The very surprising foods that could put you in HOSPITAL

We all know you can be allergic to nuts. But now restaurants are warning us about everything from celery to mustard ...

Not long ago the only warning symbols you were likely to find on a restaurant menu were an ‘N’ for nuts, and perhaps a ‘V’ to indicate a dish suitable for vegetarians. But at gastropubs and food chains alike nowadays, it’s a different story, with some menus carrying a long list of ingredients in the dishes that could potentially cause problems.

So, are these restaurants playing into the hands of the worried well, gripped by some new food fad, or are we in the midst of a new allergy epidemic? In fact, they’re simply obeying the law. A change in EU regulations in 2014 meant that restaurants and takeaways now have to indicate if their food contains any of 14 different ingredients that can cause allergies. these are ‘recognised as the most common and potent causes of food allergies and intolerances across Europe’, according to the Food Standards Authority. Many ingredients that tend to be hidden, in dressings or sauces, for example.

Restaurants must either flag up these ingredients on a menu, or have a notice telling customers to ask staff about allergy information.

‘this legislation is one of the few good things to come out of Europe — it’s very important people with allergies know what’s in their food,’ says Dr Adrian Morris, a consultant allergist at the Surrey Allergy Clinic .

But there are concerns about the effects of the new warning labels. For instance, some experts warn that by highlighting the potential of a food to cause a reaction, there’s a risk of fuelling anxiety around food.

‘that can make people more focused on their bodies, and they start to look for things to go wrong,’ says Jane ogden, a professor of health psychology at the University of Surrey. ‘then they make links between their symptoms, such as a headache, and what they’ve eaten, when the two may be unconnected.’ the added risk is that they end up needlessly cutting out important food groups, such as wheat.

With some restaurants going way beyond the top 14 — Pizza Express highlights 21 potentially problematic ingredients, including garlic, onions, tomatoes, rapeseed and mushrooms — you can see Professor ogden’s point. Pizza Express says it identified these extra ingredients as cause for concern, ‘following requests for information by our guests in our restaurants’.

Meanwhile, other experts point out that some of the allergens in the top 14 actually rarely cause problems for people in the UK, and that there may be other ingredients menus should warn about.

Most food allergies occur when the body produces an antibody (called iGe) in response to a protein in a specific food.

It is not known why this happens but it means whenever you come into contact with that food, it triggers an immune response and release of chemicals including histamine as the body tries to kill off the allergen which it sees as a threat. this can spark a range of symptoms, from itching and swelling to sneezing, wheezing and gut symptoms such as abdominal pain.

More seriously, it can cause anaphylaxis, a potentially lifethreatening reaction which affects the whole body.

AllERGIES to food are becoming increasingly common, with 5 or 6 per cent of children affected and around 1 per cent of adults — and there’s been a big increase over the past 20 years, in children particularly, says Dr Adam Fox, a consultant paediatric allergy specialist at Guy’s and St thomas’s Hospital, london.

But despite the large numbers genuinely affected, the amount of people who think they have an allergy, when they actually don’t, is even higher.

‘Something like 40per cent of people think they have a food allergy — but when they come to our clinic and you test them, the vast majority of them don’t,’ says Dr Morris. ‘they may just have itchy skin for another reason — being stressed can make you itchy, for example, because it triggers the release of histamine — and they just need some antihistamine and a moisturiser. It may be unrelated to what they’ve eaten.’

If you do suspect an allergy, it’s important to get referred for proper testing rather than cut it from your diet permanently, says Dr Isbael Skypala, a consultant allergy dietitian at the Royal Brompton and Harefield NHS Foundation trust in london.

‘Unless you’re good at replacing it with things that contain similar nutrients, it could do more harm than good.’

But if the new rules are designed to protect people with genuine allergies, ensuring food outlets actually abide by them is another thing. last year, a restaurant owner from Easingwold in North Yorkshire was convicted of manslaughter following the death of 38-year-old Paul Wilson from nut allergy after he’d been assured his food contained no nuts.

Some of the 14 ‘danger’ foods such as peanuts aren’t surprising, but here we look at the less wellknown, to see which ones you should worry about.

CELERY NOT SO INNOCENT?

It’S HARD to think of a food more apparently harmless than celery.

Yet it’s on the EU list of 14 major allergens, because it’s a serious problem in France, Germany and Switzerland, where celery and celeriac (the root of a related plant) are more of a dietary staple.

It’s not that eating more of a food makes a person more likely to become allergic, simply that the more people there are in a population who are eating a food, the more likely you are to find people who are allergic to it, explains Dr Fox.

In fact, celery is ‘a very uncommon allergy in the UK,’ he says. But if you are one of the few affected, be warned that it has the potential to hide away in various dishes. ‘It’s a good flavour-enhancer, so you may find it in stock cubes and soups,’ says Amanda Squire of the British Dietetic Association.

BEWARE DANGER IN HUMMUS

ALLERGY to sesame is rising globally, probably because it’s increasingly used as an ingredient. these tiny seeds are often sprinkled on burger buns and crackers, and found in popular dishes such as hummus, and sesame oil is used in Asian cooking.

the problem is that it can be difficult to diagnose because tests for it aren’t always effective, says Dr Skypala. this is because the proteins that trigger the allergy in some people are difficult to reproduce for use in a test.

IS THAT SOY LATTE A GOOD IDEA?

SOYA is one of the more common allergens in the UK after milk, eggs and nuts. As well as being eaten whole — as edamame beans, for example — it’s also ground into flour and is used as a bulking agent in everything from sausages to bread.

Meanwhile, fermented soybeans are used in tofu and soy sauce. the allergy typically affects children, but adults may still be affected in certain contexts.

the new warnings might be particularly pertinent if you have an allergy to birch pollen (and suffer from hay fever as a result), because your soy latte could cause problems, too.

Dr Skypala explains: ‘the unprocessed soy bean contains a protein that’s similar to birch pollen, so if someone is allergic to the pollen they may get a swelling in the mouth and throat after drinking soy milk.’ these

patients won’t react to soy flour, because the protein has been processed out.

DO YOU HAVE A WINE ALLERGY?

PEOPLE with asthma may be more prone to reactions to sulphites (chemicals including sulphur dioxide), additives used to preserve foods and drinks, particularly foods that may turn brown, says Dr Skypala. Horseradish sauce contains a lot of sulphites, she says.

They may also be used in dried apricots, cheaper meats such as beef burgers and some sausages, dried onions, lemon juice and white wine.

The sulphites can prompt symptoms such as tightness of the chest, wheezing and nasal congestion — these aren’t typical allergy symptoms, and sulphites aren’t usually thought to cause a true allergic reaction. This means that they can’t be tested for via skin prick or blood tests.

‘We know they can cause anaphylaxis but we don’t really know how,’ says Dr Morris.

Red wine can also cause reactions but not necessarily because of sulphites.

‘Red wine is naturally high in histamine [the same chemical the body produces in an allergic reaction] so it can cause symptoms that mimic an allergic reaction,’ says Dr Skypala. ‘And some people are allergic to alcohol generally or to the grape’.

Even so, allergy specialists are seeing falling numbers of patients who have a problem with sulphites, says Dr Skypala.

‘It might be that it’s being used less nowadays.’

NOT SO KEEN AS MUSTARD

IT’S NOT just your jar of Colman’s — the leaves, flower and seeds of the mustard plant can crop up in curries, marinades and dressings.

Allergy to mustard is much more common in France. But Amena Warner, the head of clinical services at Allergy UK, says: ‘It could become more common here, particularly as people want to reduce salt intake and add flavouring differently.’

‘Some people may have a mustard allergy without realising it,’ adds Dr Morris.

‘People often think they are allergic to the tomato in a salad when it’s actually the mustard in the dressing.’

Genuine allergies to tomatoes, as well as strawberries, are rare. ‘They contain histamine-like substances that irritate around the mouth, especially if you have eczema there — but this is not an allergy,’ says Dr Fox.

DON’T BUY FISH ON A MONDAY

FISH — which may crop up in stock cubes and Worcestershire sauce — can cause a severe allergic reaction in susceptible people. Along with shellfish, it’s one of the few allergies that could develop during adulthood, says Dr Fox.

Yet not all apparent fish allergies are as they seem, adds Dr Morris. ‘If the fish is not stored properly, its flesh can break down and release histamine, and if you eat it you can get scombroid poisoning — with symptoms such as rash, flushing and vomiting.’

It’s common with dark fish such as tuna and mackerel, which naturally contains a high level of histamine. To avoid it, Dr Morris advises buying fish that’s as fresh as possible — ‘don’t buy fish on Monday — it will probably be three days old by then,’ he adds.

As for shellfish, restaurants must, by law, differentiate between crustaceans — such as prawns, crab, lobster — and molluscs, such as mussels and squid. ‘Crustaceans cause the most problems,’ says Dr Skypala. This may because crustaceans are eaten more widely.

LUPIN THREAT IN FRENCH BREAD

LUPINS are a flower commonly found in English gardens, but what many people may not realise is that their seeds are often crushed into flour and used in breads, pastries and pasta — usually those manufactured on the continent.

It may be found in bread sold here at French markets, warns the Anaphylaxis Campaign. ‘Lupin flour is more commonly used in Italy and France, where they don’t use genetically modified soy — it gives texture to a bake,’ says Dr Skypala. ‘We tend to use soy in Britain, so you don’t find as many people with lupin allergy.’

But she has seen the allergy develop in surprising ways — one patient who’d had severe anaphylaxis triggered by food containing lupin, was thought to have become sensitised by using a skincare product containing lupin for years.

Lupin oil (extracted from the seeds) is said to have antioxidant properties. Research suggests a link between lupin and peanut allergy. But those with peanut allergy should be tested before cutting lupin out of their diet ‘otherwise you will avoid bread for life, perhaps unnecessarily’, says Dr Morris.

OTHER FOODS TO WORRY ABOUT

BUT what about the foods that don’t need to be declared by law which can still cause serious reactions? It’s not in the top 14, but experts warn that kiwi fruit allergy is becoming more common in Britain.

‘Like sesame, it’s one of those foods that we just weren’t eating 20 years ago,’ says Dr Fox. ‘If this were UK legislation, I think kiwis would be very relevant.’

Experts are also seeing more people with allergies to bananas, chickpeas and lentils. ‘It’s a bit worrying that chickpeas are not on the list — maybe they will be in future,’ adds Amena Warner.

At least with kiwi fruit, you can spot it quite easily and avoid it, says Dr Morris.