1
|
Turner PJ, Bognanni A, Arasi S, Ansotegui IJ, Schnadt S, La Vieille S, Hourihane JO, Zuberbier T, Eigenmann P, Ebisawa M, Morais-Almeida M, Barnett J, Martin B, Monaci L, Roberts G, Wong G, Gupta R, Tsabouri S, Mills C, Brooke-Taylor S, Bartra J, Levin M, Groetch M, Tanno L, Hossny E, Weber BB, Fierro V, Remington B, Gerdts J, Gowland MH, Chu D, Van Ravenhorst M, Koplin J, Fiocchi A. Time to ACT-UP: Update on precautionary allergen labelling (PAL). World Allergy Organ J 2024; 17:100972. [PMID: 39381624 PMCID: PMC11459638 DOI: 10.1016/j.waojou.2024.100972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/30/2024] [Accepted: 08/30/2024] [Indexed: 10/10/2024] Open
Abstract
Background Precautionary Allergen ("may contain") Labelling (PAL) is used by industry to communicate potential risk to food-allergic individuals posed by unintended allergen presence (UAP). In 2014, the World Allergy Organization (WAO) highlighted that PAL use was increasing, but often applied inconsistently and without regulation - which reduces its usefulness to consumers with food allergy and those purchasing food for them. WAO proposed the need for a regulated, international framework to underpin application of PAL. In 2019, the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) of the United Nations convened an expert consultation to address the issue of PAL, the outputs of which are now being considered by the Codex Committee on Food Labelling (CCFL). Objectives To summarise the latest data to inform the application of PAL in a more systematic way, for implementation into global food standards. Methods A non-systematic review of issues surrounding precautionary labelling and food allergens in pre-packaged products. Results Approximately, 100 countries around the world have legislation on the declaration of allergenic ingredients. Just a few have legislation on UAP. Given the risks that UAP entails, non-regulated PAL creates inconvenience in real life due to its unequal, difficult interpretation by patients. The attempts made so far to rationalize PAL present lights and shadows. Conclusions At a time when CCFL is considering the results of the FAO/WHO Expert Consultation 2020-2023, we summarise the prospects to develop an effective and homogeneous legislation at a global level, and the areas of uncertainty that might hinder international agreement on a regulated framework for PAL of food allergens.
Collapse
Affiliation(s)
- Paul J. Turner
- National Heart & Lung Institute, Imperial College London, London,
UK
| | - Antonio Bognanni
- Department of Health Research Methods, Evidence, and Impact, McMaster
University, Hamilton, ON, Canada
- Clinical Epidemiology and Research Center (CERC), Humanitas University
& Humanitas Research Hospital, Via Rita Levi Montalcini 4, 20090 Pieve
Emanuele, Milano, Italy
- Department of Medicine, Evidence in Allergy Group, McMaster University,
Hamilton, ON, Canada
| | - Stefania Arasi
- Allergy Unit, Pediatric Hospital Bambino Gesù IRCCS, Rome,
Italy
| | | | - Sabine Schnadt
- Deutscher Allergie- und Asthmabund (DAAB), Moenchengladbach D,
Germany
| | - Sébastien La Vieille
- Food Directorate, Health Canada, Ottawa, ON, Canada
- Food Science Department, Laval University, Québec, QC, Canada
| | - Jonathan O’B. Hourihane
- Paediatrics and Child Health, Royal College of Surgeons Ireland, Dublin,
Ireland
- Children's Health Ireland, Dublin, Ireland
| | | | | | | | | | | | - Bryan Martin
- Medicine and Pediatrics, The Ohio State University in Columbus, Columbus,
OH, USA
| | - Linda Monaci
- Institute of Sciences of Food Production, National Research Council
(ISPA-CNR), Bari, Italy
| | | | - Gary Wong
- The Chinese University of Hong Kong, Hong Kong, PR China
| | - Ruchi Gupta
- Northwestern University, Chicago, IL, USA
- Food Allergy Research & Education (FARE), McLean, VA, USA
| | - Sophia Tsabouri
- EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) and Child
Health Department, University of Ioannina School of Medicine, Ioannina,
Greece
| | | | | | - Joan Bartra
- Allergy Department, Hospital Clinic and IDIBAPS. Universitat de
Barcelona, Spain
- RICORS de Enfermedades Inflamatorias (ISCIII), Madrid, Spain
| | - Michael Levin
- Division of Paediatric Allergy, Department of Paediatrics and Child
Health, University of Cape Town, Cape Town, South Africa
| | - Marion Groetch
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Elham Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital,
Ain Shams University, Cairo, Egypt
| | - Barbara Ballmer Weber
- Department of Dermatology, University Hospital Zürich, Zürich,
Switzerland and Clinic for Dermatology and Allergology, Kantonsspital St.
Gallen, St. Gallen, Switzerland
| | - Vincenzo Fierro
- Allergy Unit, Pediatric Hospital Bambino Gesù IRCCS, Rome,
Italy
| | - Ben Remington
- Food Allergy Research and Resource Program, Department of Food Science
and Technology, University of Nebraska, Lincoln, NE, USA
- Remington Consulting Group B.V, Utrecht, the Netherlands
| | | | | | - Derek Chu
- Department of Health Research Methods, Evidence, and Impact, McMaster
University, Hamilton, Ontario, Canada
- Department of Medicine, Evidence in Allergy Group, McMaster University,
Hamilton, Ontario, Canada
| | | | - Jennifer Koplin
- Child Health Research Centre, University of Queensland, Brisbane,
Queensland, Australia
- Centre for Food and Allergy Research, Melbourne, Victoria,
Australia
| | | | - World Allergy Organization Consensus on the Use of PAL (ACT-UP!) Working
Group
- National Heart & Lung Institute, Imperial College London, London,
UK
- Department of Health Research Methods, Evidence, and Impact, McMaster
University, Hamilton, ON, Canada
- Clinical Epidemiology and Research Center (CERC), Humanitas University
& Humanitas Research Hospital, Via Rita Levi Montalcini 4, 20090 Pieve
Emanuele, Milano, Italy
- Department of Medicine, Evidence in Allergy Group, McMaster University,
Hamilton, ON, Canada
- Allergy Unit, Pediatric Hospital Bambino Gesù IRCCS, Rome,
Italy
- Hospital Quironsalud Bizkaia, Bilbao, Spain
- Deutscher Allergie- und Asthmabund (DAAB), Moenchengladbach D,
Germany
- Food Directorate, Health Canada, Ottawa, ON, Canada
- Food Science Department, Laval University, Québec, QC, Canada
- Paediatrics and Child Health, Royal College of Surgeons Ireland, Dublin,
Ireland
- Children's Health Ireland, Dublin, Ireland
- Charite University, Berlin, Germany
- Pediatric Allergy Unit, University of Geneva, Switzerland
- Sagamihara National Hospital, Sagamihara, Japan
- Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal
- Department of Psychology, University of Bath, UK
- Medicine and Pediatrics, The Ohio State University in Columbus, Columbus,
OH, USA
- Institute of Sciences of Food Production, National Research Council
(ISPA-CNR), Bari, Italy
- University Hospital Southampton, Southampton, UK
- The Chinese University of Hong Kong, Hong Kong, PR China
- Northwestern University, Chicago, IL, USA
- Food Allergy Research & Education (FARE), McLean, VA, USA
- EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) and Child
Health Department, University of Ioannina School of Medicine, Ioannina,
Greece
- University of Manchester, Manchester, UK
- Brooke-Taylor & Co Pty Ltd, Milawa, Victoria, Australia
- Allergy Department, Hospital Clinic and IDIBAPS. Universitat de
Barcelona, Spain
- RICORS de Enfermedades Inflamatorias (ISCIII), Madrid, Spain
- Division of Paediatric Allergy, Department of Paediatrics and Child
Health, University of Cape Town, Cape Town, South Africa
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Sanas Epidemiology and Research, Sao Paulo, Brazil
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital,
Ain Shams University, Cairo, Egypt
- Department of Dermatology, University Hospital Zürich, Zürich,
Switzerland and Clinic for Dermatology and Allergology, Kantonsspital St.
Gallen, St. Gallen, Switzerland
- Food Allergy Research and Resource Program, Department of Food Science
and Technology, University of Nebraska, Lincoln, NE, USA
- Remington Consulting Group B.V, Utrecht, the Netherlands
- Food Allergy Canada, Toronto, Ontario, Canada
- Allergy Action, St Albans, UK
- Department of Health Research Methods, Evidence, and Impact, McMaster
University, Hamilton, Ontario, Canada
- Department of Medicine, Evidence in Allergy Group, McMaster University,
Hamilton, Ontario, Canada
- Allergenen Consultancy BV, Scherpenzeel (Gld), the
Netherlands
- Child Health Research Centre, University of Queensland, Brisbane,
Queensland, Australia
- Centre for Food and Allergy Research, Melbourne, Victoria,
Australia
| |
Collapse
|
2
|
Lizée K, Dominguez S, Théolier J, La Vieille S, Godefroy SB. Simulated use of thresholds for precautionary allergen labeling: Impact on prevalence and risk. Heliyon 2024; 10:e33316. [PMID: 39035549 PMCID: PMC11259825 DOI: 10.1016/j.heliyon.2024.e33316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/23/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Kamila Lizée
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - Silvia Dominguez
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - Jérémie Théolier
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - Sébastien La Vieille
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
- Health Canada, Food Directorate, 251 Sir Frederick Banting Driveway, Ottawa, Ontario, K1A 0K9, Canada
| | - Samuel B. Godefroy
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| |
Collapse
|
3
|
Schaible A, Kabourek J, Elverson W, Venter C, Cox A, Groetch M. Precautionary Allergen Labeling: Avoidance for All? Curr Allergy Asthma Rep 2024; 24:81-94. [PMID: 38270804 DOI: 10.1007/s11882-024-01129-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE OF REVIEW Precautionary allergen labeling (PAL) suggests the risk of unintended allergen presence (UAP) in food but is unregulated in most countries and inconsistently applied by food manufacturers. This review evaluates the current use of PAL, its relevance to allergic consumers, and weighs possible advantages and disadvantages of avoiding products with PAL. RECENT FINDINGS In most countries, manufacturers are free to decide whether, when, and how to apply PAL resulting in inconsistencies and consumer confusion. Patients with food allergy often interpret PAL incorrectly and without guidance from their health care providers. Health care providers are also prone to misinterpreting PAL, indicating a need for better education. Consumers desire guidance on whether to avoid products with PAL or not. Until further regulatory guidance is available, shared decision-making between patient and provider is required to offer individualized, rather than one-size-fits-all, approaches to PAL.
Collapse
Affiliation(s)
- Allison Schaible
- Division of Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1198, New York, NY, 10029, USA
| | - Jamie Kabourek
- Food Allergy Research and Resource Program, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Wendy Elverson
- Department of Clinical Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Carina Venter
- Section of Pediatric Allergy and Immunology, University of Colorado, Children's Hospital Colorado, Denver, Co, USA
| | - Amanda Cox
- Division of Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1198, New York, NY, 10029, USA
| | - Marion Groetch
- Division of Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1198, New York, NY, 10029, USA.
| |
Collapse
|
4
|
Yan Y, Li L, Long C, Dong Y, Li J, Shen C, Zhao Y, Zhao J, Wang J, Xiong A, Li X, Chen H, He S. A novel IgE epitope-specific antibodies-based sandwich ELISA for sensitive measurement of immunoreactivity changes of peanut allergen Ara h 2 in processed foods. Front Nutr 2024; 11:1323553. [PMID: 38439921 PMCID: PMC10910080 DOI: 10.3389/fnut.2024.1323553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Background Peanut is an important source of dietary protein for human beings, but it is also recognized as one of the eight major food allergens. Binding of IgE antibodies to specific epitopes in peanut allergens plays important roles in initiating peanut-allergic reactions, and Ara h 2 is widely considered as the most potent peanut allergen and the best predictor of peanut allergy. Therefore, Ara h 2 IgE epitopes can serve as useful biomarkers for prediction of IgE-binding variations of Ara h 2 and peanut in foods. This study aimed to develop and validate an IgE epitope-specific antibodies (IgE-EsAbs)-based sandwich ELISA (sELISA) for detection of Ara h 2 and measurement of Ara h 2 IgE-immunoreactivity changes in foods. Methods DEAE-Sepharose Fast Flow anion-exchange chromatography combining with SDS-PAGE gel extraction were applied to purify Ara h 2 from raw peanut. Hybridoma and epitope vaccine techniques were employed to generate a monoclonal antibody against a major IgE epitope of Ara h 2 and a polyclonal antibody against 12 IgE epitopes of Ara h 2, respectively. ELISA was carried out to evaluate the target binding and specificity of the generated IgE-EsAbs. Subsequently, IgE-EsAbs-based sELISA was developed to detect Ara h 2 and its allergenic residues in food samples. The IgE-binding capacity of Ara h 2 and peanut in foods was determined by competitive ELISA. The dose-effect relationship between the Ara h 2 IgE epitope content and Ara h 2 (or peanut) IgE-binding ability was further established to validate the reliability of the developed sELISA in measuring IgE-binding variations of Ara h 2 and peanut in foods. Results The obtained Ara h 2 had a purity of 94.44%. Antibody characterization revealed that the IgE-EsAbs recognized the target IgE epitope(s) of Ara h 2 and exhibited high specificity. Accordingly, an IgE-EsAbs-based sELISA using these antibodies was able to detect Ara h 2 and its allergenic residues in food samples, with high sensitivity (a limit of detection of 0.98 ng/mL), accuracy (a mean bias of 0.88%), precision (relative standard deviation < 16.50%), specificity, and recovery (an average recovery of 98.28%). Moreover, the developed sELISA could predict IgE-binding variations of Ara h 2 and peanut in foods, as verified by using sera IgE derived from peanut-allergic individuals. Conclusion This novel immunoassay could be a user-friendly method to monitor low level of Ara h 2 and to preliminary predict in vitro potential allergenicity of Ara h 2 and peanut in processed foods.
Collapse
Affiliation(s)
- Yan Yan
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Liming Li
- Department of Dermatology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Caiyun Long
- Department of Laboratory, Ganzhou Center for Disease Control and Prevention, Ganzhou, China
| | - Yaping Dong
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Jinyu Li
- Department of Dermatology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Caiyi Shen
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Yiqian Zhao
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Jiangqiang Zhao
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Jianbin Wang
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Anqi Xiong
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Xin Li
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang, China
| | - Hongbing Chen
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang, China
| | - Shengfa He
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
- Key Laboratory of Environment and Health of Ganzhou, Gannan Medical University, Ganzhou, China
| |
Collapse
|
5
|
Precautionary allergen labeling: Current communication problems and potential for future improvements. Food Control 2023. [DOI: 10.1016/j.foodcont.2022.109561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
6
|
Versluis A, Le TM, Houben GF, Knulst AC, Van Os-Medendorp H. Accidental allergic reactions to food in adolescents and adults: An overview of the factors involved and implications for prevention. FRONTIERS IN ALLERGY 2023; 4:1062049. [PMID: 36970066 PMCID: PMC10036762 DOI: 10.3389/falgy.2023.1062049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
Accidental allergic reactions to food are one of the major problems in adult patients diagnosed with food allergy. Such reactions occur frequently, are often severe and are associated with higher medical and non-medical costs. The aim of this Perspective is to provide insight into the different factors involved in the occurrence of accidental allergic reactions and to present an overview of practical implications for effective preventive measures. Several factors affect the occurrence of accidental reactions. These factors are related to the patient, health care, or food. The most important patient-related factors are age, social barriers to disclosing their allergy and non-adherence to the elimination diet. With regards to healthcare, the degree to which clinical practice is tailored to the individual patient is an important factor. The major food-related factor is the absence of adequate precautionary allergen labeling (PAL) guidelines. Since many factors are involved in accidental allergic reactions, different preventive strategies are needed. It is highly recommended that health care be tailored to the individual patient, with regard to education about the elimination diet, support on behavioral and psychosocial aspects, usage of shared decision-making and taking into account health literacy. In addition, it is crucial that steps are taken to improve policies and guidelines for PAL.
Collapse
Affiliation(s)
- Astrid Versluis
- Department of Dermatology and Allergology, University Medical Centre Utrecht, University Utrecht, Utrecht, Netherlands
- Correspondence: Astrid Versluis Harmieke Van Os-Medendorp
| | - Thuy-My Le
- Department of Dermatology and Allergology, University Medical Centre Utrecht, University Utrecht, Utrecht, Netherlands
- Center for Translational Immunology, University Medical Centre Utrecht, University Utrecht, Utrecht, Netherlands
| | - Geert F. Houben
- Center for Translational Immunology, University Medical Centre Utrecht, University Utrecht, Utrecht, Netherlands
- TNO, Netherlands Organization for Applied Scientific Research, Utrecht, Netherlands
| | - André C. Knulst
- Department of Dermatology and Allergology, University Medical Centre Utrecht, University Utrecht, Utrecht, Netherlands
- Center for Translational Immunology, University Medical Centre Utrecht, University Utrecht, Utrecht, Netherlands
| | - Harmieke Van Os-Medendorp
- School of Health, Saxion University of Applied Sciences, Enschede, Netherlands
- Correspondence: Astrid Versluis Harmieke Van Os-Medendorp
| |
Collapse
|
7
|
La Vieille S, Hourihane JO, Baumert JL. Precautionary Allergen Labeling: What Advice Is Available for Health Care Professionals, Allergists, and Allergic Consumers? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:977-985. [PMID: 36682535 DOI: 10.1016/j.jaip.2022.12.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 01/21/2023]
Abstract
In most countries, the use of precautionary allergen labeling (PAL) is not governed by regulation. PAL was initially identified as a judicious risk management measure to address instances of "unavoidable" cross-contact with priority food allergens during food processing. However, PAL has gradually been devalued in part due to overuse and inconsistent application by the food industry. Currently, most food products do not contain detectable allergen residue or contain only low concentrations of residue of the allergens declared using PAL; however, occasionally, high concentrations of allergen residue are reported, rendering it an ineffective risk communication tool for allergic consumers. In this context, several reasons exist that make the consumption of products bearing a PAL statement not advisable for people with food allergies. The main reason is that the risk is generally not correlated with the statement used by manufacturers. Because of the increased use of PAL on prepackaged food products, and to maximize food choices for allergic individuals, health care professionals increasingly advise some patients considered to be "not highly allergic" to consume products bearing a PAL statement. This article explains why the consumption of products with PAL is not advisable without having a full clinical evaluation and knowledge that an allergen risk assessment has been conducted. It also discusses the perspectives for a better use of PAL on the basis of the recent Food and Agricultural Organization/World Health Organization recommendations on food allergens.
Collapse
Affiliation(s)
- Sébastien La Vieille
- Food Directorate, Health Canada, Ottawa, ON, Canada; Food Science Department, Laval University, Québec, QC, Canada.
| | | | - Joseph L Baumert
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska, Lincoln, Neb
| |
Collapse
|
8
|
Silvia D, Jérémie T, Povolo B, Gerdts J, Samuel Benrejeb G. Allergen management under a voluntary PAL regulatory framework – A survey of Canadian food processors. Heliyon 2022; 8:e11302. [DOI: 10.1016/j.heliyon.2022.e11302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/04/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
|
9
|
Allergic Inflammation: Effect of Propolis and Its Flavonoids. Molecules 2022; 27:molecules27196694. [PMID: 36235230 PMCID: PMC9570745 DOI: 10.3390/molecules27196694] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022] Open
Abstract
The incidence of allergic diseases and their complications are increasing worldwide. Today, people increasingly use natural products, which has been termed a "return to nature". Natural products with healing properties, especially those obtained from plants and bees, have been used in the prevention and treatment of numerous chronic diseases, including allergy and/or inflammation. Propolis is a multi-component resin rich in flavonoids, collected and transformed by honeybees from buds and plant wounds for the construction and adaptation of their nests. This article describes the current views regarding the possible mechanisms and multiple benefits of flavonoids in combating allergy and allergy-related complications. These benefits arise from flavonoid anti-allergic, anti-inflammatory, antioxidative, and wound healing activities and their effects on microbe-immune system interactions in developing host responses to different allergens. Finally, this article presents various aspects of allergy pathobiology and possible molecular approaches in their treatment. Possible mechanisms regarding the antiallergic action of propolis on the microbiota of the digestive and respiratory tracts and skin diseases as a method to selectively remove allergenic molecules by the process of bacterial biotransformation are also reported.
Collapse
|
10
|
Remington BC, Baumert J, Blom WM, Bucchini L, Buck N, Crevel R, De Mooij F, Flanagan S, Hindley J, Javed B, Stavropoulou DA, van den Dungen MW, van Ravenhorst M, Wang S, Walker M. Allergen quantitative risk assessment within food operations: Concepts towards development of practical guidance based on an ILSI Europe workshop. Food Control 2022. [DOI: 10.1016/j.foodcont.2022.108917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
11
|
Roche I, Vale SL, Hornung CJ, Zurzolo GA, Netting MJ, Dharmage SC, Gray C, Lee NA, Lacis-Lee J, Jorgensen PF, Smith J, Freeman W, Perrett KP, Voukelatos S, McWilliam VL, Grinter K, Koplin JJ, Said M, Campbell DE. An International First: Stakeholder Consensus Statement for Food Allergen Management in Packaged Foods and Food Service for Australia and New Zealand. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2056-2065. [PMID: 35381394 DOI: 10.1016/j.jaip.2022.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
Food-allergic consumers encounter inadequate, confusing, and ambiguous allergen information for packaged and unpackaged foods. Key Australian and New Zealand allergy organizations convened multiple forums to facilitate discussions among consumers, food manufacturers, food retailers, regulatory bodies, researchers, and health professionals to develop a unified approach to improving food allergen management. The following stakeholder consensus statement provides a foundation for advocacy for improved food allergen management and safety. It is the responsibility of consumers to: 1. declare their food allergies and read food labels (including ingredient lists and allergen declaration statements), and 2. ultimately make their own judgment about the foods they choose to consume. We consider that to enable consumers to make informed decisions about their safety, It is the responsibility of packaged food manufacturers to: 1. follow robust allergen management practices including quantitative risk assessment, and 2. use clear, consistent labeling to inform consumers about that food's allergen content, including the possible presence of unintended allergens. It is the responsibility of food service establishments and providers to: 1. follow robust allergen management practices, and 2. ensure that staff understand and can inform consumers about the allergen content of the food they provide, including the possible presence of unintended allergens.
Collapse
Affiliation(s)
- Ingrid Roche
- Perth Children's Hospital, Perth, Western Australia, Australia; Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia
| | - Sandra L Vale
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia; National Allergy Strategy, Sydney, New South Wales, Australia; The University of Western Australia, Perth, Western Australia, Australia; Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia.
| | - Catherine J Hornung
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Giovanni A Zurzolo
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Merryn J Netting
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia; Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Shyamali C Dharmage
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nanju A Lee
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; University of New South Wales, Kensington, New South Wales, Australia
| | | | | | - Jill Smith
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia
| | - Wendy Freeman
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia; National Allergy Strategy, Sydney, New South Wales, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia
| | - Kirsten P Perrett
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sally Voukelatos
- National Allergy Strategy, Sydney, New South Wales, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia
| | - Vicki L McWilliam
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia; Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Jennifer J Koplin
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Said
- National Allergy Strategy, Sydney, New South Wales, Australia; The University of Western Australia, Perth, Western Australia, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia
| | - Dianne E Campbell
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; The Children's Hospital at Westmead, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
12
|
Miller TA, Koppelman SJ, Bird JA, Hernandez-Trujillo V, Thyagarajan A, Mack D, Chalil JM, Green TD, Baumert JL. Peanut cross-contamination in randomly selected baked goods. Ann Allergy Asthma Immunol 2022; 128:439-442. [PMID: 35131409 DOI: 10.1016/j.anai.2022.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The current standard of care for managing peanut allergy includes avoidance of peanut and use of injectable epinephrine; however, strict avoidance is difficult and accidental ingestion is common with potentially serious consequences. Despite vigilance and efforts to minimize the risk of accidental exposure, peanut protein cross-contamination continues to occur in a variety of foods, including baked goods. OBJECTIVE To assess and quantify the presence of peanut protein contamination in certain baked goods. METHODS Randomly selected baked goods were collected from bakeries in the New York and Miami metropolitan areas that sold a variety of ethnic cuisines. A second set of samples from the same bakeries was collected at least 1 week after to evaluate between-batch variability. Samples were sent to the Food Allergy Research and Resource Program to analyze peanut contamination by enzyme-linked immunosorbent assay. Consumption estimates were based on 2003 to 2010 National Health and Nutrition Examination Survey survey data. RESULTS Of 154 samples from 18 bakeries, 4 (2.6%) had detectable peanut contamination with peanut protein levels ranging from 0.1 mg/100 g to 650 mg/100 g. Consumption estimates for single occasion ingestion of a contaminated item ranged from 0.07 mg to 832 mg of peanut protein. CONCLUSION In this study, unintended peanut protein was present in a small, but not insignificant, proportion of baked goods, with the potential to trigger a reaction in individuals with peanut allergy. Some products contained high levels of unintended peanut protein. The current data support the potential for accidental exposure to peanut protein with its associated risk.
Collapse
Affiliation(s)
| | - Stef J Koppelman
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska-Lincoln, Lincoln, Nebraska; DBV Technologies, Montrouge, France.
| | - J Andrew Bird
- Department of Pediatrics, The University of Texas Southwestern, Dallas, Texas
| | - Vivian Hernandez-Trujillo
- Allergy and Immunology Care Center of South Florida, Division of Allergy & Immunology, Nicklaus Children's Hospital, Miami, Florida
| | | | - Douglas Mack
- McMaster University, Hamilton, Ontario, Canada; Halton Pediatric Allergy, Burlington, Ontario, Canada
| | - Joseph M Chalil
- DBV Technologies, Montrouge, France; Nova Southeastern University, Fort Lauderdale, Florida
| | - Todd D Green
- DBV Technologies, Montrouge, France; UPMC Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph L Baumert
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska-Lincoln, Lincoln, Nebraska
| |
Collapse
|
13
|
Jan L, Naig A. Food allergen labeling of commonly used ingredients in Chinese restaurants in the United States. Food Control 2021. [DOI: 10.1016/j.foodcont.2021.108381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
14
|
Yang LGL, Brewster RK, Donnell MT, Hirani RN. Risk characterisation of milk protein contamination in milk-alternative ice cream products sold as frozen desserts in the United States. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2021; 39:1-13. [PMID: 34732089 DOI: 10.1080/19440049.2021.1989496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Milk protein is recognised as one of the eight most common food allergens in the United States, and one of the most common causes of fatal or near-fatal food-induced anaphylactic reactions globally. Undeclared allergens in food products are the leading cause of the U.S. Food and Drug Administration (FDA) requests for food recalls, with undeclared milk protein as the most frequently cited allergen. The purpose of this study was to evaluate the prevalence of milk protein contamination in milk-alternative ice cream products sold as frozen dessert in the U.S. and labelled as 'non-dairy', 'dairy-free', and/or 'vegan', and to characterise the potential risk for allergic individuals consuming these products. Thirty-two unique milk-alternative frozen dessert products, including flavours with and without inclusions, from 16 different brands, were tested for the presence of milk proteins using enzyme-linked immunosorbent assay. Milk protein was detected in three of the tested products: two contained solid inclusions, and one did not have inclusions. One of the three products with detectable milk protein had an advisory statement indicating the product was made in a facility that processed milk. Although no consensus exists as to the minimal dose of milk protein necessary to elicit an adverse effect in a milk-sensitised individual, the milk protein quantities in one serving of each of the three products exceeded some of the published thresholds. These results suggest that one serving of certain milk-alternative frozen dessert products could potentially elicit an allergic response in highly sensitive individuals.
Collapse
|
15
|
Holleman BC, van Os-Medendorp H, van den Bergh H, van Dijk LM, Linders YFM, Blom WM, Verhoeckx KCM, Michelsen-Huisman A, Houben GF, Knulst AC, Lentz LR. Poor understanding of allergen labelling by allergic and non-allergic consumers. Clin Exp Allergy 2021; 51:1374-1382. [PMID: 34288165 PMCID: PMC8519062 DOI: 10.1111/cea.13975] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Abstract
Background Understanding consumers’ interpretation of allergy information is crucial for effective food safety policies. We evaluated consumer understanding of allergy information on foods in controlled, experimental studies. Method Using 18 packaged foods, we evaluated consumer understanding of information about allergens in two experiments: First, a comparison of foods with no stated allergen versus allergen as a stated ingredient versus a precautionary allergen label (PAL); second, a comparison of three common variants of PAL. In each experiment, consumers with and without self‐reported food allergy were asked to estimate the risk of allergic reaction and to rate the comprehensibility of the allergen information. In the second experiment, consumers were also asked which form of PAL they preferred. Results Risk of reaction was assessed as high and low for foods with the allergen stated as ingredient, or without any mention of allergen. However, risk assessment for PAL varied and was judged as higher by non‐allergic than allergic participants (82% vs. 58%, p < .001). Understanding of risk associated with PAL also varied by health literacy (p < .001). Both allergic and non‐allergic consumers judged all forms of allergy information to be unclear, especially products with no allergy information for non‐allergic consumers. Products with a ‘Produced in a Factory’ PAL were perceived as less risky than ‘May contain’ or ‘Traces of’ PALs (p < .001), less than 40% of participants judged PAL information to be comprehensible, and participants preferred ‘May contain’ over the other PALs. Conclusion Both allergic and non‐allergic consumers find allergen information difficult to interpret on packaged foods and misunderstand PAL, incorrectly distinguishing different risk levels for different PAL wording. Clearer allergy information guidelines are called for, and the use of only one PAL wording is recommended.
Collapse
Affiliation(s)
- Bregje C Holleman
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - Harmieke van Os-Medendorp
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,The Netherlands Organization for Applied Scientific Research TNO, Utrecht, The Netherlands
| | - Huub van den Bergh
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - Liselotte M van Dijk
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - Yvette F M Linders
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - W Marty Blom
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Saxion University of Applied Science, School of Health, Deventer, The Netherlands
| | - Kitty C M Verhoeckx
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anouska Michelsen-Huisman
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geert F Houben
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Saxion University of Applied Science, School of Health, Deventer, The Netherlands
| | - André C Knulst
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Leo R Lentz
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
16
|
Sicherer SH, Abrams EM, Nowak-Wegrzyn A, Hourihane JO. Managing Food Allergy When the Patient Is Not Highly Allergic. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:46-55. [PMID: 34098164 DOI: 10.1016/j.jaip.2021.05.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/12/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
Few patients with food allergy are "highly allergic," meaning they always have severe reactions and always react to very small amounts of allergen. Standard medical approaches for allergy management have focused on the safety and lifestyle modifications this group truly needs, but consequently families with food allergy are typically advised to strictly avoid any exposure to their implicated allergens. Most food-allergic subjects are actually not reactive to very low doses, and many never experience severe reactions. There are also notable conditions where a different care plan is already commonly offered: patients with pollen-related food allergy syndrome, with food-associated exercise-induced anaphylaxis, and with resolving or mild milk or egg allergy might be advised to ingest the allergens in specific circumstances with detailed instructions. Because oral immunotherapy and allergy prevention by early exposure have emphasized alternatives to strict avoidance, there is increasing interest in prospects to forego strict avoidance in those with food allergy. For patients with a high threshold of reactivity (low-dose tolerant, high-dose mildly reactive), there may be options such as allowing the ingestion of products with precautionary allergen labels, allowing dietary indiscretions with small amounts of the allergen, or even encouraging ingestion of subthreshold amounts with therapeutic intent. These practices have not been extensively studied and could be considered controversial. If these approaches are considered, shared decision making is needed in discussing them with patients and families. This review considers the potential approaches to those who are "not highly allergic": the risks, benefits, shared decision making, and research needs.
Collapse
Affiliation(s)
- Scott H Sicherer
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Anna Nowak-Wegrzyn
- New York University Grossman School of Medicine, Allergy and Immunology, Hassenfeld Children's Hospital, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Jonathan O'B Hourihane
- Paediatrics and Child Health, Royal College of Surgeons in Irerland, Dublin, Ireland; Childrens Health Ireland Temple St, Dublin, Ireland
| |
Collapse
|
17
|
Manny E, La Vieille S, Barrere V, Théolier J, Godefroy SB. Peanut and hazelnut occurrence as allergens in foodstuffs with precautionary allergen labeling in Canada. NPJ Sci Food 2021; 5:11. [PMID: 33976231 PMCID: PMC8113233 DOI: 10.1038/s41538-021-00093-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/23/2021] [Indexed: 11/29/2022] Open
Abstract
Precautionary allergen labeling (PAL) is widely used by food industries. Occurrence studies revealed that few analyzed products contained the allergen(s) present in the statement, but little is known in Canada. To improve manufacturing practices and better manage allergen cross-contamination, occurrence data is needed to determine the exposure of allergic individuals eating those products. Samples were analyzed for peanuts (n = 871) and hazelnuts (n = 863) using ELISA methods. Within samples analyzed for peanuts, 72% had a PAL (n = 628), 1% had peanuts as a minor ingredient (n = 9) and 27% were claimed “peanut-free” (n = 234). Most hazelnut samples had a PAL for tree nuts/hazelnuts (94%; n = 807) with 6% claimed “nut-free” (n = 56). Peanuts and hazelnuts were found in 4% (0.6–28.1 ppm) and 9% (0.4–2167 ppm) of all samples, respectively. Chocolates were mostly impacted; they should be treated apart from other foods and used in risk assessments scenarios to improve manufacturing practices, reducing unnecessary PAL use.
Collapse
Affiliation(s)
- Emilie Manny
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Québec, Canada.
| | - Sébastien La Vieille
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Québec, Canada.,Food Directorate, Health Canada, 251 Sir Frederick Banting Driveway, Ottawa, ON, Canada
| | - Virginie Barrere
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Québec, Canada
| | - Jérémie Théolier
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Québec, Canada
| | - Samuel Benrejeb Godefroy
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Québec, Canada
| |
Collapse
|
18
|
A comprehensive survey of allergen labeling on pre-packaged food products imported from Mainland China. Food Control 2021. [DOI: 10.1016/j.foodcont.2020.107749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
19
|
Lieberman JA, Gupta RS, Knibb RC, Haselkorn T, Tilles S, Mack DP, Pouessel G. The global burden of illness of peanut allergy: A comprehensive literature review. Allergy 2021; 76:1367-1384. [PMID: 33216994 PMCID: PMC8247890 DOI: 10.1111/all.14666] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 10/30/2020] [Accepted: 11/14/2020] [Indexed: 01/05/2023]
Abstract
Peanut allergy (PA) currently affects approximately 2% of the general population of Western nations and may be increasing in prevalence. Patients with PA and their families/caregivers bear a considerable burden of self‐management to avoid accidental peanut exposure and to administer emergency medication (adrenaline) if needed. Compared with other food allergies, PA is associated with higher rates of accidental exposure, severe reactions and potentially fatal anaphylaxis. Approximately 7%–14% of patients with PA experience accidental peanut exposure annually, and one‐third to one‐half may experience anaphylaxis, although fatalities are rare. These risks impose considerably high healthcare utilization and economic costs for patients with PA and restrictions on daily activities. Measures to accommodate patients with PA are often inadequate, with inconsistent standards for food labelling and inadequate safety policies in public establishments such as restaurants and schools. Children with PA are often bullied, resulting in sadness, humiliation and anxiety. These factors cumulatively contribute to significantly reduced health‐related quality of life for patients with PA and families/caregivers. Such factors also provide essential context for risk/benefit assessments of new PA therapies. This narrative review comprehensively assessed the various factors comprising the burden of PA.
Collapse
Affiliation(s)
- Jay A. Lieberman
- University of Tennessee Health Science Center/Le Bonheur Children’s Hospital Memphis TN USA
| | - Ruchi S Gupta
- Institute for Public Health and Medicine Ann & Robert H. Lurie Children's Hospital of ChicagoNorthwestern School of Medicine Chicago IL USA
| | | | | | | | - Douglas P. Mack
- Department of Pediatrics McMaster University Hamilton ON Canada
| | - Guillaume Pouessel
- Pneumology and Allergology Unit Children's HospitalLille University Hospital Jeanne de Flandre France
| |
Collapse
|
20
|
Manny E, La Vieille S, Dominguez SA, Kos G, Barrère V, Théolier J, Touma J, Godefroy SB. Probabilistic risk assessment for milk in dark chocolate, cookies and other baked goods with PAL sold in Canada. Food Chem Toxicol 2021; 152:112196. [PMID: 33862120 DOI: 10.1016/j.fct.2021.112196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022]
Abstract
The risk of having an allergic reaction in milk-allergic individuals consuming products with precautionary allergen labelling (PAL) for milk has been rarely studied in products such as dark chocolate, cookies, and other baked goods. A probabilistic risk assessment model was developed to estimate potential risks. Milk occurrence and contamination levels were reported in a previous article from our group. Dose-response curves for milk were constructed using values (n = 1078) from published double-blind placebo-controlled food challenges. Canadian consumption data was extracted from a national survey, and a homemade survey involving food-allergic Canadians. Milk eliciting doses (ED) were 0.23 (ED01), 1.34 (ED05), 3.42 (ED10), and 16.3 (ED25) mg of milk protein (Log-Normal distribution). Average exposures, per eating occasion, were 24 mg (dark chocolate), 3.9 mg (baked goods), and 0.20 mg (cookies) of milk proteins. The estimated risk of having a milk-induced allergic reaction by consuming foods with PAL for milk was higher for dark chocolate (16%; 15,881/100,000) than baked goods (3.8%; 3802/100,000) or cookies (0.6%; 646/100,000) in milk-allergic Canadians. Dark chocolate, cookies, and baked goods with PAL for milk, should be avoided by milk-allergic Canadians (consuming or not products with PAL) to prevent allergic reactions.
Collapse
Affiliation(s)
- Emilie Manny
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada.
| | - Sébastien La Vieille
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada; Health Canada, 251 Sir F. Banting Driveway, Ottawa, Ontario, H1A 0K9, Canada
| | - Silvia A Dominguez
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - Gregor Kos
- Department of Chemistry & Biochemistry, 7141 Sherbrooke Street West, Concordia University, Montreal, Quebec, H4B 1R6, Canada
| | - Virginie Barrère
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - Jérémie Théolier
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - Joseph Touma
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - Samuel Benrejeb Godefroy
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| |
Collapse
|
21
|
Manny E, La Vieille S, Barrere V, Theolier J, Godefroy SB. Occurrence of milk and egg allergens in foodstuffs in Canada. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2020; 38:15-32. [PMID: 33201786 DOI: 10.1080/19440049.2020.1834153] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Food allergies are life-threatening conditions that allergic individuals can avoid by consulting the food labels before consuming. Precautionary allergen labelling (or PAL), to warn against possible allergen cross-contamination, is widely used by food industries, reducing the food choices for allergic individuals. In Canada, there is limited information on the actual occurrence of allergens in products with a PAL related to the given allergen. This study attempted to fill the data gap by evaluating the occurrence of milk and egg allergens in Canadian products with PAL. A total of 1125 samples were analysed for milk and 840 for eggs, with 23% and 7% of these samples showing positive detection of ≥2.5 mg kg-1 for milk and ≥0.245 mg kg-1 for eggs. Chocolate products gave the largest number of positive results. Although the proportion of positive results was low, the levels detected reached 6471 mg kg-1 in a chocolate sample and were indicative of possible health consequences, if PAL was ignored by allergic consumers. The occurrence data generated is destinated to be used in exposure and risk assessments, to support allergen management linked to cross-contamination, with the possible development of allergen action levels that would be used by food industries, thus improving a risk-based approach for the application of PAL.
Collapse
Affiliation(s)
- Emilie Manny
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods, and Food Science Department, Faculty of Food and Agricultural Sciences, Université Laval , Quebec, Quebec, Canada
| | - Sébastien La Vieille
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods, and Food Science Department, Faculty of Food and Agricultural Sciences, Université Laval , Quebec, Quebec, Canada.,Food Directorate, Health Canada , Ottawa, Ontario, Canada
| | - Virginie Barrere
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods, and Food Science Department, Faculty of Food and Agricultural Sciences, Université Laval , Quebec, Quebec, Canada
| | - Jérémie Theolier
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods, and Food Science Department, Faculty of Food and Agricultural Sciences, Université Laval , Quebec, Quebec, Canada
| | - Samuel Benrejeb Godefroy
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods, and Food Science Department, Faculty of Food and Agricultural Sciences, Université Laval , Quebec, Quebec, Canada
| |
Collapse
|
22
|
Stockhammer D, Katelaris CH, Simpson MD, Vanniasinkam T. Parent perceptions in managing children with food allergy: An Australian perspective. World Allergy Organ J 2020; 13:100468. [PMID: 33133333 PMCID: PMC7578552 DOI: 10.1016/j.waojou.2020.100468] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/31/2020] [Accepted: 09/14/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Food allergy affects up to 10% of Australian children, and living with food allergic children can be challenging for parents. This study explored parental perceptions and knowledge as they navigate a new reality of keeping their child safe. METHODS Parents of children with food allergies completed an online food allergy survey in 2015. Questions explored health knowledge, skills, and attitudes (KSAs) as well as quality of life (QoL) through the inclusion of the Food Allergy Quality of Life - Parental Burden instrument (FAQL-PB). Notification of the survey included advertisements to more than 700 randomly selected Australia-wide preschools, 44 allergy specialists, and Allergy & Anaphylaxis Australia. Responses were tabulated and analysed. RESULTS Of the 400 participants who logged on, 357 commenced the survey and 318 finished. Questionnaire analysis showed that 44.1% of parents (n = 135) hesitated to use an adrenaline auto-injector and may be influenced by a classification system where symptom severity is not universally understood. While 79% would sign up to a national Anaphylaxis Registry, intention to participate in clinical trials using vaccines was disclosed by only 56%. Allergen labelling and community acceptance continue to be the most challenging aspects of managing a food allergy, and 50% of parents reported that food allergy played a role in choosing a preschool or primary school. Overall, quality of life for participants was influenced more by gender (male) and age of the child than where they lived - capital city or regional location; however, regional participants were more frustrated over lack of appreciation relating to the seriousness of food allergy (p = 0.010). CONCLUSION Results highlight the need for educational strategies for both the food allergy community and public, particularly in regional areas, since there is a perceived lack of appreciation as to the seriousness of food allergy. Educational resources and relevant networks are required to support parents and caregivers in the management of children with food allergy.
Collapse
Key Words
- ABC, Australian Broadcasting Corporation
- ANOVA, Analysis of variance
- CA, California
- FAQL-PB
- FAQL-PB, Food Allergy Quality of Life – Parental Burden
- Food allergy
- GP/GPs, General Practitioner(s)
- KSA, Knowledge, Skills, Attitudes
- LOC, Locus of control
- NSW, New South Wales, Australia
- NVivo Pro, NVivo Pro, QSR International Pty Ltd
- PAF, Principal Axis Factoring
- PRIME7, Prime Television Australia
- Parental burden
- QoL, Quality of Life
- Quality of life
- SPSS/IBM SPSS Statistics, IBM Statistical Package for the Social Sciences
- VIC, Victoria, Australia
- WIN Television, WIN Corporation Australia
Collapse
Affiliation(s)
- Debbi Stockhammer
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia
| | | | | | - Thiru Vanniasinkam
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia
| |
Collapse
|
23
|
Understanding Precautionary Allergen Labeling (PAL) Preferences Among Food Allergy Stakeholders. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:254-264.e1. [PMID: 33007499 DOI: 10.1016/j.jaip.2020.09.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/21/2020] [Accepted: 09/13/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Food allergy (FA) is an increasing public health concern in the United States, affecting approximately 8% of children and 11% of adults. The United States currently lacks clear requirements for the use of precautionary allergen labeling (PAL) on packaged foods, such as "may contain" or "made on shared equipment." This lack of specific governmental policy results in inconsistent labeling practices and confusion. OBJECTIVE This study aimed to understand current knowledge and preferences for PAL statements among FA stakeholders. METHODS A cross-sectional survey was sent to FA stakeholders. Descriptive statistics and associations from logistic regressions were used to assess respondents' knowledge of PAL policy, shopping habits, and preferences around PAL. RESULTS Of 3008 respondents, 24.2% were able to correctly answer 4 questions surrounding PAL policies. When asked about their shopping habits, the majority of respondents never purchase products with a "May contain traces of allergen" label (85.5%) in comparison with never purchasing products with a "Good manufacturing practices used to segregate ingredients in a facility that also processes allergen" label (35.0%). Their top preferences for a PAL statement were "Not suitable for people with 'blank' allergy" (29.3%) and "May contain" (22.1%). Health care provider discussions around PAL varied and were strongly associated with purchasing behaviors. CONCLUSIONS These results suggest that FA consumers are not aware of PAL policies and make decisions based on the words in the PAL. They prefer having clearer, more specific, and consistent labeling on products, indicating that explicit PAL policies are needed to allow customers to easily identify safe foods.
Collapse
|
24
|
Calvani M, Anania C, Caffarelli C, Martelli A, Miraglia Del Giudice M, Cravidi C, Duse M, Manti S, Tosca MA, Cardinale F, Chiappini E, Olivero F, Marseglia GL. Food allergy: an updated review on pathogenesis, diagnosis, prevention and management. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020012. [PMID: 33004782 PMCID: PMC8023067 DOI: 10.23750/abm.v91i11-s.10316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
Food allergy (FA) is an adverse immunologic response triggered by normally innocuous food protein antigens. FA can be broadly classified into those that are IgE mediated, those that are mediated by both IgE-dependent and IgE-independent pathways (mixed), and those that are not IgE mediated Immunoglobulin E. (IgE)-mediated reaction is characterized by rapid onset of symptoms involving respiratory, gastrointestinal, dermatologic and cardiovascular systems; mixed and non-IgE-mediated has a longer onset and manifests primary in the gastrointestinal tract and skin. The diagnosis of food allergy is based on clinical history, diagnostic testing (skin prick test and allergen-specific IgE levels in the serum), elimination diet and, oral food challenge. In recent years the diagnosis and treatment of pediatric FA have notably improved. In the diagnostic pathway of FA an important recent innovation is the CRD introduction. This resulted in the possibility of improving diagnostic accuracy through FA prediction severity and prognosis and thereby decreasing the OCF necessity. Recent studies emphasize the possibility of preventing FA through early introduction of food (peanuts and egg) to high-risk infants. FA management is based on avoidance of offending food and prompt treatment of allergic reaction. Currently under study are recently developed treatment approaches for FA management including specific OIT.
Collapse
Affiliation(s)
- Mauro Calvani
- UOC di Pediatria. Azienda Ospedaliera S. Camillo Forlanini, Roma, Italy.
| | - Caterina Anania
- Dipartimento Materno Infantile e Scienze Urologiche, Policlinico Umberto I, "La Sapienza" Università di Roma, Italy.
| | - Carlo Caffarelli
- Clinica Pediatrica, Dipartimento di Medicina e Chirurgia, Università di Parma, Italy.
| | - Alberto Martelli
- Department of Pediatrics, G.Salvini Hospital, Garbagnate Milanese, Milan, Italy.
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery. University of Campania"Luigi Vanvitelli" Naples, Italy.
| | - Claudio Cravidi
- Agenzia Tutela della Salute, ATS (National Healthcare System), Pavia, Italy.
| | - Marzia Duse
- Department of Pediatrics, Sapienza University, Rome, Italy.
| | - Sara Manti
- UOC Broncopneumologia Pediatrica e Fibrosi Cistica, AOUP "Vittorio-Emanuele", San Marco Hospital, Università di Catania, Catania, Italy.
| | - Maria Angela Tosca
- Allergy Center, Department of Pediatrics, Istituto G. Gaslini, Genoa, Italy.
| | - Fabio Cardinale
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria Consorziale-Policlinico, Ospedale Pediatrico Giovanni XXIII, Bari, Italy..
| | - Elena Chiappini
- Division of Paediatric Infectious Disease, Anna Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy.
| | - Francesca Olivero
- Pediatric Clinic Department of Pediatrics, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
| | - Gian Luigi Marseglia
- Pediatric Clinic Department of Pediatrics, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
| |
Collapse
|
25
|
Odisho N, Carr TF, Cassell H. Food Allergy: Labelling and exposure risks. JOURNAL OF FOOD ALLERGY 2020; 2:115-118. [PMID: 39022153 PMCID: PMC11250542 DOI: 10.2500/jfa.2020.2.200027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
In the United States, food allergen labeling is regulated by the U.S. Food and Drug Administration with the implementation of the Food Allergen Labeling and Consumer Protection Act in 2006 that requires packaged foods to clearly indicate the presence of any milk, egg, peanut, tree nuts, wheat, soybeans, fish, and crustacean shellfish. Educating patients and their families how to read food labels includes reading the ingredients list as well as the declaration statement that begins with "Contains." In addition, there is widespread use of precautionary advisory labeling, and patients should be counseled that these precautionary statements are not mandatory and not regulated and, therefore, do not necessarily identify foods with allergen contamination. An allergic reaction to undeclared food allergens as well as complacency with label reading, including precautionary advisory statements, remains a relevant risk for patients with food allergy.
Collapse
Affiliation(s)
- Nora Odisho
- From the Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, University of Arizona, Tucson, Arizona
| | - Tara F. Carr
- From the Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, University of Arizona, Tucson, Arizona
| | - Heather Cassell
- From the Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, University of Arizona, Tucson, Arizona
| |
Collapse
|
26
|
Abrams EM, Simons E, Gerdts J, Nazarko O, Povolo B, Protudjer JLP. "I want to really crack this nut": an analysis of parent-perceived policy needs surrounding food allergy. BMC Public Health 2020; 20:1194. [PMID: 32738893 PMCID: PMC7395383 DOI: 10.1186/s12889-020-09309-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background In Canada, anaphylaxis-level food allergy constitutes a legal disability. Yet, no nationwide policies exist to support families. We sought to understand what parents of children with food allergy perceive as the most pressing food allergy-related policy concerns in Canada. Methods Between March–June 2019, we interviewed 23 families whose food allergic children (N = 28mean age 7.9 years) attending an allergy clinic in Winnipeg, Canada. Interviews were audio-recorded, transcribed and analyzed using content analysis. Results Over 40% of children had multiple food allergies, representing most of Health Canada’s priority allergens. We identified four themes: (1) High prevalence. High priority?. (2) Food labels can be misleading, (3) Costs and creative ideas, and (4) Do we have to just deal with the status quo around allergies? Conclusion Food allergy ought to be a national policy priority, to improve the process for precautionary labelling, to improve funding, educational tools access to care, and knowledge of current allergy guidelines.
Collapse
Affiliation(s)
- Elissa M Abrams
- Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Elinor Simons
- Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | | | - Orla Nazarko
- Participant Advisory Committee to J Protudjer, Winnipeg, MB, Canada
| | - Beatrice Povolo
- Advocacy and Media Relations, Food Allergy Canada, Toronto, ON, Canada
| | | |
Collapse
|
27
|
Graham F, Caubet JC, Eigenmann PA. Can my child with IgE-mediated peanut allergy introduce foods labeled with "may contain traces"? Pediatr Allergy Immunol 2020; 31:601-607. [PMID: 32160355 DOI: 10.1111/pai.13244] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/16/2020] [Accepted: 02/25/2020] [Indexed: 01/19/2023]
Abstract
Peanut IgE-mediated food allergy is one of the most common food allergies in children with a prevalence that has increased in the past decades in Westernized countries. Peanut allergies can trigger severe reactions and usually persist over time. Peanut-allergic children and their families are often confronted to processed foods with precautionary allergen labeling (PAL) such as "may contain traces of peanuts," which are frequently used by the food industry. Patients are generally confused as to whether eating such foods entails a risk of allergic reaction, which can ultimately lead to dietary restrictions and decreased quality of life. Thus, guidance toward eviction of foods with PALs such as "may contain traces of peanuts" is a recurring problem that peanut-allergic patients address during pediatric allergy consultations with varying attitudes among allergists. Many studies have evaluated peanut contamination in foods with PALs, with generally less than 10% of foods containing detectable levels of peanuts, albeit heterogeneous amounts, with in rare occasions levels that could trigger allergic reactions in certain patients. The risk of reacting to foods with traces varies significantly with threshold, with patients with the lowest reaction thresholds at highest risk, and a dramatic reduction of risk as threshold increases. Thus, risk stratification based on individual reaction threshold may help stratify patients' risk of reacting to foods with PAL. In clinical practice, a single-dose 30 mg peanut protein oral food challenge may be an option to stratify peanut-allergic patients' risk when introducing foods with PAL, as illustrated by three clinical cases.
Collapse
Affiliation(s)
- François Graham
- Pediatric Allergy Unit, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland.,Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine and Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Jean-Christoph Caubet
- Pediatric Allergy Unit, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Philippe A Eigenmann
- Pediatric Allergy Unit, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| |
Collapse
|
28
|
Protudjer JLP, Mikkelsen A. Veganism and paediatric food allergy: two increasingly prevalent dietary issues that are challenging when co-occurring. BMC Pediatr 2020; 20:341. [PMID: 32650748 PMCID: PMC7350184 DOI: 10.1186/s12887-020-02236-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/02/2020] [Indexed: 12/16/2022] Open
Abstract
Vegan diets - defined as the exclusion of all foods of animal origin from the diet- are becoming popular. In recent years, the prevalence of food allergy has also increased, and disproportionately affects children. When vegan diets and food allergy co-occur, this combination can be challenging and pose risks of nutritional deficiencies, particularly during childhood. In this paper, we aim to summarise the major concerns regarding vegan diets and food allergy, review the literature on this topic, and provide some suggestions for healthcare providers, particularly dietitians and nutritionists, who work with food allergic, vegan patients and their family. When working with this patient population, a regular and complete medical nutrition history, including screening for any possible nutritional deficiencies, is warranted. Likewise, the routine tracking of serum markers (especially iodine, iron, zinc, calcium, Vitamins B12, D, B2, and A, selected n-3 fatty acids and protein, which are more abundant in animal vs. plant foods) and symptoms of co-morbid diseases, including asthma, is important, as comorbid diseases may increase energy and nutrient requirements. For infants and children, anthropometry ought to be tracked longitudinally at regular intervals to identify any deviations from the child's previous growth pattern, and to accommodate any increased requirements for growth and development. Correct diagnoses, education and allergy management must be disseminated to the family in a clear and appropriate manner. Children with allergy may have increased nutritional needs due to comorbidity. This is complicated by coincident food allergy and vegan diet as both impose diet restrictions (limiting sources of important nutrients, need for dietary variety and/or increased consumption due to reduced bioavaliability).
Collapse
Affiliation(s)
- Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada.
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada.
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
| | - Andrea Mikkelsen
- Paediatric Primary Health Care Clinics of Västra Götaland, Västra Götaland, Sweden
- Research and Development Primary Health Care, Gothenburg and Södra Bohuslän, Region Västra Götaland, Sweden
- Institute of Medicine, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
29
|
Blackman AC, Staggers KA, Kronisch L, Davis CM, Anagnostou A. Quality of life improves significantly after real-world oral immunotherapy for children with peanut allergy. Ann Allergy Asthma Immunol 2020; 125:196-201.e1. [PMID: 32278075 DOI: 10.1016/j.anai.2020.03.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/12/2020] [Accepted: 03/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Peanut oral immunotherapy (POIT) is a novel and active form of treatment for patients with peanut allergy, with multiple research studies supporting its efficacy and safety. However, there are limited data available on changes in patients' quality of life (QoL) after successful desensitization. The Food and Drug Administration in the United States recently approved the first POIT drug for commercial use. OBJECTIVE To evaluate the QoL of patients with peanut allergy receiving POIT in a real-world academic setting. METHODS Twenty-one patients aged 4 to 17 years with a physician-established diagnosis of peanut allergy were offered POIT. Quality-of-life scores were assessed with the use of a validated Food Allergy Quality of Life questionnaire. Changes in quality-of-life scores were measured for each patient before and after POIT. The Wilcoxon signed-rank test was used to compare the distributions of scores before and after therapy. RESULTS We noted a statistically significant drop (reflecting improvement in the QoL) in the overall Food Allergy Quality of Life score (median 3.70 vs 2.97, P = .049) between baseline and successful desensitization to 300-mg peanut protein. In addition, the Social and Dietary Limitations subscale score (median 4.33 vs 2.89, P = .02) and the Food Allergy Independent Measure score (median 3.17 vs 2.22, P = .001) also improved significantly after therapy. CONCLUSION We report a significant improvement in the overall QoL before and after POIT treatment, with fewer concerns about accidental exposures and severity of allergic reactions as well as fewer limitations in dietary choices and social interactions.
Collapse
Affiliation(s)
- Andrea C Blackman
- Section of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Kristen A Staggers
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Lauren Kronisch
- Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Carla M Davis
- Section of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Aikaterini Anagnostou
- Section of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas.
| |
Collapse
|
30
|
|
31
|
Reis VS, Consolin Filho N, Baqueta MR, Demczuk Junior B. Avaliação do teor de sódio em salgadinhos comerciais e da rotulagem de acordo com a RDC nº 26/2015 sobre alergênicos alimentares. BRAZILIAN JOURNAL OF FOOD TECHNOLOGY 2020. [DOI: 10.1590/1981-6723.09319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Resumo Os alimentos extrusados snacks são consumidos mundialmente por causa da variedade de formas, texturas e sabores, além da praticidade no consumo. Contudo, a maioria das formulações possui valor biológico reduzido e elevados teores de cloreto de sódio (NaCl). Atualmente, no Brasil, além das informações nutricionais, é obrigatório informar ao consumidor a presença de alimentos alergênicos. Alguns requisitos sobre esse assunto foram estabelecidos pela RDC nº 26, de 2 de julho de 2015. Desde a regularização dessa resolução, existe uma falta de estudos com foco na avaliação da rotulagem de diversos alimentos, incluindo os snacks. Assim, o presente estudo teve dois objetivos: verificar os rótulos de snacks de diferentes marcas comerciais de acordo com a RDC nº 26/2015 sobre alergênicos e determinar o teor de sódio, comparando-o com a descrição na informação nutricional fornecida na embalagem dos produtos. A avaliação da rotulagem dos “snacks” extrusados encontrou inconformidades em 4 marcas das 16 analisadas. Com base na RDC nº 26/2015 sobre alergênicos alimentares, foram constatadas ausências de informações obrigatórias relacionadas a ingredientes alergênicos, como a farinha de trigo. Foi verificado que 87,5% dos snacks continham algum alergênico e que apenas 68,75% dos rótulos estavam de acordo com a RDC nº 26/2015. Além disso, foi identificado que, na maioria dos rótulos, falta a informação sobre contaminação cruzada por alergênicos no processamento dos produtos. Quanto à análise de sódio por espectrometria de absorção atômica com chama, os resultados obtidos mostraram que, na maioria das amostras, a concentração de sódio era elevada e que diferia dos valores indicados na tabela nutricional das embalagens. Portanto, a adição elevada de sódio na forma de cloreto de sódio nos “snacks” extrusados pode contribuir para exceder a ingestão diária recomendada e, consequentemente, aumentar a disponibilidade para decorrência de riscos de doenças cardiovasculares, coronárias, entre outras, associadas ao consumo de NaCl em excesso.
Collapse
|
32
|
Sheridan MJ, Koeberl M, Hedges CE, Biros E, Ruethers T, Clarke D, Buddhadasa S, Kamath S, Lopata AL. Undeclared allergens in imported packaged food for retail in Australia. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2019; 37:183-192. [PMID: 31750787 DOI: 10.1080/19440049.2019.1679890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The Australia New Zealand Food Standards Code (the Code) requires a declaration of the presence of 11 different allergens made through the label on a food product. Most food recalls in Australia are now due to undeclared allergens . This survey determined the extent of undeclared allergens in imported food products on the Asian retail market in Australia. A total of 50 imported packaged foods were selectively purchased from local Asian grocery retail stores in Melbourne and the presence of undeclared gluten, milk, peanut and egg determined. Analysis was performed using commercial enzyme-linked immunosorbent assay (ELISA) (R-Biopharm). Thirty-seven undeclared allergens (gluten n = 12, milk n = 12, peanut n = 6, and egg n = 7) were detected in 23 of the 50 products analysed (46%), with 18% containing multiple undeclared allergens. The high number of undeclared allergens is alarming and in line with the increasing number of food recalls and anaphylaxis recorded in Australia.
Collapse
Affiliation(s)
- Michael John Sheridan
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Martina Koeberl
- Food Allergen Laboratory, Analytical Services Branch, Department of Industry, Innovation and Science, National Measurement Institute, Melbourne, Australia
| | - Claire Elizabeth Hedges
- Food Allergen Laboratory, Analytical Services Branch, Department of Industry, Innovation and Science, National Measurement Institute, Melbourne, Australia
| | - Erik Biros
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Thimo Ruethers
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Dean Clarke
- Food Allergen Laboratory, Analytical Services Branch, Department of Industry, Innovation and Science, National Measurement Institute, Melbourne, Australia
| | - Saman Buddhadasa
- Food Allergen Laboratory, Analytical Services Branch, Department of Industry, Innovation and Science, National Measurement Institute, Melbourne, Australia
| | - Sandip Kamath
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia.,Australian Institute for Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Andreas Ludwig Lopata
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia.,Australian Institute for Tropical Health and Medicine, James Cook University, Townsville, Australia
| |
Collapse
|
33
|
DunnGalvin A, Roberts G, Regent L, Austin M, Kenna F, Schnadt S, Sanchez-Sanz A, Hernandez P, Hjorth B, Fernandez-Rivas M, Taylor S, Baumert J, Sheikh A, Astley S, Crevel R, Mills C. Understanding how consumers with food allergies make decisions based on precautionary labelling. Clin Exp Allergy 2019; 49:1446-1454. [PMID: 31400020 DOI: 10.1111/cea.13479] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/16/2019] [Accepted: 06/26/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understanding consumer perceptions is crucial if effective food safety policy and risk communication are to be developed and implemented. We sought to understand how those living with food allergy assess risk with precautionary allergen labelling (PAL) and their preference in how risks are communicated within a quantitative risk assessment (QRA) framework. METHODS The Integrated Approaches to Food Allergen and Allergy Risk Management (iFAAM) labelling online survey was developed for adults and parents of children with food allergy and distributed across Germany, Ireland, Netherlands, Spain and UK via patient support groups. RESULTS There were 1560 complete responses. 'This product is not suitable for' was selected as first choice for PAL by 46% overall and 'May contain' was selected as the first choice by 44%. Seventy-three percent reported that it would improve their trust in a product if a QRA process had been used to make a decision about whether to include 'may contain'. Overall, 66% reported that a 'statement + symbol' on the label indicating a QRA, would help them to understand the risk assessment process that had been used by the food manufacturer. CONCLUSIONS Consumers want to know what process has actually taken place for the placing of a PAL and/or risk assessment statement on a particular food product. Our findings provide a basis for the development of more informative communication around food allergen risk and safety and support evidence-based policy-making in the context of the legislative requirements of the European Union's Food Information for Consumers Regulation.
Collapse
Affiliation(s)
- Audrey DunnGalvin
- Paediatrics and Child Health, University College, Cork, Ireland.,School of Applied Psychology, University College, Cork, Ireland.,Paediatrics and Child Infectious Diseases, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Graham Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | | | | | | | - Sabine Schnadt
- Deutscher Allergie- und Asthmabunde.V., German Allergy and Asthma Association, Mönchengladbach, Germany
| | - Angel Sanchez-Sanz
- Asociación Española de Personas con Alergia a Alimentos y Látex, Madrid, Spain
| | - Pilar Hernandez
- Asociación Española de Personas con Alergia a Alimentos y Látex, Madrid, Spain
| | | | | | - Steve Taylor
- Food Allergy Research and Resource Program, University of Nebraska, Lincoln, NE, USA
| | - Joseph Baumert
- Food Allergy Research and Resource Program, University of Nebraska, Lincoln, NE, USA
| | - Aziz Sheikh
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | | | - Rene Crevel
- Unilever Safety and Environmental Assurance Centre, Bedford, UK.,René Crevel Consulting Limited, Bedford, UK
| | - Clare Mills
- Manchester Institute of Biotechnology, Division of Infection, Inflammation and Respiratory Medicine, School of Biological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| |
Collapse
|
34
|
Jackson DJ, Sicherer SH. Evidence-Based Product Label Reading in Food Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2944-2945. [PMID: 31540814 DOI: 10.1016/j.jaip.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Scott H Sicherer
- Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
35
|
Remington BC, Krone T, Kim EH, Bird JA, Green TD, Lack G, Fleischer DM, Koppelman SJ. Estimated risk reduction to packaged food reactions by epicutaneous immunotherapy (EPIT) for peanut allergy. Ann Allergy Asthma Immunol 2019; 123:488-493.e2. [PMID: 31442495 DOI: 10.1016/j.anai.2019.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/06/2019] [Accepted: 08/11/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Peanut allergy is a generally persistent, sometimes life-threatening food allergy. With no treatments demonstrating the ability to cure a food allergy, the focus of drugs in development has been on providing a level of protection against accidental exposure reactions. However, no study has estimated the relative risk reduction of a food-allergic population receiving a specific immunotherapeutic treatment for their allergies. OBJECTIVE To estimate the relative risk reduction when consuming peanut-contaminated packaged food products in a double-blind, placebo-controlled Phase 3 study population of children treated with epicutaneous immunotherapy (EPIT) for 12 months with either a patch containing 250 μg peanut protein (250-μg patch) or a placebo patch. METHODS The probability of an allergic reaction due to the unintended presence of peanut protein in packaged food products was modeled per study group and food category combination using Monte Carlo simulations. Risks per eating occasion of a contaminated packaged food product and the number of individuals per study population predicted to react on a yearly basis were investigated. RESULTS The population treated with the 250-μg patch demonstrated a significantly increased dose-response distribution after 12 months of treatment, which resulted in a relative risk reduction of 73.2% to 78.4% when consuming peanut-contaminated packaged food products. In contrast, no statistically significant change was observed for the placebo group at the 12-month point. CONCLUSION Our study estimates a substantial relative risk reduction for allergic reactions among peanut-allergic children after 12 months of EPIT with the 250-μg patch, supporting the potential real-world clinical relevance of this investigational immunotherapy and its possible role as a future therapy for peanut-allergic children. ClinicalTrials.gov Identifier: NCT02636699.
Collapse
Affiliation(s)
- Benjamin C Remington
- Netherlands Organisation for Applied Scientific Research TNO, Zeist, The Netherlands.
| | - Tanja Krone
- Netherlands Organisation for Applied Scientific Research TNO, Zeist, The Netherlands
| | - Edwin H Kim
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - J Andrew Bird
- University of Texas Southwestern Medical School, Dallas, Texas
| | - Todd D Green
- DBV Technologies, Montrouge, France; Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Gideon Lack
- Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - David M Fleischer
- Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Stef J Koppelman
- DBV Technologies, Montrouge, France; Food Allergy Research and Resource Program, University of Nebraska-Lincoln, Lincoln, Nebraska
| |
Collapse
|
36
|
Croote D, Braslavsky I, Quake SR. Addressing Complex Matrix Interference Improves Multiplex Food Allergen Detection by Targeted LC-MS/MS. Anal Chem 2019; 91:9760-9769. [PMID: 31339301 DOI: 10.1021/acs.analchem.9b01388] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The frequent use of precautionary food allergen labeling (PAL) such as "may contain" frustrates allergic individuals who rely on such labeling to determine whether a food is safe to consume. One technique to study whether foods contain allergens is targeted liquid chromatography-tandem mass spectrometry (LC-MS/MS) employing scheduled multiple reaction monitoring (MRM). However, the applicability of a single MRM method to many commercial foods is unknown as complex and heterogeneous interferences derived from the unique composition of each food matrix can hinder quantification of trace amounts of allergen contamination. We developed a freely available, open source software package MAtrix-Dependent Interference Correction (MADIC) to identify interference and applied it with a method targeting 14 allergens. Among 84 unique food products, we found patterns of allergen contamination such as wheat in grains, milk in chocolate-containing products, and soy in breads and corn flours. We also found additional instances of contamination in products with and without PAL as well as highly variable soy content in foods containing only soybean oil and/or soy lecithin. These results demonstrate the feasibility of applying LC-MS/MS to a variety of food products with sensitive detection of multiple allergens in spite of variable matrix interference.
Collapse
Affiliation(s)
- Derek Croote
- Department of Bioengineering , Stanford University , Stanford , California 94305 , United States
| | - Ido Braslavsky
- Department of Bioengineering , Stanford University , Stanford , California 94305 , United States.,Robert H. Smith Faculty of Agriculture, Food, and Environment , The Hebrew University of Jerusalem , Rehovot 7610001 , Israel
| | - Stephen R Quake
- Department of Bioengineering , Stanford University , Stanford , California 94305 , United States.,Department of Applied Physics , Stanford University , Stanford , California 94305 , United States.,Chan Zuckerberg Biohub , San Francisco , California 94158 , United States
| |
Collapse
|
37
|
Dua S, Ruiz-Garcia M, Bond S, Durham SR, Kimber I, Mills C, Roberts G, Skypala I, Wason J, Ewan P, Boyle R, Clark A. Effect of sleep deprivation and exercise on reaction threshold in adults with peanut allergy: A randomized controlled study. J Allergy Clin Immunol 2019; 144:1584-1594.e2. [PMID: 31319102 DOI: 10.1016/j.jaci.2019.06.038] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peanut allergy causes severe and fatal reactions. Current food allergen labeling does not address these risks adequately against the burden of restricting food choice for allergic patients because of limited data on thresholds of reactivity and the influence of everyday factors. OBJECTIVE We estimated peanut threshold doses for a United Kingdom population with peanut allergy and examined the effect of sleep deprivation and exercise. METHODS In a crossover study, after blind challenge, participants with peanut allergy underwent 3 open peanut challenges in random order: with exercise after each dose, with sleep deprivation preceding challenge, and with no intervention. Primary outcome was the threshold dose triggering symptoms (in milligrams of protein). Primary analysis estimated the difference between the nonintervention challenge and each intervention in log threshold (as percentage change). Dose distributions were modeled, deriving eliciting doses in the population with peanut allergy. RESULTS Baseline challenges were performed in 126 participants, 100 were randomized, and 81 (mean age, 25 years) completed at least 1 further challenge. The mean threshold was 214 mg (SD, 330 mg) for nonintervention challenges, and this was reduced by 45% (95% CI, 21% to 61%; P = .001) and 45% (95% CI, 22% to 62%; P = .001) for exercise and sleep deprivation, respectively. Mean estimated eliciting doses for 1% of the population were 1.5 mg (95% CI, 0.8-2.5 mg) during nonintervention challenge (n = 81), 0.5 mg (95% CI, 0.2-0.8 mg) after sleep, and 0.3 mg (95% CI, 0.1-0.6 mg) after exercise. CONCLUSION Exercise and sleep deprivation each significantly reduce the threshold of reactivity in patients with peanut allergy, putting them at greater risk of a reaction. Adjusting reference doses using these data will improve allergen risk management and labeling to optimize protection of consumers with peanut allergy.
Collapse
Affiliation(s)
- Shelley Dua
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Allergy, Addenbrooke's Hospital, Cambridge, United Kingdom.
| | - Monica Ruiz-Garcia
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom
| | - Simon Bond
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Stephen R Durham
- Allergy and Clinical Immunology, Section Inflammation Repair and Development National heart and Lung Institute, Faculty of Medicine, Imperial College, London and Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Clare Mills
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Graham Roberts
- NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; University of Southampton Faculty of Medicine, Southampton, United Kingdom
| | - Isabel Skypala
- National Heart and Lung Institute, Imperial College London and Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - James Wason
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Pamela Ewan
- Department of Allergy, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Robert Boyle
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom; Centre of Evidence-based Dermatology, University of Nottingham, Nottingham, United Kingdom
| | - Andrew Clark
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Allergy, Addenbrooke's Hospital, Cambridge, United Kingdom
| |
Collapse
|
38
|
Abstract
PURPOSE OF REVIEW The aim of this review is to describe effective management strategies in nursery or school based upon research findings. RECENT FINDINGS The prevalence of food allergy and number of emergency department visits for food-related anaphylaxis are increasing in children and adolescents. As there is currently no cure, the most effective strategy to decrease allergic reactions is food allergen avoidance. However, allergic reactions are inevitable in both food allergic children as well as in first-time reactors. Misconceptions exist on the safety of products with advisory labels and questions remain on whether school-wide bans decrease the risk of allergic reactions in school. Recent legislation has prompted schools to consider requiring unassigned epinephrine autoinjectors to better manage those who have allergic reactions in nursery or school. SUMMARY A collective effort is required to keep children with food allergies safe at school. Families, healthcare providers, and school personnel should be informed on food allergen avoidance strategies, symptoms consistent with allergic reactions and anaphylaxis, how to respond to allergic reactions, and the impact the diagnosis of food allergy may have on quality of life for affected children and their families.
Collapse
|
39
|
Self-reported anaphylaxis to packaged foods in Australia. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:687-689. [DOI: 10.1016/j.jaip.2018.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/31/2018] [Accepted: 09/07/2018] [Indexed: 01/09/2023]
|
40
|
Calegari LP, Fettermann DC. Uma análise conjunta para identificação dos atributos de um dispositivo para reconhecimento de características de produtos alimentícios customizados. BRAZILIAN JOURNAL OF FOOD TECHNOLOGY 2019. [DOI: 10.1590/1981-6723.02418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Resumo A possibilidade de combinação de ingredientes alimentícios em cada refeição torna complexo o reconhecimento das características dos alimentos personalizados. A utilização de dispositivos com tecnologias da Internet of Things (IoT) consiste em uma alternativa para os clientes acessarem informações dos alimentos personalizados. Nesta pesquisa, foram identificados cinco principais atributos na composição desses dispositivos com objetivo de reconhecimento dos ingredientes em refeições customizadas: (A) portabilidade, (B) precisão, (C) personalização de dieta, (D) análise de qualidade do produto alimentício e (E) preço. Este estudo possui como objetivo identificar a combinação desses atributos que geram valor em um dispositivo de reconhecimento de características alimentares de alimentos customizados. Foi realizado um planejamento fatorial fracionado 25-1 para a apresentação dos atributos do dispositivo na forma de cenários, seguindo o método de análise conjunta baseada em escolha. Para a coleta de dados, foi realizada uma pesquisa com uma amostra de 303 respondentes. Ainda foram analisadas as variáveis moderadoras: gênero e presença de restrição alimentar. Os resultados obtidos apresentaram maior significância para os atributos: precisão de medida e análise de qualidade. Como contribuições, este estudo apresenta informações para o direcionamento de investimentos em pesquisa para elaboração de um dispositivo tecnológico com a finalidade de reconhecer características de um produto alimentício customizado em massa.
Collapse
|
41
|
Food Allergy Prevalence in Salvadoran Schoolchildren Estimated by Parent-Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112446. [PMID: 30400207 PMCID: PMC6266739 DOI: 10.3390/ijerph15112446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 01/28/2023]
Abstract
The prevalence of food allergy (FA) has not been estimated at a population level in Central American countries and, consequently, the magnitude and relevance of the problem in the Central American region remains unknown. Thus, our aim was to evaluate the parent-reported prevalence of FA in a population of schoolchildren from the Central American country El Salvador. A Spanish version of a structured questionnaire was utilized. Five hundred and eight (508) parents returned the questionnaire with valid responses (response rate, 32%). The estimated prevalence rates (95% CI) were: adverse food reactions 15.9 (13.0–19.3), “perceived FA, ever” 11.6 (9.1–14.6), “physician-diagnosed FA, ever” 5.7% (4.0–8.0), “immediate-type FA, ever” 8.8% (6.6–11.6), “immediate-type FA, current” 5.3% (3.6–7.6), and anaphylaxis 2.5% (1.5–4.3). The most common food allergens were milk (1.7%), shrimp (1.3), chili (0.7%), chocolate (0.7%), and nuts (0.3%). Most of the “food-dependent anaphylaxis” cases (60.5%) sought medical attention, but only one case reported the prescription of an epinephrine autoinjector. Mild and severe FA cases are not uncommon among Salvadoran schoolchildren and both the prescription of epinephrine autoinjectors by healthcare personnel and the use of the autoinjectors by anaphylactic individuals should be encouraged.
Collapse
|
42
|
Remington BC, Krone T, Koppelman SJ. Quantitative risk reduction through peanut immunotherapy: Safety benefits of an increased threshold in Europe. Pediatr Allergy Immunol 2018; 29:762-772. [PMID: 30054934 DOI: 10.1111/pai.12961] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/16/2018] [Accepted: 07/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The clinical relevance of increasing an allergic individual's peanut sensitivity threshold by immunotherapy, that is, eliciting dose (ED) to 300 or 1000 mg peanut protein, has not been previously characterized in a European population. In this study, we quantify the clinical benefits of an increased threshold of reaction following immunotherapy for the peanut-allergic individual. METHODS Quantitative risk assessments incorporated numerous inputs to predict the risk of an allergic reaction after exposure to residual peanut protein in packaged foods. The three primary inputs for the risk assessment were the peanut-allergic individual's clinical threshold value, the amount of food consumed per eating occasion of selected packaged foods, and the concentration of peanut protein in the consumed product. Individual risk reductions were calculated for both children and adolescents-adults. RESULTS Using available consumption and packaged food contamination data, children reaching an ED of 300 mg (if initial ED ≤ 100 mg) or 1000 mg (if initial ED 300 mg) achieved >99.99% risk reduction. Adolescents-adults also achieved >99.99% risk reduction in all cases but one. Adolescents-adults who reached an ED of 300 mg (if initial ED ≤ 100 mg) achieved 99.3%-99.9% risk reduction when consuming ice cream. CONCLUSIONS It is concluded that an increase in threshold following immunotherapy which achieves an eliciting dose of 300 or 1000 mg peanut protein is clinically relevant for the European peanut-allergic population. Benefits of an increased threshold include a significant reduction in risk due to traces of peanut protein.
Collapse
Affiliation(s)
| | | | - Stef J Koppelman
- Food Allergy Research and Resource Program, University of Nebraska-Lincoln, Lincoln, Nebraska
| |
Collapse
|
43
|
Papadopoulos A, Elegbede CF, Ait-Dahmane S, Dubuisson C, Deschildre A, Crépet A. Tree nut allergy and anxiety related factors modulate food consumption behaviour in peanut-allergic patients: Results of the MIRABEL survey. Regul Toxicol Pharmacol 2018; 99:191-199. [DOI: 10.1016/j.yrtph.2018.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
|
44
|
|
45
|
Blom WM, Michelsen-Huisman AD, van Os-Medendorp H, van Duijn G, de Zeeuw-Brouwer ML, Versluis A, Castenmiller JJ, Noteborn HP, Kruizinga AG, Knulst AC, Houben GF. Accidental food allergy reactions: Products and undeclared ingredients. J Allergy Clin Immunol 2018; 142:865-875. [DOI: 10.1016/j.jaci.2018.04.041] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 03/28/2018] [Accepted: 04/09/2018] [Indexed: 11/29/2022]
|
46
|
Soon JM. Structural modelling of food allergen knowledge, attitude and practices among consumers in Malaysia. Food Res Int 2018; 111:674-681. [PMID: 30007732 DOI: 10.1016/j.foodres.2018.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
Abstract
The aim of this study was to assess food allergen knowledge, attitude and self-reported practices among consumers in Malaysia. An online survey was conducted and data were analysed using descriptive statistics and exploratory factor analysis. A model linking food allergen knowledge and attitude and their direct effects on practices were confirmed using structural equation modelling (SEM). Consumers demonstrated moderate food allergen knowledge in this study but scored highly in their attitude towards food allergens. Although participants scored moderately in food allergen knowledge, this does not necessarily translate into practices. There is a possibility that an increase in food allergen knowledge can increase optimistic bias or a sense of over-confidence to manage allergen risks. Consumers' attitude towards food allergens has a positive and significant influence on practices. A positive attitude represents personal beliefs and reflects the level of motivation and care required to manage food allergens effectively. There was insignificant relationship between food allergen knowledge and attitude. This demonstrates a need to tailor targeted risk communication and learning strategies to influence consumers' practices.
Collapse
Affiliation(s)
- Jan Mei Soon
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK.
| |
Collapse
|
47
|
Graham F, Eigenmann PA. Clinical implications of food allergen thresholds. Clin Exp Allergy 2018; 48:632-640. [DOI: 10.1111/cea.13144] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- F. Graham
- Pediatric Allergy Unit; University Hospitals of Geneva and University of Geneva; Geneva Switzerland
| | - P. A. Eigenmann
- Pediatric Allergy Unit; University Hospitals of Geneva and University of Geneva; Geneva Switzerland
| |
Collapse
|
48
|
Calegari LP, Barbosa J, Marodin GA, Fettermann DC. A conjoint analysis to consumer choice in Brazil: Defining device attributes for recognizing customized foods characteristics. Food Res Int 2018; 109:1-13. [PMID: 29803431 DOI: 10.1016/j.foodres.2018.03.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/27/2018] [Accepted: 03/30/2018] [Indexed: 01/20/2023]
Abstract
the availability of information about food products may be an essential factor in the consumer's value perception in their purchasing decision. As the food product becomes personalized, the customization of this information becomes complex due to the possible combinations of product components. The use of smart technology in devices is one way to provide customers with customized food information. In the following research five attributes were identified in the composition of these devices: (A) portability; (B) precision; (C) diet customization; (D) food quality analysis; and (E) price. This study aims to identify the appropriate combination of possible functionalities or attributes that must be present in a device in order to detect the food composition of customized foods and their relation to market characteristics. One experiment used fractional factorial project to present the attributes in the form of scenarios following the Choice-Based Conjoint Analysis (CBCA) method. The data collection was done using survey methodology, through online questionnaire, with some 303 Brazilian respondents. So, the Logistic Regression was applied to data analysis. The moderating variables-gender, age, gluten restriction, lactose restriction and other restrictions-were also added to verify potential interactions with the primary attributes. From the results obtained, it was possible to observe higher significance for the primary attributes of diet personalization and quality food analyzes function. Our study contributes to the literature by enhancing the understanding about what the attributes should be in a technological device that has the purpose of recognizing food characteristics and is capable of generating information about customized food products. Furthermore, this device can enabler the production of mass customized food with the nutritional labels for each possible combination.
Collapse
Affiliation(s)
- L P Calegari
- Department of Industrial Engineering and Systems, Federal University of Santa Catarina, Florianópolis, Brazil.
| | - J Barbosa
- Department of Industrial Engineering and Systems, Federal University of Santa Catarina, Florianópolis, Brazil
| | - G A Marodin
- Departament of Management Science, University of South Carolina, Columbia, USA..
| | - D C Fettermann
- Department of Industrial Engineering and Systems, Federal University of Santa Catarina, Florianópolis, Brazil.
| |
Collapse
|
49
|
Soon JM. Food allergen labelling: "May contain" evidence from Malaysia. Food Res Int 2018; 108:455-464. [PMID: 29735079 DOI: 10.1016/j.foodres.2018.03.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/23/2018] [Accepted: 03/25/2018] [Indexed: 10/17/2022]
Abstract
Food allergen labelling is mandatory and regulated whilst precautionary allergen labelling (PAL) remains voluntary in most countries. It is the aim of this study to identify the food allergens declared in food products sold in a developing country and to what extent food allergens and PAL are emphasised in the products. A total of 505 food and beverages (snacks, baked goods, confectionary, baby food, condiments & jams, beverages, powder & paste, instant food, chilled & frozen food and canned food) were evaluated in Malaysia. Soybean represents the largest group of food allergen declared in labels, followed by wheat and milk products. Thirteen variations of contains statement were found with "Contains [allergen(s)]" being the most common (55.02%). There were 22 different types of "may contain" statements with 'May contain traces of [allergen(s)]' being the most common advice labelling used (55.41%). Different font type or emphasis such as brackets (51.57%) and bold font (33.86%) were used to inform consumers about presence of allergens. The national regulations on food allergen labelling are then critically contrasted with other Asian countries and the EU Regulation No. 1169/2011, which represents one of the most stringent food regulations in the world. Improving current allergen labelling limitations and practices would be of great benefit to consumers to prevent risk of food hypersensitivity.
Collapse
Affiliation(s)
- Jan Mei Soon
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK.
| |
Collapse
|
50
|
Greenhawt M. Environmental exposure to peanut and the risk of an allergic reaction. Ann Allergy Asthma Immunol 2018; 120:476-481.e3. [PMID: 29555352 DOI: 10.1016/j.anai.2018.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/07/2018] [Accepted: 03/12/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To review the evidence of the risk of environmental exposure to peanut to a peanut allergic individual. DATA SOURCES AND STUDY SELECTION A narrative review was performed using a PubMed search of relevant articles involving peanut environmental distribution, environmental peanut abatement, and public policy regarding peanut restriction. RESULTS Data from 4 studies have shown that peanut butter vapors and smeared peanut butter on skin do not cause systemic reactions, that peanut can be abated from hands and surfaces using appropriate cleaning agents, and that shelled peanut dust does not become airborne. Studies have recently confirmed dose of 1.5 mg of peanut protein would be generally tolerated by approximately 95% of the peanut-allergic population based on objective symptoms in challenge-based studies, affirming earlier research. Restrictive policies that focus on bans (or restricted presence in certain areas) of peanuts or peanut-containing products in environments such as schools or on commercial aircraft are not backed by evidence that such measures work, which may raise an uncomfortable clash between accommodations that lack any medical evidence of necessity and a desire to provide measures that comfort our patients. CONCLUSION There is little risk posed from non-oral exposure to peanut in the environment, from casual contact, proximity, or inhalation. If 5% of the population may tolerate a threshold of approximately 1.5 mg of peanut protein, this may help liberate behavior and situational-decision making regarding the necessity of certain avoidances and restrictions. Continued work is needed to dispel myths about the mechanisms of how peanut may induce an allergic reaction.
Collapse
Affiliation(s)
- Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Section of Allergy and Immunology, Aurora, Colorado.
| |
Collapse
|