Sensitivity analysis to derive a food consumption point estimate for deterministic food allergy risk assessment

Simulated use of thresholds for precautionary allergen labeling: Impact on prevalence and risk

Heterogeneity and overuse of precautionary allergen labelling (PAL) in prepackaged foods have eroded its risk communication efficacy. Experts recommend applying PAL based on allergen concentration thresholds, but adoption remains limited. The aim of this study was to quantitatively assess the potential impact of this approach using Monte Carlo risk simulations. Four allergens and 9 food categories were considered in 2 scenarios: (1) consumption of products currently carrying PAL in Canada where individuals with food allergy (FA) are assumed to consume them, and (2) consumption of products without PAL, in a hypothetical context where PAL is applied based on thresholds that would protect 99 % (ED01) and 95 % (ED05) of individuals with FA, and individuals with FA systematically avoid products with PAL. In scenario (1), although several cases studied would cause <10 reactions/10 000 eating occasions (e.o.), there were also many that would cause >20 reactions/10 000 e.o. Cross-contact milk posed the highest risk (max. 1120 reactions/10 000 e.o.), and peanut, the least (max. 10 reactions/10 000 e.o.). In scenario (2), consumption of products without PAL, when using thresholds for PAL based on ED01, could lead to a maximum of 15 reactions/10 000 e. o. for all studied cases, and based on ED05, to 57 (if excluding dark chocolate with milk PAL). In most cases, the estimated number of reactions per 10 000 e.o. attributed to products with PAL currently on the market would be higher (p < 0.05) than that attributed to products without PAL, if PAL is applied based on the simulated thresholds. Thus, a threshold driven approach to adopt PAL on prepackaged foods, while advising consumers to avoid these products, could be beneficial for individuals with FA in Canada, as products without PAL would result in very few and generally mild adverse reactions.

The 50th percentile of the general population single eating occasion intake of food is optimal for the calculation of action levels for precautionary allergen labelling

Lack of guidance regarding selection of food intake values for allergen risk assessment can lead to different outcomes for similar levels of allergens in food products. Several food consumption survey databases (United States, North-West Europe, and Netherlands) were analyzed to identify optimal food intake percentiles using a sensitivity analysis. Deterministic risk assessment scenarios using the 50th percentile up to the maximum intake per food group were compared with probabilistic risk assessment outcomes. The optimal intake percentile is the lowest percentile that results in a deterministic risk assessment outcome compliant with the predefined safety objective, i.e., the predefined risk of an objective allergic reaction at ED01, ED2.5, ED05 or ED10 doses of 14 allergenic foods. The P50 intake met these criteria in more than 99.9% of all 28,784 scenarios tested. The P50 is therefore recommended for deterministic allergen risk assessment and calculation of action levels for precautionary allergen labelling. In case a P50 value is not available, the mean is a good alternative, as analyses of the intake data showed that the mean generally is between the P50 and P65.

Secure Food-Allergen Determination by Combining Smartphone-Based Raw Image Analyses and Liquid Chromatography-Mass Spectrometry for the Quantification of Proteins Contained in Lateral Flow Assays

The current food safety testing system, based on laboratory-based quantification, is difficult to scale up in line with the growth in the export market and does not enable traceability through the nodes of the food supply system. Screening assays, for example, lateral flow assays (LFAs), can improve traceability but often lack the required reliability to guarantee compliance. Here, we present an alternative pipeline for secure on-site compliance testing, using allergens as a case study. The pipeline features smartphone-driven LFA quantification and an liquid chromatography-mass spectrometry (LC-MS) method enabling direct quantification of the allergens contained in the LFA. The system enables swift and objective screening and provides a control measure to verify LFA assay reliability. For the smartphone assay, 8-bit RGB and grayscale colorimetric channels were compared with 16-bit raw intensity values. The latter outperformed RGB and grayscale channels in sensitivity, repeatability, and precision, while ratiometric ambient light correction resulted in excellent robustness for light-intensity variation. Calibration curves for peanut determination using two commercial LFAs featured excellent analytical parameters (R² = 0.97-0.99; RSD 7-1%; LOD 3-7 ppm). Gluten determination with a third commercial LFA was equally established. A prediction error of 13 ± 11% was achieved for the best performing assay. Good performance-calibration curves (R² = 0.93-0.99) and CVs (<15%)- were observed for the analyte quantification from the LFA by LC-MS. The LOD for the LC-MS assay was 0.5 ppm, well below the LODs reported for the LFAs. This method creates a digital, fast, and secure food safety compliance testing paradigm that can benefit the industry and consumer alike.

A Chinese-Specific Reference Amounts Study With TNO Food Allergen Risk Assessment Models - China, 2022

What is already known about this topic?

There are no consistent regulations on possible unintended allergen presence in food. The Netherlands Organization for Applied Scientific Research (TNO) has been committed to developing a quantitative risk assessment methodology for the unintentional intake of allergens.

What is added by this report?

This study aims to derive the optimal food consumption point for a deterministic food allergy risk assessment under the TNO framework based on Chinese national consumption data. A case study has been presented as an illustration.

What are the implications for public health practice?

A robust evidence-based food consumption input in quantitative risk assessment of unintended allergens is necessary for future public policy on Precautionary Allergen Labeling for specific products to meet the safety objectives and to be adequately conservative.

Targeted proteomics for rapid and robust peanut allergen quantification

This study improves LC-MS-based trace level peanut allergen quantification in processed food by refining method robustness, total analysis time and method sensitivity. Extraction buffer (six compared) and peptide choice were optimised and found to profoundly affect method robustness. A rapid extraction and in-solution digestion method was developed omitting subsequent reduction, alkylation and sample clean-up steps effectively reducing total analysis time from the previously reported ∼5.5-20 h to ∼2.5 h. For the three best performing peptides, accurate quantification (CVs < 15%) with matrix-matched calibration curves (R² = 0.99-0.97) was achieved for peanut muffin and ice-cream with excellent linearity (0.25-1000 mg kg^-1). The best performing peptide enabled excellent recovery rates in ice-cream (106.0 ± 15.1%) and peanut muffin (72.7 ± 13.4%). Sensitivity (LOD = 0.25-0.5 mg kg^-1; LOQ = 0.5-1.0 mg kg^-1) was 2- to 20-fold improved compared to previous methods depending on the peptide. These methodological improvements contribute to robust peanut detection in food and can be translated to additional food-borne allergens.

Using data from food challenges to inform management of consumers with food allergy: A systematic review with individual participant data meta-analysis

BACKGROUND

Eliciting doses (EDs) (eg, ED01 or ED05 values, which are the amounts of allergen expected to cause objective symptoms in 1% and 5% of the population with an allergy, respectively) are increasingly being used to inform allergen labeling and clinical management. These values are generated from food challenge, but the frequency of anaphylaxis in response to these low levels of allergen exposure and their reproducibility are unknown.

OBJECTIVE

Our aim was to determine (1) the rate of anaphylaxis in response to low-level peanut exposure and (2) the reproducibility of reaction thresholds (and anaphylaxis) at food challenge.

METHODS

We conducted a systematic review and individual participant data meta-analysis of studies that reported at least 50 individuals with peanut allergy reacting to peanut at double-blind, placebo-controlled food challenge (DBPCFC) and were published between January 2010 and September 2020. Risk of bias was assessed by using National Institute for Clinical Excellence methodologic checklists.

RESULTS

A total of 19 studies were included (covering a total of 3151 participants, 534 of whom subsequently underwent further peanut challenge). At individual participant data meta-analysis, 4.5% (95% CI, 1.9% to 10.1%) of individuals reacted to 5 mg or less of peanut protein with anaphylaxis (moderate heterogeneity [I2 = 57%]). Intraindividual thresholds varied by up to 3 logs, although this variation was limited to a half-log change in 71.2% (95% CI, 56.2% to 82.6%) of individuals. In all, 2.4% (95% CI, 1.1% to 5.0%) of patients initially tolerated 5 mg of peanut protein but then reacted to this dose at subsequent challenge (low heterogeneity [I2 = 16%]); none developed anaphylaxis.

CONCLUSION

Around 5% of individuals reacting to an ED01 or ED05 level of exposure to peanut might develop anaphylaxis in response to that dose. This equates to 1 and 6 anaphylaxis events per 2500 patients exposed to an ED01 or ED05 dose, respectively, in the broader population of individuals with peanut allergy.

Full range of population Eliciting Dose values for 14 priority allergenic foods and recommendations for use in risk characterization

Previously, we published selected Eliciting Dose (ED) values (i.e. ED01 and ED05 values) for 14 allergenic foods, predicted to elicit objective allergic symptoms in 1% and 5%, respectively, of the allergic population (Remington et al., 2020). These ED01 and ED05 values were specifically presented and discussed in the context of establishing Reference Doses for allergen management and the calculation of Action Levels for Precautionary Allergen Labeling (PAL). In the current paper, we publish the full range of ED values for these allergenic foods and provide recommendations for their use, specifically in the context of characterizing risks of concentrations of (unintended) allergenic proteins in food products. The data provided in this publication give risk assessors access to full population ED distribution information for 14 priority allergenic foods, based on the largest threshold database worldwide. The ED distributions were established using broad international consensus regarding suitable datapoints and methods for establishing individual patient's NOAELs and LOAELs and state of the art statistical modelling. Access to these ED data enables risk assessors to use this information for state-of-the-art food allergen risk assessment. This paper contributes to a harmonization of food allergen risk assessment and risk management and PAL practices.

Evidence-based approaches to the application of precautionary allergen labelling: Report from two iFAAM workshops

Food allergy is a major public health concern with avoidance of the trigger food(s) being central to management by the patient. Food information legislation mandates the declaration of allergenic ingredients; however, the labelling of the unintentional presence of allergens is less defined. Precautionary allergen labelling (PAL) was introduced by the food industry to help manage and communicate the risk of reaction from the unintended presence of allergens in foods. In its current form, PAL is counterproductive for consumers with food allergies as there is no standardized approach to applying PAL. Foods with a PAL often do not contain the identified food allergen while some products without a PAL contain quantities of common food allergens that are capable of inducing an allergic reaction. Integrated Approaches to Food Allergen and Allergy Risk Management (iFAAM) was an EU-funded project that aimed to improve the management of food allergens by the food industry for the benefit of people with food allergies. Within iFAAM, a clinically validated tiered risk assessment approach for food allergens was developed. Two cross-stakeholder iFAAM workshops were held on 13-14 December 2016 and 19-20 April 2018. One of the objectives of these workshops was to develop a proposal to make PAL effective for consumers. This paper describes the outcomes from these workshops. This provides the basis for the development of more informative and transparent labelling that will ultimately improve management and well-being in consumers with food allergy.

Probabilistic carcinogenic and non-carcinogenic risk assessment of heavy metal ingestion through consumption of different walnut cultivars: An Iranian study

The heavy metal levels in six walnut cultivars from five geographical zones of Iran were measured. An assessment of risks was conducted by calculating the Target Hazard Quotient (THQ) and Incremental Lifetime Cancer Risk (ILCR) by use of the Monte Carlo simulation method. The highest amounts of As and Pb were reported in Farouj samples. Also, the highest levels of Cr, Zn, Cu and Mn were determined in samples collected from Tuyserkan. Accordingly, 50th and 95th ILCRs for general population due to consumption of walnut were 1.03 × 10^-4 and 3.11 × 10^-4 (for As), 4.10 × 10^-6 and 1.1 × 10^-5 (for Cr) and 4.71 × 10^-9 and 1.05 × 10^-8 (for Pb), respectively. In addition, the 50th and 95th centiles of the HIs for walnut ingestion by Iranians were 1.02 and 2.05, respectively, indicating a minor chance of non-cancer effects. Based on the calculated 95% ILCR, dietary exposure to As through the consumption of walnut poses a risk to Iranian consumer health. However, ILCR values of other heavy metals (HMs) were in acceptable ranges (ILCR < 1 × 10^-4), representing no toxicological concern for consumers. The most significantly influential parameters were determined by sensitivity analysis during the MCS. According to THQ and ILCR methods, concentration was the most sensitive parameters. For THQ method the concentration effects were ranged from 72.4 to 85.1%. Moreover, for ILCR method the effects of concentration in As, Cr, and Pb were 87.1, 79.1 and 83.54%, respectively.