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    Did You Know? Allergen Labeling in the USA vs. Canada


    Yvonne (Vonnie) Mostat


    • Journal of Gluten Sensitivity Autumn 2017 Issue


    Image Caption: Image: CC--Emanuele Spies

    Celiac.com 11/09/2017 - Did you know that the precautionary labeling regarding allergies is widely misunderstood, (meaning you are not the only one that is confused!). Not only is the writing so small you need a microscope to read it, this warning is not necessarily listed in the "Ingredients" column.


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    The United States and Canada have different laws concerning allergy labeling. A survey presented in March at the AAAAI Allergists' Conference in Los Angeles reveals that 40 percent of consumers avoiding one or more allergens bought foods manufactured in a facility that also processes allergens.

    Beyond buying habits the researchers also found a lack of awareness of labeling. Another problem occurs with differences in the food laws of our two countries, the United States and Canada. 45 percent of people surveyed were unaware that precautionary warnings are not required by law. In Canada labeling regulations do require manufacturers to clearly indicate if major allergens are ingredients of a product. But there are no legal guidelines on how companies should identify products that may have come into contact with food allergens during manufacturing. As a result, the manufacturers have been choosing their own phrasing for precautionary labels.

    Recently, Health Canada recommended companies limit the advisories to the phrase "may contain", but this is not a legal requirement. A recent study tested 186 products with precautionary peanut labels and found 16, just under nine percent, contained the allergen. A 2009 audit of nearly 100 U.S. supermarkets found that half of all chocolate, candy and cookie products had precautionary labels, many worded in different ways.

    The consequences to allergic consumers ignoring labels have proved tragic. Bruce Kelly, a 22 year old Minnesota man with a peanut allergy, died of anaphylaxis in January after eating chocolate candy with a label that said it had been made in a plat that also processed peanuts. "There are too many different types of wording" says study author Dr. Susan Waserman, a professor of Medicine in the division of allergy and immunology at McMaster University in Hamilton, Ontario. She stated, "Patients assume that differences in wording imply a lower level of risk, which they don't." Gupta and Waserman would like to see precautionary labels reduced to one or two clearly defined phrases. For instance, Gupta says if a "May contain" label meant that the food might have up to 100 milligrams of an allergen, then patients could work with their doctors to find out just how much of their allergen may be safe to consume and purchase foods accordingly. The study noted that research is "underway to develop thresholds" for such labels.

    Meanwhile, we as two neighboring countries need to urge the U.S. Food and Drug Administration and the Canadian FDA to work with foods coming into our countries that have no labeling advisories at all. For example my husband and I picked up Sweet Shoppe candies sold in both countries, but made in Argentina. The Starlight Mints mints sold in the United States list at the very bottom in small print, "Made in facility that also processes peanuts, tree nuts, soya, milk and eggs." The label did not list wheat, at least on the green and white mints. I have eaten the green and white striped mints in the United States and have had no reaction to them (I am very sensitive to gluten), but yesterday my husband crossed the border to the United States and picked up a package of the Starlight Mints with the red and white stripes. The ingredients listed are glucose syrup, sugar, natural flavor, (peppermint) artificial colors, Titanium Dioxide, FD&C red #40, FD&C blue, Sunflower oil, Propylene Glycol. Nowhere on this packaging does it show "gluten-free" or "wheat-free," or the "Cover all Bases" listing of "Made in a facility that processes...".

    I will keep you in touch with my findings, but beware, especially with many of us living close to the U.S./Canada borders that the same products may carry different labeling. It may mean that I am on the internet or calling companies like this one to determine their guidelines for allergy labeling. I am particularly surprised by the United States allowing this Starlight Mint into the country without any "Cover all Bases" type of listing for allergies. Canada often looks to the United States for their guidelines, or rulings for other countries, The researchers at the AAAA1 Allergist' Conference in Los Angeles in March cautions, "In the meantime avoid products with precautionary labels...(i)t still seems to be the best way to maximize safety" says Waserman.

    We have to be pro-active, just like the people struggling with peanut allergies have been for years. They fought the airlines with over serving peanuts to passengers, only to have them substituted for pretzels, which are poison to celiacs. We need to get on the Bandwagon and "unite and fight" until we get the same consideration as those with peanut allergies. Ironically, the peanut folks are now trying to get the same parts per million type labeling that we celiacs won years ago on products that are labeled "gluten-free."

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    Whatever the reason that stuttering has not been reported in the medical literature in association with gluten ingestion, a number of personal disclosures and comments suggesting a connection between gluten and stuttering can be found on the Internet. Abid Hussain, in an article about food allergy and stuttering said: “The most common food allergy prevalent in stutterers is that of gluten which has been found to aggravate the stutter” (10). Similarly, Craig Forsythe posted an article that includes five cases of self-reporting individuals who believe that their stuttering is or was connected to gluten, one of whom also experiences stuttering from foods containing yeast (11). The same site contains one report of a stutterer who has had no relief despite following a gluten free diet for 20 years (11). Another stutterer, Jay88, reports the complete disappearance of her/his stammer on a gluten free diet (12). Doubtless there are many more such anecdotes to be found on the Internet* but we have to question them, exercising more skepticism than we might when reading similar claims in a peer reviewed scientific or medical journal.
    There are many reports in such journals connecting brain and neurological ailments with gluten, so it is not much of a stretch, on that basis alone, to suspect that stuttering may be a symptom of the gluten syndrome. Rodney Ford has even characterized celiac disease as an ailment that may begin through gluten-induced neurological damage (13) and Marios Hadjivassiliou and his group of neurologists and neurological investigators have devoted considerable time and effort to research that reveals gluten as an important factor in a majority of neurological diseases of unknown origin (14) which, as I have pointed out previously, includes most neurological ailments.
    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023