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Allergy and intolerance

Food allergies and food intolerances can be unpleasant, complicated and can cause death. However, food allergies and intolerances can be managed, to improve quality of life.

Below is more information on managing food allergies and intolerances, especially when buying food or eating out.

Food allergies and intolerances – a growing concern

Food allergy now affects 1 in 10 infants and about 2 in 100 adults in Australia. Australia has one of the highest allergy rates in the world and can be genetic. Food intolerance is even more common. Surveys indicate that up to 25% of the population believe they have a food intolerance.

Remember:

  • Food allergy = immune system reaction to a food
  • Food intolerance = inability to digest a food

The high rate of food allergies and intolerances is a concern,as currently there is no cure for food allergies.The only successful method of managing a food allergy or intolerance is to avoid the foods containing that allergen or food component.

The difference between food allergy and food intolerance

Food allergy and intolerance are both types of food sensitivity which can cause illness. A food allergy causes the immune system to react to a particular food with immediate symptoms, such as itchiness, rash and swelling. Sometimes a reaction can be so severe that it can trigger a life-threatening reaction known as anaphylaxis.

Food intolerance doesn’t involve the immune system. Food intolerance is an adverse reaction to a particular food. The symptoms can be unpleasant and in some cases severe, but are generally not life-threatening.

Food allergy or intolerance needs proper diagnosis

If you think you have a food allergy or intolerance, 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 as you could miss out on important nutrients. Your GP should be able to provide you with advice and support.

Food allergies

People with a food allergy experience an uncommon immune reaction to a food that is harmless to others. Antibodies are produced in the body to fight the protein in the food (the allergen) so when eaten, histamine and other defensive chemicals are released into the body causing inflammation. It is these chemicals that trigger reactions which can affect the respiratory system, gastrointestinal tract, skin or cardiovascular system.

Food allergy symptoms

  • low blood pressure, dizziness, faintness or collapse
  • swelling of the lips and throat, nausea and feeling bloated
  • diarrhoea, and vomiting
  • dry, itchy throat and tongue, coughing, wheezing and shortness of breath and a runny or blocked nose
  • itchy skin or a rash, hives and sore, red and itchy eyes.

A severe food allergy can cause a life-threatening reaction called anaphylaxis. Anaphylaxis affects the whole body, often within minutes of eating the food.Symptoms such as rapid spreading of hives, swelling of the face, tongue and throat, difficulty breathing, wheezing, vomiting and loss of consciousness are common signs of an anaphylactic attack.

Immediate treatment with injected adrenaline can be lifesaving. People at risk of anaphylaxis should always carry an EpiPen® for emergency use.

Most common food allergens

The 10 most common food allergens are:

  • crustaceans
  • eggs
  • fish
  • milk
  • peanuts
  • soybeans
  • tree nuts
  • sesame seeds
  • gluten
  • lupin.

These allergens and sulphites (which are added to food as a preservative) are required by law to be declared on food labels.

Food intolerances

People with a food intolerance will experience an adverse reaction to certain food components that does not involve the immune system.

Food intolerance symptoms

  • stomach and bowel upsets
  • bloating
  • headaches and migraines
  • wheezing and a runny nose
  • hives
  • generally feeling under the weather.

Most common food intolerances

There are many types of food people can have an intolerance to, 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.

Milk intolerance is common in children under the age of two years - if left untreated it can result in malnutrition.

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

Sulphites must be declared on all packaged products under the Food Act 2003 (NSW). Sulphites are a preservative commonly found in wine and dried fruit. The additive numbers for Sulphites are 220-228 which appear in the ingredient list. Sulphite reactions cause asthma, rashes, irritable bowel syndrome and headaches in sensitive people.

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 and rye). 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). Symptoms include nausea, wind, tiredness, constipation, reduced growth and skin problems.

Buying food

Food label information to look for

If you have a food allergy or intolerance or shop for someone who does, it’s important to check the label on any pre-packed food you buy.

The 10 most common allergens (crustaceans, eggs, fish, milk, peanuts, soybeans, tree nuts, sesame seeds, gluten, and lupin), plus sulphite preservatives, must be declared on packaging or in connection with the display.

These allergens are not always easy to find on labels. Other words may also refer to the allergen, eg.a milk product may be referred to as casein. Allergy & Anaphylaxis Australia, in association with the NSW Food Authority and Food Standards Australia New Zealand (FSANZ), has produced allergen ingredient cards that list ingredients you should avoid if you are allergic to milk, peanuts, eggs, fish, tree nuts, sesame, soybean, crustacea or lupin.

To order your free copies of these cards call Allergy & Anaphylaxis Australia on 1300 728 000.

Ingredients lists

There are 3 ways you might see allergens declared in ingredients lists:

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

Always check the ingredients list carefully. All ingredients must be listed on the labels of pre-packaged foods, even uncommon allergens.

'May contain' warnings

Remember:

  • Check the ingredients every time you buy a product – the recipe might have changed since last purchase.
  • 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.

Some food labels may also have a warning to show the food product may contain foods people are commonly allergic to, eg.‘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 the food doesn’t accidentally contain small amounts of the allergen.

If you are allergic to any of the foods mentioned in ‘May contain’ warnings, you should avoid these food products.

Tip: You can call food manufacturers and ask about ingredients or manufacturing processes if unsure about a product.

Foods not pre-packed or not labelled

Foods that aren’t pre-packed or labelled include those sold from:

  • bakeries
  • butchers
  • deli counters
  • salad bars
  • foods weighed and sold loose.

It also includes meals served in:

  • restaurants
  • takeaways
  • other eating out venues.

It’s possible that this type of food could contain small amounts of allergens in the ingredients. The allergen may have also been introduced to these products due to contact with another food,knife or spoon, or from being wrapped in a bag that has touched another food containing an allergen.

If you have a severe food allergy, you should always disclose your allergy clearly, ask about ingredients and never make presumptions about food content. You should always have your emergency medication with you.

What you should do if you think a food has been incorrectly labelled

If you think a food has been incorrectly labelled, or an allergen has not been properly declared on packaged food, call us 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.

Eating out tips

Eating a meal from a restaurant, café or takeaway 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 allergens. There are however some guidelines to make eating out safer and more simple.

Strategies to help manage food allergy and intolerance include:

  • Plan ahead.
  • Educate those around you.
  • Always read the food label, even if the product has been eaten safely before.
  • If there is no label and you can't access clear information on food content, do not eat the food.

Tell the restaurant

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

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
  • Always ask the waiter – food allergens are not always stated on menus
  • Give staff your order and ask them to check with the chef that the dish does not contain the food you need to avoid. Speak to the chef personally if you can
  • If the staff can’t answer your questions or don’t seem certain, it’s better to order something else or eat elsewhere.

Ask about cross contamination

  • Ask staff if your food will be prepared with equipment and utensils that are separate to those used for foods containing the allergen, to avoid cross contamination
  • 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.

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 accidentally, (eg. people might use the same spoons for different dishes) so even if it looks safe, you can’t be sure.

Take your Epipen®

  • If you have a severe allergy, don’t eat out without your Epipen®

The NSW Food Authority's role

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 Food Act 2003 and the 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:

  • Declaring allergens on the label (usually in the ingredient list)
  • Displaying information about allergens next to food on sale (if it’s not packaged)
  • Providing information about food allergens in 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, the business may be breaking the law. Contact us and report it.

The Food Authority will investigate suspected breaches, penalise noncompliance and can recall food to protect public health.