Interpretation of commercial food ingredient labels by parents of food-allergic children

Background: To avoid allergic reactions, food-allergic consumers depend on the ingredient labels of commercial products. Complex ingredient terminology (eg, casein and whey for milk) and label ambiguities (eg, natural flavor and may contain peanut) might compromise the ability of patients/parents to determine the safety of particular products. Objective: The purpose of this investigation was to determine the accuracy of label reading among parents of food-allergic children. Methods: Parents of children on restricted diets attending our referral center were asked to review a group of 23 food labels taken from widely available commercial products. For each label, each parent/parent pair was asked to indicate whether the product was safe for the allergic child and, if it was not, which foods restricted from the child's diet were in the product. Results: There were 91 participants. Peanut was the most commonly restricted food (82 children), followed by milk, egg, soy, and wheat (60, 45, 27 and 16 children, respectively). Identification of milk and soy was the most problematic: only 4 (7%) of 60 parents correctly identified all 14 labels that indicated milk, and only 6 (22%) of 27 parents correctly identified soy protein in 7 products. Peanut was correctly identified in 5 products by 44 (54%) of the 82 parents restricting peanut. Wheat (10 labels) and egg (7 labels) were correctly identified by most parents (14/16 and 42/45, respectively). Correct label identification was associated with prior instruction by a dietitian. Conclusions: With current labeling practices, most parents are unable to identify common allergenic food ingredients. These results strongly support the need for improved labeling with plain-English terminology and allergen warnings as well as the need for diligent education of patients about reading labels.