Presented on behalf of the Irish Food Allergy Network at the Annual meeting of the Irish Association of Immunology & Allergy, July 2011, Meath.

1. Confiscate or reinstate? That is the question for Food Allergy in Ireland.Ruth Charles, Paediatric Dietitian, MINDI.Ballinderry Clinic, St. Francis Hospital, Mullingar,Co. Westmeath.info@nutrikids.ie

2. Irish Food Allergy NetworkOctober 2009. Increased presentation of allergy at dietetic OPD clinics. The associated burden of care and quality of life issues are significant. No dedicated HSE funded Childhood Food Allergy (CFA) service in the Republic Wealth of knowledge and experience currently exists. General consensus reached on the need to network, collaborate, share resources, reconfigure existing structures and avoid duplication. Stakeholders database. Affiliation with IAAI (EAACI).

3. IFAN members: 61 Nutrition & Dietetics (Paediatrics, Adult & Community) 23 Nursing (Allergy, Respiratory, Dermatology) 23 Medicine (Paediatrics, Dermatology & Community Health) 7 Nutrition industry 3 Allergy Academia 2 Food and nutrition legislators, enforcers & trainers 2 Patient support groups 1

4. IFAN Issues Patient issues DIAGNOSIS, management & rechallenge: who, where, how No basic GP/A&E/HCP training Awareness/understanding of allergy and implications lacking Replication/duplication best avoided Food issues Food labelling Eating outside the home

5. Food labelling & the law Legislation European Directives 2003/89/EC and 2006/142/EC All ingredients Presence of 14 recognised allergens intentionally added to prepacked foods Not applicable to low level unintentional contaminants or non prepacked. www.fsai.ie

6. EAACI Food Allergy & Anaphylaxis Meeting February 2011 Food Allergy & Anaphylaxis Alliance FAAA Criteria for use of precautionary statements Major allergens declared Simple language clear terms Consumer communication European Federation of Allergy & Airways Disease EFA Packaged and non packaged foods Abolish precautionary labelling Establish thresholds ( Taylor et al. Clin Exp Allergy,2004; Moneret-Vautrin. Curr Opin Allergy Clin Immunol. 2004; Crevel at al. Allergy 2008. Working groups: ILSI Europe, Europrevall, CONGEN etc)

7. Food Allergens & labelling survey June 2011. www.fsai.ie Survey: affected by Food allergy intolerances Crude, 509, voluntary, biased, web based, 5 questions, 85% medically diagnosed. Peanut & tree nuts, Egg & other, Milk Analysis: 229, no label/precautionary egg, nut, soy No allergen labelling 11/106 (nut 2, egg 5) Precautionary labelling 7/108, 93.5% had undetectable egg, peanut, soy.

8. Conclusions Scepticism and low consumer confidence in precautionary labels is justified Zero risk unfeasible National and EU registry of severe allergic reactions (Worm at al, Allergy, 2010) : detect prevalence Safety/labelling thresholds: processes for risk assessment & robust monitoring systems Food Allergens & labelling survey June 2011. www.fsai.ie

9. Where to next? The patient & family IFAN huge knowledge and skill base aims & objectives Lead/chair