Consumer attitudes and risks associated with packaged foods having advisory labeling regarding the presence of peanuts

Background: Foods with advisory labeling (eg, "may contain") are increasingly prevalent. Consumers with food allergies might ignore advisory labeling advice. Objective: We sought to determine whether consumers with food allergy heeded advisory labels and whether products with advisory labels contained detectable peanut allergen. Methods: Surveys (n = 625 in 2003 and n = 645 in 2006) were conducted at Food Allergy & Anaphylaxis Network patient conferences. Food products bearing advisory statements regarding peanuts were analyzed for the presence of peanut. Results: Consumers were less likely to heed advisory labeling in 2006 (75%) compared with in 2003 (85%, P < .01); behavior varied significantly according to the form of the statement. Peanut protein was detected in 10% (20/200) of total food products bearing advisory statements, although clinically significant levels of peanut (>1 mg of peanut or >0.25 mg of peanut protein) were detected in only 13 of 200 such products. Conclusion: Consumers with food allergy are increasingly ignoring advisory labeling. Because food products with advisory labeling do contain detectable levels of peanuts, a risk exists to consumers choosing to eat such foods. The format of the labeling statement did not influence the likelihood of finding detectable peanut, except for products listing peanuts as a minor ingredient, but did influence the choices of consumers with food allergy. Clinical implications: Allergic patients are taking risks by increasingly disregarding advisory labeling.