Questions and answers

On this page

• 1. Food allergies
• 2. Food intolerances
• 3. What about coeliac disease?
• 4. Eating a balanced diet
• 5. Buying food
• 6. Eating out
• 7. How the NSW Food Authority works to help you
• 8. School guidelines to manage children with food allergies
• 9. Information for the food industry
• 10. Where can I get more help?

1. Food allergies

Having a food allergy means you experience an abnormal immune reaction to a food that is harmless for most people. This is because antibodies are produced in your body against the protein in a food (the allergen) so that when you eat the food, histamine and other defensive chemicals are released into your system causing inflammation. It is these chemicals that trigger reactions that can affect your respiratory system, gastrointestinal tract, skin or cardiovascular system.

What are the symptoms of food allergy?

The symptoms of an allergic reaction vary and can be more or less severe on different occasions. The most common symptoms include:

• Low blood pressure, dizziness, faintness or collapse
• Swelling of the lips and throat
• Nausea, feeling bloated, diarrhoea, and vomiting
• Dry, itchy throat and tongue
• Coughing, wheezing and shortness of breath
• A runny or blocked nose
• Itchy skin or a rash, hives and sore, red and itchy eyes

What is food anaphylaxis?

If someone has a severe food allergy, this can cause a life-threatening reaction called anaphylaxis. Anaphylaxis affects the whole body, often within minutes of eating the food. Anaphylactic attacks are commonly characterised by symptoms such as the rapid spreading of hives, swelling of the face, tongue and throat, difficulty breathing, wheezing, vomiting and loss of consciousness.

Immediate treatment with injected adrenaline can be lifesaving. People at risk of anaphylaxis should always carry an EpiPen® for emergency use. Peanut is the most likely of all food allergens to cause anaphylaxis and in highly sensitive individuals, only a tiny amount of peanut or simply inhaling airborne food particles containing peanut can trigger anaphylaxis.

Anaphylaxis Australia

What are the most common food allergens?

The eight most common food allergens are crustaceans, eggs, fish, milk, peanuts, soybeans, tree nuts, sesame seeds and their products.

These allergens as well as gluten (from wheat, rye, barley, oats and their products) and sulphites (which are added to food as a preservative) are required by law to be declared on food labels.

About 160 foods have been reported as causing food allergies but these eight are responsible for 90 percent of allergic reactions to food. Others that are known to affect a small number of people in Australia include: corn/maize, kiwifruit, legumes (chickpeas, beans, peas, lentils), lupin (lupin flour), mango, seeds (sunflower, poppy), and spices (including mustard). Food supplements such as bee pollen, Royal Jelly and propolis also cause allergic reactions, as well as non food items such as latex, cosmetics and medications.

Egg and milk allergies are the most common food allergies among infants. However, children often become desensitised as they grow older. Shellfish allergy is more common in adults than children, while peanut allergy affects all ages.

2. Food intolerances

Having a food intolerance means you will experience an adverse reaction to certain food components but this does not involve the immune system. In fact, it is quite different from a food allergy. Food intolerance reactions can be triggered by a range of natural substances or additives present in many different foods. Sulphite preservatives can sometimes cause severe reactions in people with asthma.

What are the symptoms of food intolerance?

The symptoms of food intolerance will vary in severity and according to the food you are intolerant to. Symptoms include:

• Stomach and bowel upsets
• Bloating
• Headaches and migraines
• Wheezing and a runny nose
• Hives
• Generally feeling under the weather

What are the most common food intolerances?

There are many different types of food that people can be intolerant to but the most common include milk and lactose (the sugar in milk), gluten, wheat, food preservatives, and naturally occurring compounds in foods such as caffeine.

Lactose intolerance is caused by a shortage of the enzyme lactase, which is used to ensure lactose is absorbed properly into the bloodstream from the stomach. Some people can cope with small amounts of milk in their diet, eg one or two pieces of milk chocolate, but it depends on individual tolerance.

Milk intolerance is common in children under the age of two years. If left untreated it can result in malnutrition. If you think your child may be milk intolerant speak to your doctor.

Food additive intolerance only affects a very small number of children and adults. The additives most commonly linked to food intolerance are artificial colours, eg tartrazine, sulphites and benzoates (types of preservatives).

Sulphites have to be declared on all packaged products under the Food Act. They are preservatives and are commonly found in wine and dried fruit. The additive numbers are 220-228 and will appear as one of these numbers in the ingredient list. Sulphite reactions cause asthma, rashes, irritable bowel syndrome and headaches in sensitive people.

Other foods to watch out for include red wine, cheese and chocolate. These can trigger headaches and migraines in sensitive individuals.

3. What about coeliac disease?

Coeliac disease is a disorder of the small bowel caused by an immune reaction to dietary gluten (a protein found in wheat, barley, oats and rye and their products). It is not a food allergy but an auto-immune disease.

In coeliac disease, the lining of the bowel is damaged by the white blood cells of the immune system and not by antibodies (as in food allergic reactions). The symptoms are also quite different and include nausea, wind, tiredness, constipation, reduced growth and skin problems. Untreated coeliac disease can be associated with long-term health problems but is not life-threatening.

Coeliac Society |

Think you have a food allergy or intolerance?

If you think you have a food allergy or intolerance, then it’s important to get a proper diagnosis from a qualified medical practitioner. Don’t cut food groups out of your diet without medical advice, because you could miss out on important nutrients. Talk to your GP – they should be able to provide you with advice and support.

Your doctor will be able to test you and give you follow-up care and advice. Common tests for food allergens include skin prick testing and the RAST blood test. Once diagnosed, they will be able to tell you what food or foods you are allergic to, how severe your allergy is and how careful you need to be in avoiding particular foods.

Food intolerances are notoriously difficult to diagnose (with the exception of lactose intolerance) because there is no one reliable test for all intolerances. Your GP may advise eliminating different food groups from your diet to help diagnose if you have a food intolerance. Stopping eating certain foods needs to be professionally managed to ensure you still get all the essential vitamins and minerals you need for a healthy diet.

4. Eating a balanced diet

It’s important for everyone to eat a healthy balanced diet. Even if you can’t eat a certain food there are other foods you can eat to give you the nutrients you need. If you have a food allergy or intolerance you should consult a dietician to make sure your diet is adequate. This is especially important for young children who need good nutrition for growth.

5. Buying food

What should I look out for on food labels?

It is essential to look carefully at the label on any pre-packed food you buy if you have a food allergy or intolerance yourself or are shopping for someone who does.

Food labelling rules in Australia state that the eight most common allergens (crustaceans, eggs, fish, milk, peanuts, soybeans, tree nuts, sesame seeds and their products), cereals containing gluten and its products plus sulphite preservatives must be declared on packaging or in connection with the display.

These allergens are not always clearly displayed on labels and other words may also refer to the allergen. For example, a milk product may also be referred to as casein.

Anaphylaxis Australia, in association with the NSW Food Authority and Food Standards Australia New Zealand (FSANZ) has produced some allergen ingredient cards that list key ingredients you should avoid if you are allergic to milk, peanut, egg, fish, treenut, sesame, soy or shellfish. To order your free copies of these cards call the NSW Food Authority on 1300 552 406 or Anaphylaxis Australia on 1300 728 000.

Ingredients lists

There are three ways you might see allergens declared on the ingredient lists on labels:

• in brackets - wheat flour, sugar, margarine (contains milk), salt, flavour (contains wheat starch)
• in bold - wheat flour, sugar, margarine (contains milk), salt, flavour (contains wheat starch).
• in a separate declaration - wheat flour, sugar, margarine (contains milk), salt, flavour (contains wheat starch). Contains wheat and milk.

Even if you are allergic to an uncommon allergen, all ingredients have to be listed on the labels of pre-packaged foods. So always check the ingredients list carefully.

May contain . . .

Some food labels may also have a warning to show that the food product may inadvertently contain foods that people are commonly allergic to, for example, ‘may contain traces of nuts’ or ‘may contain seeds’. This means that even if nuts or seeds aren’t deliberately included as ingredients in the food, the manufacturer cannot be sure that the food doesn’t accidentally contain small amounts of them.

If you are allergic to any of the foods mentioned in these warnings you should avoid these food products.

• Remember to check the ingredients every time you buy a product – the recipe might have changed since the last time you bought it!

What about foods which are not pre-packed or labelled?

Foods that aren’t pre-packed or labelled include those sold from a bakery, butcher, deli counter or salad bar, and foods weighed and sold loose. It also includes meals served in restaurants, takeaways and other eating out venues.

It’s possible that small amounts of the food you need to avoid could be within the ingredients or could have accidentally got into one of these products. For example, from being next to another food, from a knife or spoon, or from being wrapped in bag that has touched another food. If you have a severe allergy it is safer to avoid unpackaged foods but all consumers in NSW are legally entitled to ask for information about the allergen content of foods for sale that are not pre-packed or labelled.

What should I do if I think a food has been incorrectly labelled?

If you think a food has been incorrectly labelled or that an allergen has not been declared properly on packaged food, give us a call on 1300 552 406. The NSW Food Authority has powers under the Food Act and the Food Standards Code to investigate labelling complaints and take action against food businesses breaking the law.

6. Eating out

Eating a meal from a restaurant, café or take-away can be a stressful experience if you have a food allergy or intolerance. When food is prepared by someone else you can’t be absolutely sure that it won’t contain food allergen. There are, however, some guidelines you can follow to make eating out safe and simple.

1. Tell the restaurant

• When you book a table, tell the person taking the booking about your food allergy or intolerance and ask them to either check with the chef that they can provide you with a meal that doesn’t contain the food you are allergic to.
• When you arrive at a restaurant, make sure the waiter knows about your food allergy.

2. Ask about the dishes

• Read the menu carefully to see if there is any mention of the food you are allergic to in the name or description of the dish. Remember, ingredients may not always be obvious, eg ground almonds or peanut flour can be used to thicken sauces in Indian food, nuts or seeds are commonly used in salad dressing oils or as a garnish.
• Always ask the waiter or waitress – food allergens are not always stated on menus.
• Tell them what you would like to order and ask them to check with the chef that the dish does not contain the food you need to avoid.
• If you can, speak to the chef personally.
• If the staff can’t answer your questions or don’t seem certain, it’s better to order something else.

3. Ask about cross-contamination

• Ask staff whether you food will be prepared with different equipment and utensils that are separate to those used for foods containing the allergen in order to avoid cross-contamination, e.g. your food will not be cooked in the same oil as the ‘risky’ food or cut up with the same knife.

4. Don’t assume ...
because you ate a dish safely in one restaurant that it will be made the same way the next time or in a different restaurant. 5

5. Avoid self-service areas
If you have a severe allergy, it’s best to avoid eating food from a self-service area or buffet. It’s easy for small amounts of allergenic ingredients to get into food by accident (e.g. because people use the same spoons for different dishes), so even if it looks safe, you can’t be sure.

6. If you have a severe allergy, don’t eat out without your EpiPen®. No EpiPen® - No Eat

7. How the NSW Food Authority works to help you

The NSW Food Authority works to ensure that you get accurate information about the food you buy and that the food you eat is safe.

The Authority enforces the NSW Food Act and the Australia New Zealand Food Standards Code, which requires all food businesses in NSW to provide information about the most common allergens (crustaceans, eggs, fish, milk, peanuts, soybeans, tree nuts, sesame seeds), gluten and sulphite in their food by either:

1. Declaring allergens on the label (usually in the ingredient list)
2. Displaying information about allergens next to food on sale (if it’s not packaged) or;
3. Providing information about food allergens in their food if requested by a customer.

If you find a food business that doesn’t provide information or if an allergen is found in food that was not declared or you were specifically told did not contain that allergen they may be breaking the law.

Call us and report it on 1300 552 406.

The Authority will investigate suspected breaches, penalise non-compliance and can recall food to protect public health. The NSW Food Authority has produced a postcard, Worried about food allergies and intolerances? which describes our role in regulating food businesses and when you should report food businesses. You can download a copy here.

Postcard: Worried about food allergies and intolerances? PDF 491 KB

Food recalls

All foods found to contain significant quantities of unlabelled allergens are recalled. Recall notices are placed on the Food Standards Australia New Zealand website (www.foodstandards.gov.au/foodmatters/foodrecalls/index.cfm) and can also be found at Anaphylaxis Australia’s website (www.allergyfacts.org.au/foodalerts.asp ). Such recalls are also printed in major newspapers.

8. School guidelines to manage children with food allergies

The NSW Department of Education and Training has developed guidelines for schools to assist in the management of children with allergies. The guidelines include forms for doctors/parents, action plans and EpiPen® instructions. For more information visit: www.schools.nsw.edu.au/studentsupport/studenthealth/conditions/anaphylaxis/index.php

The Royal Prince Alfred Hospital also offers training for teachers, parents and carers of children with allergies. For more information visit: cs.nsw.gov.au/rpa/allergy |

9. Information for the food industry

The Australian Food and Grocery Council has a great deal of information for businesses that package or serve food and food products that contain or may contain allergenic products.

• Food Industry Guide to Allergen Management and Labelling

The Food Safety Centre Allergen Bureau is also extremely helpful.

• Allergen Bureau Net

10. Where can I get more help?

Your Health Professional

• GP
• Allergy specialist or paediatrician
• Dietician