What the Mia St Hilaire inquest reveals about allergen safety in UK food inspections 

The inquest into the death of Mia Shay St Hilaire has brought renewed attention to the serious gaps in the way allergen safety is assessed, monitored and enforced across the food industry. 

The evidence heard at the inquest points to a broader issue: does the current inspection system provide sufficient allergen protection? Local authorities assess allergen information and cross-contamination under two separate inspections. This means there is no single check that looks at allergen risk as a whole, and a five-star hygiene rating may not tell customers what they think it does.

For people living with food allergies, clear information, effective staff training, and robust controls against cross-contamination are essential safeguards. The question now is whether the regulatory framework is clear and consistent enough to ensure those safeguards are in place. 

Why is the current food inspection system fragmented?

Food businesses are inspected by local authorities under two separate regulatory frameworks set out within the Food Law Code of Practice issued by the Food Standards Agency (FSA).

1. Food hygiene inspections focus on matters such as cleanliness, contamination risks and food handling practices. This is how food hygiene ratings are assessed and displayed at food premises. 

2. Food standards inspections assess matters such as product quality, composition, labelling and presentation. Unlike hygiene ratings, food standards scores are primarily used as an internal risk assessment tool.

Under the current framework, allergen cross-contamination is generally considered within food hygiene inspections, while allergen information provided to consumers falls within food standards inspections. This separation creates a confusing picture for both businesses and consumers alike.

A customer seeing a five-star hygiene rating may reasonably assume that all aspects of allergen management have been fully assessed and controlled, when in reality, serious allergen-related issues may go unaddressed because they are considered within the separate food standards regime.

Equally, a five-star hygiene rating may give businesses confidence that their food safety arrangements are satisfactory overall, even though allergen management is not assessed within a single, dedicated framework.

What is an allergen matrix?

One of the most striking issues raised during the inquest concerned the lack of an allergen matrix.

An allergen matrix records which allergens are present in food products and enables businesses to provide accurate information to customers.

While there is currently no legal requirement for food businesses to maintain a written allergen matrix, businesses must nevertheless be able to provide accurate allergen information to consumers for all the items on their menu.

This raises an important question: how can food businesses consistently provide accurate allergen information if there is no requirement to maintain a clear written record of allergens present in their products?

In Mia’s case, the absence of an allergen matrix was identified during a 2020 inspection. However, the issue was considered minor and did not result in any follow-up action.

What reforms are needed?

Mia’s death has highlighted the need for a clearer, more coherent and more consistent approach to allergen regulation. The Food Standards Agency and other regulatory bodies are being urged to reconsider this framework and introduce dedicated allergen safety assessments within the food inspection system.

Such reforms should: 

• Bring allergen information, allergen management and allergen cross-contamination together within a single framework.

• Introduce a publicly available allergen rating so consumers can make informed choices.

• Provide training for all local authority inspectors to ensure they carry out effective and robust inspections.

A more joined-up approach would help ensure that allergen risks are not treated as secondary to other food safety concerns, but are assessed with the same seriousness, consistency and transparency.

Mia’s legacy: what this means for people living with food allergies

What emerged from the inquest was not simply a question of individual practice, but of whether the systems designed to identify and address allergen risks are strong enough to prevent avoidable harm.

Strengthening allergen regulation would provide clearer expectations for food businesses, more consistent assessments by local authorities and greater confidence for customers who need reliable allergy information before deciding where and what to eat.

This case underlines the importance of moving from fragmented oversight to a system that recognises allergen safety as a distinct and vital part of food regulation.

For the millions of people in the UK living with food allergies, confidence in allergen information is not a matter of convenience. It can be a matter of life and death. Real change would mean they can trust the allergen information they receive every time they eat out.