Dr Hazel Gowland is an expert patient advocate, researcher and trainer at Allergy Action. She also lectures on MSc programmes at Southampton University, Imperial College and the University of Kingston. Here, she outlines the risks and challenges people with food allergies have faced during the Covid-19 pandemic.
In early March, as we experimented with elbow bumping instead of hand-shaking, carried sanitiser and tried to improve our hand-washing techniques, the focus of infection control for Covid-19 was on hands. The potentially tragic impact of contagion through shared breath, with consequent shielding, self-isolating and social distancing was yet to be recognised.
At food safety and allergy workshops and conferences, hot topics included ‘Natasha’s Law’ - the requirement to provide full ingredients and allergen information on items prepared on site and prepacked for direct sale. Local authority initiatives led to improved allergen controls in food businesses, and an increase in associated prosecutions and penalties. Concerns were being investigated about food sold via online marketplaces, like Facebook and Ebay, from unknown food suppliers, often without ingredients or allergen information.
And then we locked down….
The initial concern for many people with food hypersensitivity has been the need to ensure supplies of regularly consumed ‘free from’ items including gluten free flours and milk alternatives (almond, soya etc). Many have associated conditions such as asthma, so have become dependent on securing delivery slots and shopping from kind friends and neighbours. As ‘regular’ products disappeared from shelves through bulk-buying, these ‘free from’ essentials were bought as alternatives and consequently in short supply. This was improved by an early intervention by the British Society of Allergy and Clinical Immunology and the patient organisations.
Another challenge facing the food hypersensitive community is the need to examine products on sale and read all the ingredients and allergen labelling. Retailers are doing their best to maintain supplies, but products may have changed. Putting an item back on the shelf has led to criticism from other shoppers or staff for unnecessary handling which could cause the spread of infection. For many, visiting the supermarket is already a stressful experience, and finding suitable items is particularly difficult. Seasonal allergies to tree and grass pollens cause sniffles and coughs which can cause additional embarrassment and anxiety in public places.
With restaurants, pubs and cafés closed to diners, some businesses are offering takeaway or delivery services, perhaps for the first time. Local authorities and the Food Standards Agency have both conducted extensive social media and other campaigns to remind businesses of their obligations to provide allergen information and control risks.
Following lessons learned from reactions to food bought through delivery platforms, orders may now be declined if it is considered that there is a risk of allergen cross contamination or confusion about which dish is which during the delivery process.
Although home-schooling brings its challenges, some parents have reported reduced anxiety as their food hypersensitive children are not at nursery or school. This may also include young adults including students living with their families during lockdown, and can provide time to practice label-checking and cooking skills as well as managing any symptoms under supervision.
Inevitably people are reluctant to attend hospital in any kind of emergency at present, which has become a wider concern incase critical symptoms are missed. Leading allergy clinicians have been encouraging people to call paramedics and attend hospital as usual if they have had a severe reaction, especially if they needed to use an adrenaline auto-injector. It is important to have a clinical assessment to ensure the patient is fully stabilised, as well as to replace any auto-injectors used. There is also the question of when an effective hand sanitiser for those with atopic dermatitis (eczema) will be developed.
More hospital consultations are taking place online. Some key components of an allergy diagnosis (such as skin-prick testing, or challenges) are not possible without direct clinical supervision, but patients and their families can work with specialist doctors, nurses and dietitians to ensure adequate nutrition, and improve allergen avoidance and symptom management.
So what next?
There is no doubt that some of these changes will be necessary for a long time to come. If feasible (and economically viable), controls for Covid-19 in public places, particularly on planes and trains, like frequent and effective cleaning may benefit those with allergies, not least by improved understanding of cross contamination. The benefits of face-coverings and risks of using workplace gloves need to be fully understood, both for infection and allergen control, particularly when worn for multiple tasks.