A Seattle family's summer camping trip barely escaped tragedy last year after their highly allergic 7-year-old ate a mislabeled snack food that could have cost her her life—an alarming example of what food safety experts say are growing reports of undeclared allergens that can lead to potentially serious harm.
Isabelle Thomelin bit into what she thought were chocolate-covered banana pieces, only to realize too late that they were actually chocolate-covered walnuts.
"She comes racing back to the camp and she's saying, 'I had a nut! I had a nut!'" said Toni Thomelin, Isabelle's mother, recalling the July 2013 scare.
Within minutes, the girl diagnosed as a toddler with a severe tree nut allergy developed hives around her mouth and began having trouble breathing. The family was camped at a rural site near Washington state's Grand Coulee Dam, miles from any hospital, but her parents hustled Isabelle and her sister into the car and started racing toward the nearest emergency room.
"It took us almost 20 minutes and spotty cell phone service," recalled Toni Thomelin, 41, a technology industry worker. "We were out of cell phone range and I was trying to call an ambulance."
Five hours and a dose of steroids later, Isabelle recovered, but the memory still haunts the now-8-year-old girl.
"It was a pretty traumatic event for her," Toni Thomelin said. "She was eating something she thought was safe, something she'd eaten before. It never dawned on us that something could be completely mispackaged."
In fact, many foods that U.S. consumers routinely buy have the potential to be mispackaged—and dangerous, food safety experts say. The most common food recalls in the U.S. aren't for salmonella, listeria or other pathogens. Instead, they're for eight undeclared allergens—milk, egg, peanuts, soy, fish, crustacean shellfish, wheat and tree nuts—that accidentally get into foods because of manufacturing errors.
No one keeps tabs on how many injuries or deaths have been caused by undeclared allergens, but Food and Drug Administration researchers found dozens of reactions associated with recalls reported from 2005 to 2010—and 10 percent to 15 percent of such reactions are severe and can lead to death if untreated.
There have been nearly 70 such recalls so far this year, including an announcement last week that Ocean Spray, the top maker of dried cranberries, is recalling two production lots of its Greek Yogurt Covered Craisins because the snacks may contain peanuts instead.
"This is one of our worst nightmares!" Toni Thomelin said. "Covered with yogurt, never would we expect the inside to be a peanut."
For the up to 15 million people across the country who suffer from food allergies, such mistakes can be life-threatening, said John L. Lehr, chief executive of the advocacy group Food Allergy Research and Education, or FARE.
"Undeclared allergens are definitely a source of concern because they can have serious consequences," he said. "Every three minutes, someone is being taken to the emergency room for a food allergy reaction."
And such recalls are growing, government researchers say. Between 2005 and 2010, there were 1,637 food recalls in the U.S., including 520 for undeclared allergens, or 31 percent. When FDA officials checked again last year, using the agency's Reportable Food Registry database, undeclared allergens accounted for 44 percent of the recalls.
And those are the equivalent of Class I recalls, the most dangerous type, where there is a likelihood of serious adverse events for allergic consumers. In the 2005 to 2010 study, 64 of the allergen recalls resulted in reactions that affected 96 people.
Ten percent to 15 percent of such allergic reactions are severe or result in anaphylaxis, a severe, full-body reaction that can lead to death within minutes if left untreated. "Alarmingly, two-thirds or more of these cases involved children," FDA researchers wrote.
And those are only the reported reactions. There's no universal monitoring system for allergic reactions in the U.S. and emergency department reports often fail to say whether such problems are caused by food, said Steven Gendel, the FDA's food allergen coordinator.
Consumers often think of peanuts as the top allergen, perhaps because of growing discussion about topics like peanut-free lunch tables and allergy bullying in schools—and because the number of allergic kids in the U.S. jumped by 50 percent between 1997 and 2011, according to the Centers for Disease Control and Prevention.
But milk is actually the chief cause of reactions from undeclared allergens, FDA researchers say. Milk can make its way into many foods in many forms, with disastrous results.
"A trace amount of milk can lead to a very serious reaction," Lehr said.
The only way to prevent allergic reactions is to avoid them entirely, said Dr. Stephen A. Tilles, an asthma and allergy specialist in Seattle. And the only way to treat them is with a dose of epinephrine—a so-called EpiPen—which counteracts the allergen quickly. Undeclared allergens pose a far smaller problem than outright mistakes—eating foods made with known triggers. Still, they're dangerous, Tilles said.
"Especially in these families that have done a good job of avoiding allergens, it's easy to be caught off guard," he said, noting that he advises families to have an allergy emergency plan in place, including practicing using the EpiPen.
The key to avoiding undeclared allergens is to understand that they occur—and to be looped into particular product recalls. FARE reaches about 120,000 people through its system of email alerts, and others subscribe to recall notices offered by the FDA and the U.S. Department of Agriculture's Food Safety and Inspection Service. But those sources cover just a fraction of people who could potentially be exposed to hundreds of foods laced with undeclared allergens each year.
The risks that allergens pose in food was formally recognized in 2004, when Congress passed the Food Allergen Labeling and Consumer Protection Act, or FALCPA, which requires product labels to declare if they include one of the "Big Eight" allergens. But the law doesn't stop mistakes from happening, said Steve L. Taylor, professor and co-director of the Food Allergy Research and Resource Program at the University of Nebraska-Lincoln.
"The major reason for recalls is putting the wrong product in the box or container," he said. "You make a mistake and you put the peanut butter granola bars in the oatmeal granola bar box. That could be a pretty serious situation."
The FDA is bolstering existing rules with new ones that specifically target allergens under the new Food Safety Modernization Act, or FSMA.
Often it's the situation seen with the yogurt-coated Craisins, which were produced by a separate co-packer, a bulk packager that doesn't actually make the foods, according to Ocean Spray. The products were packed by machines that failed to differentiate between yogurt-covered dried cranberries and yogurt-covered peanuts.
Companies frequently learn of the problem when a consumer alerts them—or reports a reaction, Taylor said. Three people complained about finding peanuts in the Ocean Spray snacks, but there were no reports of allergic reactions, a company spokeswoman said.
Large companies like Ocean Spray make headlines with allergen recalls, but it's the many small firms with problems that pose more of a threat, Taylor added. They're often less stringent about preventing contamination and when problems occur, consumers are less likely to hear about them.
It was a co-packer's error that led to the chocolate-covered walnuts in Isabelle Thomelin's treats.
Kristain Stone, a spokeswoman for Tropical Valley Foods, the small Plattsburgh, New York, firm that made the Next by Nature Dark Chocolate Bananas that Isabelle ate, told NBC News the firm switched to hand-packing after the incident.
The banana products were recalled on May 16, 2013, but they were still on local store shelves two months later when the Thomelins stocked up on snacks for camp. Getting recalled foods properly off the market is yet another problem, food safety officials say.
"It is very scary. You feel very out of control," Toni Thomelin said. "Now we avoid chocolate-covered anything, of course. You don't really know what you're biting into."
—By Jonel Aleccia for NBC News