Eosinophilic esophagitis (EoE) is a chronic disease of the esophagus (the “food pipe” that goes from the mouth to the stomach). It is typically triggered by allergies to certain foods or environmental substances (such as pollen, weeds, or trees), resulting in redness, swelling, and damage to the esophagus. Adults with EoE commonly complain of difficulty swallowing (dysphagia), feeling food move slowly down the food pipe, or food getting stuck in their food pipe (food impaction).
People with EoE commonly have allergies to one or more of the following food groups:
- Dairy (milk, most commonly)
Individuals with EoE understand the challenges of identifying foods they can tolerate. Lifestyle changes include learning to read food labels so that one can avoid foods that trigger EoE symptoms. Sometimes a person with EoE thinks they are selecting foods they can tolerate, only to learn they accidentally ate something that caused their symptoms to worsen. Quite often, when the food label is more carefully scrutinized, an ingredient, such as a “natural flavoring”, may be the cause of worsening symptoms.
US Federal Law Requires Food Allergens to be Stated on Food Labels
Most people buying packaged food items read product labels to assess the calorie and nutritional content. People with EoE or other types of food allergy, scrutinize food labels for ingredients that may cause them to develop EoE symptoms or an allergic reaction.
In 2004, the US Food and Drug Administration (FDA) enacted a law called the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA). This law requires all food manufacturers to identify on their food label the names of any ingredients known to be a major food allergen. This law was written to enable people with food allergies to more accurately recognize potential allergens and avoid the risk of exposure and potential adverse health events.
The law applies only to packaged FDA-regulated foods, and mandates that “an ingredient that is a major food allergen or a protein from a major food allergen” be stated in the package labeling no matter how small the amount.1
The FDA identified 8 major food allergens that are required to be listed as “ingredients” of packaged food item and written in a language that is easy to understand.1
The law does not apply to restaurants or food services who prepare your food. Therefore, when dining outside of your home, the FDA advises that you inquire about the ingredients used to prepare your food.
Food Labels – Evaluating Ingredients for Major Food Allergens
The law requires that food labels identify the food source names of all major food allergens used to make the food. Examples of how the food source of a major food allergen must appear on food labels are shown below.2
One person with EoE who has dairy allergies shared his experience about reading food labels.
Important Considerations About Reading Packaged Food Labels
- If you’re unsure about the listed ingredients on a label, check with your doctor or the food manufacturer before eating the food.
- If a food does not list ingredients, don’t eat it.
- Imported packaged foods are subject to comply with the FDA regulations and must list ingredients on the food packaging label.
- There are some food ingredients not covered by FALCPA, which may cause EoE symptoms if you eat them. An example of an excluded item is sesame.3
- Become familiar with your food allergen, and learn all different names associated with the food allergen. As an example, if you have an allergy to milk or milk protein, you’ll need to become familiar with all the associated terminology. Milk or milk protein ingredients may be listed as whey, casein, lactose, lactulose, natural flavorings, and many other names. An exhaustive list of names associated with the major food allergens can be found at www.kidswithfoodallergies.org.4
- Organizations such as American Partnership for Eosinophilic Disorders (APFED), Kids with Food Allergies, and Food Allergy Research and Education (FARE) provide education about ingredient labeling, and recognizing names associated with major food allergens.
- Read the label of your favorite packaged food item each time you buy it. Ingredients can change over time. You must make sure no new allergy-causing ingredients have been added.
The information contained in this newsletter is intended for educational purposes only. Please talk to your doctor about your EoE symptoms, and discuss any foods that may be contributing to your symptoms. To learn more about EoE, click here, or to read other newsletters about EoE or other health-related topics, click here.
- Food Allergen Labeling and Consumer Protection Act of 2004. (https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Allergens/ucm106187.htm) Accessed November 29, 2017.
- Food Facts. Food Allergies – What You Need to Know. U.S. Food and Drug Administration. March 2017
- Food Allergy Research and Education (www.foodallergy.org). Accessed November 14, 2017.
- Kids with Food Allergies (www.kidswithfoodallergies.org). Accessed November 14, 2017.
Copyright ©2017 Link Health Group LLC. All rights reserved. Authored by Susan Jenny BScN (2017).