New Zealand Israel Australia Germany Spain 1 child 0 Children Canada USA 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Percentage Individuals asked if they would purchase a food containing their the allergen(s) if they could be assured that the amount of that allergen present in the food would not be capable of triggering an allergic reaction 70 60 50 Yes 40 No 30 I Don't Know 20 10 0 US Can Spain Ger Aus Israel N/Zeal Chile Neth UK France Ireland Italy S.Africa India EFA

Percentage Individuals asked if they would purchase a food containing their allergen(s) if they could be assured that the amount of that allergen present in the food would only be capable of triggering a mild allergic reaction (e.g. tingly lips or an itchy throat) 100 90 80 70 60 Yes No 50 40 I Don't Know 30 20 10 0 US Can Spain Ger Aus Israel N/Zeal Chile Neth UK France Ireland Italy S.Africa India EFA

UK Survey Results

Who has the allergy(ies)? 2.4% 3% 9.6% I have food allergy(ies) 56.3% 41.9% Have a child with food allergy(ies) Have a partner/spouse with food allergy(ies) Have a relative with food allergy(ies) Care for someone who has food allergy(ies) 167 people answered question

How many adults in the household have food allergies? 1% 0% 12% 0 adults 1 adult 47% 2 adults 40% 3 adults 4 adults 163 people answered question

How many children (i.e. up to 18 yrs) in your household have food allergies? 8% 0 children 1 child 39% 2 children 3 children (0)% (0)% 53% 4 children 5 children (0)% 161 people answered question

120 100 Common allergens within households 80 60 40 20 0 166 people answered question

Other food allergies identified

Response Count Who diagnosed the food allergy(ies)? 100 90 93 80 70 60 50 40 36 49 39 30 20 10 0 23 10 2 Allergist Family Physician Pediatrician Emergency Physician Dermatologist Self-diagnosis Other 166 people answered question

How long ago was the diagnosis of the food allergy? 10.2% <1 year 38% 21.7% 1-3 years 4-9 years 10+ years 30.1% 166 people answered question

Has anyone in the household ever experienced an allergic reaction to a food? 7% Yes 93% No 166 people answered question

Has anyone in the household ever experienced a severe food allergy reaction (e.g. Anaphylaxis) 17% Yes No 83% 165 people answered question

Do you purchase pre-cooked or processed food, such as biscuits, breads, canned goods, sweets, cereals, etc? 11% Yes No 89% 161 people answered question

How knowledgeable do you think you are about allergen thresholds? 80 70 60 50 40 30 20 10 0 Not knowledgeable Somewhat knowledgeable Very knowledgeable Expert 151 people answered question.

Based on what you know about, how do you feel about thresholds? Not good, I think every individual reacts different, you can't set a threshold for all If someone has an anaphylactic allergy then I would believe the threshold would be zero! I would like it to be more clear Not enough to comment, we have been advised to avoid any allergens so that's what we do I find them extremely confusing! I need to know what they mean for us everyone's allergies are different. Don't know enough about them and not willing to take the risk with my children but may do as they get older

Percentage of individuals who stated they would Never purchase a product with these statements Contains: 98% Not suitable for allergen (e.g. nut) allergy sufferers: 81% Manufactured on the same equipment as products containing allergen: 75% May contain: 70% Manufactured in a facility that also processes allergen: 53% Packaged in a facility that also packages products containing allergen: 51% Good manufacturing practices used to segregate ingredients in a facility that also processes allergen: 17% Consumers interpret meaning and risk based on statement.

Percentage of individuals who stated they would Always purchase a product with these statement Majority, not all, would purchase: Free From Allergen: 87% Allergen Free: 86% No consistent standards in place for free from claims as not regulated

Would you purchase a food that contains the allergen(s) you are avoiding if you could be assured that the amount of that allergen present in the food is not capable of triggering an allergic reaction? Yes No I don't know 15.7% 19% 153 people answered question 65.4%

Would you purchase a food that that contains the allergen(s) you are avoiding if you could be assured that the amount of that allergen present in the food is only capable of triggering a mild allergic reaction, such as tingly lips or an itchy throat? 3.9% 2.6% 93.5% 153 people answered question

Consumer Perspective of Thresholds Most consumers are finding it difficult to understand threshold : Common advice is to avoid allergenic foods How much is too much? (Unknown) Threshold concept creates confusion and concern which are reflected in responses and comments Consumers admit that they are not knowledgeable about this area

Consumer Perspectives of Thresholds Majority of responders are not comfortable with thresholds. They need more information, presented in a language they can understand, and want to be able to make informed decisions Most people would like to see: - Clearer and consistent labelling (standardized) - Labels they can trust

Food labelling Variation in precautionary statements: Some with, others without Frustration amongst consumers with too many may contain type statements Choices are restricted many ignore precautionary warnings

View of the Anaphylaxis Campaign Consistent risk management approaches using agreed action levels based on good science will provide optimal protection to allergic consumers Increasing information,including that drawn from conducting oral food challenges, offer a realistic possibility of agreement among stakeholders in the future A massive communications exercise is required with consumers, clinicians and the food industry if thresholds are to be successfully implemented

Communication challenges for patients, carers and health care professionals The need to convey that zero risk is not achievable The possible effect of extrinsic factors on threshold levels asthma exercise medications such as NSAID, alcohol

Any questions? Lynne Regent Anaphylaxis Campaign CEO @LynneRegentAC lynne.regent@anaphylaxis.org.uk 01252 546100