A recent London inquest explores the facts behind a 15-year-old girl’s fatal allergic reaction to unlabeled sesame. In the summer of 2016, Natasha Ednan-Laperouse purchased a baguette from a popular vendor, Pret a Manger, at Heathrow Airport before boarding a flight to France.
In flight, her itchy throat was treated with antihistamines, but she exhibited ongoing symptoms of an allergic reaction and received emergency epinephrine. She suffered cardiac arrest on the plane, and later died at a French hospital.
The death of this young woman brings several issues to the forefront, including the need for first-line epinephrine treatment, better in-flight preparedness for emergencies and improvements in labeling of sesame as a food allergen.
Her death marks the 10th time since 2015 a person eating food from this vendor reported an allergic reaction attributed to sesame. The events led the company to create additional allergy alerts, but reportedly, they were not evident on the day Natasha purchased her food.
It is 10 times too many.
Although laws in the European Union, Canada, Australia, and New Zealand require that sesame be labeled as an allergen in pre-packaged food, unfortunately freshly made food — such as the baguette Natasha consumed — is exempt from this labeling.
In the United States, sesame labeling is even less comprehensive. Labeling sesame as an allergen isn’t required at all, so both pre-packaged and freshly made foods may not prominently indicate that they contain this allergen, posing a life-threatening risk to sesame-allergic children and adults.
For families dealing with sesame allergies, shopping for groceries or grabbing a quick bite to eat becomes a calculated risk. Instead of mulling over what’s on sale or what looks tasty, we pore over menu choices and the allergen labeling to make a safe choice (if we choose anything at all). Depriving allergic customers of that specific information for sesame allergies is downright wrong.
To protect every person, food service providers need to take responsibility for the safety and protection of their customers.
The 2018 Center for Science in the Public Interest report, "Seeds of Change" warns that current sesame labeling lacks clarity and contributes to confusion among consumers. While many manufacturers voluntarily label for sesame allergens and potential cross-contact, CSPI found that over a third of manufacturers surveyed for their report do not.
The problem is not a new one. The CSPI report follows a 2014 petition filed by CSPI and others urging clear labeling of sesame in foods.
Perhaps the lack of action on this petition is a symptom of the low level of awareness of sesame allergies in the U.S., despite estimates of an incidence of 0.1 percent. To put that statistic in perspective, over 300,000 adults and children in the U.S. — a number equal to the population of St. Louis — are believed to be allergic to sesame.
Although sesame allergy ranks as the ninth most common allergen in the US , the Food Allergen Labeling and Consumer Protection Act (FALCPA) only covers the top eight allergens — milk, eggs, peanuts, tree nuts, fin fish, crustacean shellfish, wheat, and soy — leaving those with sesame allergy without the same assurance of safe ingredients as those with other allergies.
Many common staples, such as hamburger buns, bread crumbs, bagels, bread, breaded foods, cereals, granola, hummus, pizza crusts, soups, sushi, and even cookies, candy, and ice cream, and an array of other products, such as lip balms, soaps, and lotions, aren’t mandated to have sesame highlighted as an allergen.
This could be fatal for many.
Sesame isn’t always a straightforward ingredient, and is sometimes a component of flours, oils and pastes and may be listed by other names, such as benne seed, gingelly, gomasio, halvah, sesamum indicum, sim sim, tahini or til, to name a few.
Another labeling loophole permits sesame to be listed as a food ingredient under natural flavoring or spices.
FALCPA labeling options for foods containing proteins from a major food allergen — currently, the top eight — are probably familiar to shoppers who read labels. The first labeling option includes the name of the allergen in parenthesis after the ingredient. For example, the ingredient enriched flour would be followed by (wheat).
Alternatively, labels may include the “contains” statement, so the item would be labeled as Contains wheat. In addition, some foods are labeled with a “may contain” statement, but this advisory information is voluntary and not required by FALCPA.
THE CSPI has made several recommendations for consumers, food manufacturers, Congress and the FDA, prioritizing that the FDA should use its authority to mandate allergen labeling for sesame that is equivalent to other major allergens.
Managing food allergies is much more complicated than just reading label Some consumers call food companies to confirm ingredients, but safe labeling for all prevalent allergens provides information that consumers can used to reduce the risk of unknowingly ingesting sesame.
Clear labeling of allergens is the least we can do to keep sesame-allergic children and adults safer. While labeling required for pre-packaged foods doesn’t address all allergen disclosure issues, it does offer a measure of reassurance to those with sesame allergies as they shop for food items.
Congress needs to pass the Food Labeling Modernization Act, introduced as S.2647 by Sen. Richard Blumenthal (D-Conn.) and as H.R.5425 by Rep. Frank Pallone, Frank, Jr. (D-N.J.), which would change requirements for sesame labeling.
To be sure, manufacturers may incur additional expense for packaging changes. But providing allergen labels could save lives. And that is priceless.
Josie Howard-Ruben is an assistant professor at Rush University College of Nursing and a Public Voices Fellow through The OpEd Project. She has family members with food allergies.