Methodology - Understanding international provision of allergen information

A mixed-methods approach was used to deliver this project, including a rapid evidence assessment for our literature and data review, and fieldwork to conduct stakeholder interviews, as well as a co-production panel review with our advisor and members of Allergy UK and the FSA. The project was divided into three work-packages, as follows: 

• searching, screening and extracting of information from the literature to trace legislation and trends in deaths and incident data per country (section 4.1)
• Conducting fieldwork with stakeholders through one-to-one interviews to consolidate on findings and gaps from the literature review (section 4.2)
• synthesising, triangulating, and reporting evidence into a final report (section 4.3)

There were 18 countries within scope for this work, including UK, Republic of Ireland, Netherlands, Belgium, Denmark, Norway, Germany, Lithuania, Sweden, Switzerland, Australia, Canada, India, Malta, New Zealand, Philippines, South Africa, and US. However, depending on the geography covered by the literature, we extended this to also include the EU and global region.

4.1 Literature search, screening and data extraction

A literature search was performed using several strategies, including:

• purposive searches ^{(footnote 1)} of legislation, data registries for food allergy related deaths and incidents, unpublished studies, evaluations, and media reports using the search terms in Appendix A
• a targeted search (as per the search terms in Appendix B) of two academic databases - Web of Science and SCOPUS
• a call for evidence amongst our FSA panel of experts and advisors

Figure 1 PRISMA style reporting of records at each stage of screening

Altogether, the searches resulting a longlist of N = 632 titles which were rigorously screened as detailed in Figure 1. This resulted in a shortlist of 56 articles as listed in Appendix C. At each stage, two reviewers were involved in screening and any discrepancies were resolved through discussion and consensus development.

4.2 Interviews

13 interviews were conducted with national and international stakeholders to consolidate findings from the literature review. We had two objectives for interviews – to build upon literature review findings and to address gaps in the literature. The interviews were conducted remotely on a one-to-one basis via Microsoft Teams. These included stakeholders from four categories: (a) consumers with FHS and patient advocates, (b) academic researchers working within the field of FHS, (c) enforcement authorities or policymakers, and (d) FBOs and trade bodies. Table 2 provides information on the number of interviewees per category as well the country they represented. We had difficulties recruiting interview participants specifically from enforcement officers outside of the UK and FBOs within or beyond the UK, despite a large outreach attempt through emails sent via RSM, FSA and our advisors as detailed in Table 2. For the topic guides used to facilitate the interviews, please see Appendix D.

Table 2 Mapping of interviewees in terms of their categories and countries

4.3 Analysis and reporting

Findings from the literature review and interviews were triangulated and summarised, guided by the five themes of this research based on the study aims: 

1. Non-prepacked legislation
2. Trends in related deaths or incidents
3. Enforcement process and capabilities
4. Consequences of non-compliance
5. What works (or may work) for whom and why