Food Allergen Recalls Are Becoming A Huge Problem

This story is part of a partnership between MedPage Today and VICE News.

Lily Roth is careful about what she puts in her mouth, but one day when she threw up after just a few spoonfuls of soup, she knew it must have contained one of the ingredients she's allergic to.

The 19-year-old University of Pittsburgh sophomore rushed to her friend Maria's apartment as her face became hot and itchy, and her lips and tongue began to swell. She knew it would soon feel as though she was breathing through a crushed straw, her blood pressure would drop, and her heart rate would speed up.

Although she can do it herself, she handed Maria her epinephrine autoinjector, commonly referred to as an epi-pen, and asked Maria to jam the needle into her leg to stop the potentially fatal allergic reaction, called anaphylaxis, from continuing.

"Maria did it and didn't even leave a bruise," Roth wrote on her blog, adding that she spent the next few hours in the emergency room napping on her friends' laps, waiting to see whether it was necessary for her to check in as a patient. For hours, she text-messaged photos of her swollen face to her worried mother to keep her in the loop.

For Roth and millions of others, food can be poison. Roth is among a growing number of people with deadly allergies to everyday foods, like milk and eggs. The wrong snack can kill her, which makes accurate food labeling crucial to her survival.

Related: Salmonella-Tainted Cucumbers Kill Three People, Sicken Hundreds

Just as the Food and Drug Administration announces recalls for packaged foods with pathogens like E. coli, it announces recalls for foods that contain ingredients not listed on the label. These are called undeclared allergens because they have the potential to cause extreme allergic reactions like the ones Roth experiences.

VICE News and MedPage Today analyzed those recalls and found that there were more undeclared allergen recalls this year than for salmonella and listeria combined, though these are the two foodborne pathogens that often dominate news coverage.

As of October 28, there have been 150 undeclared allergen recalls this year, which is more than any complete year since the publicly available data begins in 2009. For instance, Tastee Apple recalled caramel applies in September because they contained peanuts that weren't listed on the label, and Bella Rosa recalled parmesan cheese in July because it had egg in it, but didn't list egg among its ingredients.

By comparison, there were only 47 listeria and 67 salmonella recalls over the same period, plus two more that included both listeria and salmonella.

"Every time they send out a recall, your heart stops a little bit. What if someone ate some of that and they died?" said Roth, who blogs about her allergies to milk, eggs, tree nuts, potatoes, and tomatoes, and has had 20 anaphylactic reactions in her life. "You ultimately realize so many things are out of your control with food allergies…. You're putting your life in the hands of a stranger when you eat anything packaged."

This fall, three food-allergic teens died within three weeks of one another. On September 21, Simon Katz, 16, died in Denver after unknowingly eating a s'more containing peanut butter. On September 18, Andrea Mariano, 18, died on her second day of college after she had a severe allergic reaction from drinking a smoothie in Ontario. And on October 5, Morgan Crutchfield, 17, died of a fatal allergic reaction to food in Stanley, North Carolina.

Deaths from anaphylaxis are rare, but they're considered more common among children, teens, and young adults. According to FARE — Food Allergy Research Education, the largest food allergy nonprofit in the country — an allergic reaction to food sends someone to the emergency room every three minutes.

FARE is the organization behind all those teal Halloween pumpkins that lets food-allergic trick-or-treaters know which houses are giving out non-food treats. And for good reason. Of the 878 undeclared food allergen recalls since 2009, 179 were for candies and chocolates with undeclared nuts, dairy, or eggs, according to the VICE News/MedPage Today analysis.

"We often get stories from people who know they're, for example, tree nuts–allergic," said Dr. Stacy Dorris, an allergy specialist at Vanderbilt University Medical Center in Nashville, Tennessee. "But on a day they had a reaction, they did not eat tree nuts at all to their knowledge."

Food allergies have been on the rise for years, with a Centers for Disease Control and Prevention study revealing that between 1997 and 2011, food allergies among children had risen 50 percent. Food allergies affect about 5.6 percent of U.S. children, or 4.1 million of them, and 8 percent of the general population, according to a 2012 CDC survey.

The rise in food allergies is mysterious, according to allergist Dr. Scott Sicherer, of the Icahn School of Medicine at Mount Sinai in Manhattan.

"A leading theory is the 'hygiene' hypothesis, that our modern lifestyle does not expose us to germs as much as in years past and our immune system may respond with misdirected 'attacks' against innocent proteins like ones in foods," Sicherer told VICE News and MedPage Today.

But there are plenty of other theories, he said. One hypothesizes that less sun exposure leads to less vitamin D, which leads to an immune system effect, he said. Another deals with unhealthy foods and how they perhaps lead to more food allergies.

Related: This Weight-Loss Company Says It Will Sue You for Leaving a Negative Review

According to the CDC, 90 percent of serious allergic reactions are due to eight allergens: eggs, crustacean shellfish, fish, milk, peanuts, soy, tree nuts, and wheat. And thanks to the Food Allergen Labeling and Consumer Protection Act of 2004, enacted in 2006, these ingredients are required to be listed on labels under their common names. Milk must be listed at least once as "milk" rather than "casein," "sodium caseinate," or "whey," which also indicate proteins in milk, for instance. This can either be in the ingredients list or in a "contains" label.

"Families and individuals managing food allergies depend on accurate labels to help them make informed choices, avoid reactions and stay safe," FARE said in a statement to VICE News and MedPage Today. "A labeling error from the production facility can have grave consequences for an individual with a food allergy."

A 2013 FDA report on the implementation of the Food Allergen Labeling and Consumer Protection Act found that 44 percent of undeclared allergen recalls were discovered during government audits or inspections of the facilities where the foods were processed, 12 percent were found because a consumer had a reaction and reported it, and 27 percent were found because of a complaint without a reaction.

This month, General Mills recalled 1.8 million boxes of gluten-free Cheerios because they contained wheat. (And wheat contains gluten.) It was one of 63 undeclared wheat recalls this year.

"In an isolated incident involving purely human error, wheat flour was inadvertently introduced into our gluten-free oat flour system at Lodi, [California]," General Mills vice president of cereal Jim Murphy wrote in a blog post minutes after the recall. "That error resulted in an undeclared allergen — wheat — being present in products labeled as gluten-free at levels above the FDA gluten-free standard."

People for whom wheat is a problem aren't only allergic to it. About 1 percent of the population has celiac disease, an autoimmune disorder triggered by eating gluten, the protein found in wheat, barley, and rye. The reaction causes inflammation of the small intestine and can over time result in malabsorption of nutrients from food. Classic symptoms include diarrhea and weight loss, but complications can involve nervous system problems, joint pain, and even infertility and miscarriage.

Food safety lawyer Bill Marler said one of his clients is a woman who ate the not-so-gluten-free cereal. She has celiac disease and became "quite ill," he said.

Another puzzler this year was a series of cumin recalls because somewhere along the line, the spice had become contaminated with peanuts. Marler said he represented someone with a peanut allergy who had a horrible reaction, but was baffled as to what caused it.

"This is the largest single allergen recall to date," FDA spokeswoman Megan McSeveney told VICE News and MedPage Today, adding that it may explain why 2015 has seen a bump in food allergen recalls.

The recalls included ground cumin powder products, Tex-Mex spice mixes, Cajun seasoning, prepared soups, Indian sauces, and croutons.

Still, more recalls are likely a sign of better vigilance, Marler said.

"There's a larger population of people that are vulnerable," he said. "And I think we're seeing businesses realizing that and double checking their supply chain."

Follow Sydney Lupkin on Twitter: @slupkin Photo via Wikimedia Commons