For those in the food business, labels will probably be changed again. The family of a woman with a severe dairy allergy who died after eating a “vegan” Pret a Manger wrap contaminated with milk protein have warned that more people will die unless comprehensive testing throughout the food supply chain and better labelling are introduced. Celia Marsh’s family also said they believed the 42-year-old dental nurse would still be alive if a company that made a coconut yoghurt added to the wrap had informed Pret there was a risk it could have been contaminated because it was made in a factory that used milk.
Marsh, from Melksham in Wiltshire, died two hours after eating a “super-veg rainbow flatbread” bought from a Pret in Bath during a post-Christmas shopping trip in 2017. Maria Voisin, the senior coroner for Avon, concluded that the wrap contained a “dairy-free coconut yoghurt alternative” supplied to Pret by the Kent company Planet Coconut. The coroner said the yoghurt included milk protein, which caused Marsh’s anaphylaxis.
Giving a narrative conclusion, Voisin said: “A product which is marked dairy-free should be free from dairy.” She said the contamination arose because a stabiliser in the yoghurt called HG1 had become contaminated during its manufacture at Tate & Lyle’s plant in north Wales. The inquest heard that Tate & Lyle sent the HG1 to Planet Coconut in bags making clear they were not made in an allergen-free area and Planet Coconut had documentation that flagged the risk. But Voisin said Planet Coconut had not highlighted this risk to Pret.
The coroner said she would write to the Food Standards Agency raising concerns about the labelling on products claiming to be dairy-free and the testing process. Outside court, Marsh’s daughter Ashleigh Grice, 27, said Marsh was “our rock, the soul of the family”. She continued: “On that terrible day she trusted the labelling in the Pret a Manger store. But the vegan wrap had been contaminated. The contents were poisonous to her.”
Grice said there was a “woeful lack of testing” in the food supply chain and too much “vague labelling” such as “may contain”. She also claimed there was a failure in the healthcare system to help people with serious food allergies. She added: “It is now clear to us that if Planet Coconut had passed on the warnings in their possession to Pret a Manger about the risk of cross-contamination, Mum would still be alive today. Mum’s death, like so many allergy deaths, was entirely avoidable.”
Natasha’s Law
Tanya Ednan-Laperouse, whose 15-year-old daughter, Natasha, died in 2016 after eating a Pret baguette containing sesame seeds, said: “Celia died one year after we lost our own daughter Natasha, who also died from an allergic reaction to food she considered safe to eat. We need urgent reform of the flawed and misleading precautionary allergen labelling system.”
On July 17, 2016, teenager Natasha Ednan-Laperouse lost her life after a cardiac arrest caused by an allergic reaction. It was triggered by a prepacked baguette which, at the time, did not have allergen labelling. Natasha suffered an anaphylactic reaction to the sesame seeds of the baguette. To improve the quality of life of persons who have food hypersensitivity and to assist them in making safe and informed food choices—allowing them to manage risk effectively—Natasha’s Law was enacted.
The UK Food Information Amendment, also known as “Natasha’s Law” intends to protect food allergy sufferers and give them security in the food that they are buying. Natasha’s Law aims to increase transparency within the food industry in order to better protect both the customers and businesses.
Natasha’s Law took effect on the 1st of October 2021—requiring all food produced and packed for sale in the same premises to provide complete ingredient lists. This means that any food business selling Prepacked for Direct Sale (PPDS) foods will be required to identify all ingredients on the product label, with an emphasis on the 14 allergenic ingredients. Any food that is wrapped in foil, in a membrane, or in paper bags before being sold is targeted by this law. This new legislation covers England, Wales, Scotland, and Northern Ireland.
Food business’ responsibilities under Natasha’s Law are:
- Accurate Information – food sellers must provide accurate food labelling information. This information should be updated as new recipes or ingredient lists change or are substituted by suppliers.
- Communication with Suppliers – food sellers need to have good communication with the supplier, who has a legal obligation to provide the exact and full list of ingredients.
- Allergen Awareness Training – ensuring that there is a proper allergen management system and training among staff, and understanding of Natasha’s Law.
The Marsh family and Ednan-Laperouse called for anaphylaxis to be recognised as a notifiable disease. “This would result in instant precautionary product recalls, which could save lives, and an accurate picture of the true toll of the numbers of serious incidents and fatalities,” said Ednan-Laperouse.
Call for clearer rules
The bosses of 11 leading food businesses have penned an open letter calling for clearer rules on food labelling after the deaths of two Pret a Manger customers who suffered allergic reactions. The letter, which news publication The Guardian says is addressed to officials, including government ministers, the Food Standards Agency (FSA) and the Food and Drink Federation, argues the FSA needs to “make a clear decision on [allergen] thresholds and a strong recommendation to ministers.” The Guardian says it adds that “this would provide sellers of food with an absolute definition of how much of a specific allergen pre-packed food could safely contain before being labelled as free of that allergen”.
The letter was organised by the Natasha Allergy Research Foundation, which was named after Natasha Ednan-Laperouse, who died in 2018 after eating a mislabelled baguette containing sesame seeds. Natasha’s Law was launched in 2021, and made it a legal requirement for pre-packaged and freshly prepared food to have full ingredient labelling and allergen labelling on the packaging for full consumer transparency.
The issue was also highlighted during the inquest on Celia Marsh, who is said to have died from her dairy allergy after eating a “vegan” Pret a Manger wrap contaminated with milk protein. The coroner said at the time that labels implying the absence of an allergen – especially terms like “free-from” and “vegan” – were “potentially misleading”. A comment piece written by the consumer analysts at Packaging Gateway’s parent company, GlobalData at the time, suggested the cases demonstrate the importance of mandatory allergen labelling for foodservice and FCMG brands to acknowledge on their packaging. The analysts also highlighted that it confirms the ineffectiveness of labels if consumers don’t understand their meanings when making purchases.
No harmonised approach
While carrying an EpiPen is an option for many consumers with allergies to counteract a reaction after it’s occurred, it’s not a sustainable, or appropriate, preventative measure for food allergy sufferers. And fatal reactions can still occur. The best way of protecting against a reaction is to avoid consuming foods containing the allergen, which is why accurate product labelling is so important.
Unfortunately, as we’ve seen in recent high-profile cases, it’s a challenging task for brands to ensure either the complete removal of a known allergenic ingredient from the production process and supply chain of ingredients, or – where that is not possible – to ensure clear, effective and accurate communication of the risk of exposure.
On the global stage, the management of allergens is handled similarly across the board (perhaps with varying effectiveness). The World Health Organization (WHO) through Codex is clear on the regulatory approach to be taken – countries must manage food allergies within a local context.
They must also understand which foods are problematic to the population (national or even local), ensure their presence is communicated clearly and work on how to determine acceptable levels. WHO established that priority allergens globally are those that create an immune-mediated reaction (i.e., not ‘intolerances’), including cereals containing gluten, crustaceans, eggs, fish, milk, peanuts, sesame and specific tree nuts (almond, cashew, hazelnut, pecan, pistachio and walnut).
Pulses, insects and other foods, such as kiwi fruits, are commonly included in a ‘watch list’ and evaluated for the priority allergen list when data on prevalence, severity and potency continues to evolve. When trading – both locally and globally – it’s crucial to understand your product, extensively research what is considered allergenic in the destination market, and therefore identify what needs to be indicated on a label or other method of providing information (which will also vary by country).
It’s obvious that the presence of relevant ingredients in products must be indicated in accordance with local legislation (e.g., on a label). “May contain” or precautionary allergen labelling (PAL) is seen to be problematic in many ways. Prior to formally established allergen labelling, it was argued that general product safety requirements needed a manufacturer to make specific risks to consumers known via labelling. As time moved on, it’s now suggested that without the rigour of good manufacturing practice and better prevention of cross-contamination, such warnings are useless, as they may not be taken seriously.
It’s also possible that some businesses may view the addition of a warning as an easier option to making sure the appropriate controls are in place. Such warnings, loosely applied, do – in turn – reduce the number of foods available to affected consumers, and therefore reduce warning effectiveness. They can also be confusing due to nuances in wording which can make them vague in intent, such as “produced in a factory where X is used”.
The recent inquest into Celia Marsh and Pret-A-Manger resulted in the coroner talking about a testing regime to ensure the absence of cross-contamination. (The reported facts of this incident suggest that testing was not necessary if the correct information had been communicated, but testing has now been brought to the fore). Japan, as well as specifying interrogation of manufacturing records for PAL, also requires analytical testing.
Testing might be a reasonable activity and form part of a robust system, but that also depends on the overall checks and balances in place, as well as the confidence in the supply chain and any claims made in association with the product.
Much is evolving within the food industry around allergens, and the regulations and labelling requirements in place to protect those who suffer with allergies. With the suggested changes to “may contain” warnings, and the introduction of PAL, food manufacturers need to remain vigilant in order to comply with legislation – and ensure they thoroughly understand their regulatory obligations in each market.
