1
|
Li JC, Rotter NS, Stieb ES, Stockbridge JL, Theodorakakis MD, Shreffler WG. Utility of food allergy thresholds. Ann Allergy Asthma Immunol 2024; 132:321-327. [PMID: 38114041 DOI: 10.1016/j.anai.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023]
Abstract
Food allergy is a prevalent disease worldwide that is a significant quality-of-life burden, and accidental exposures to food allergens may elicit severe, life-threatening reactions such as anaphylaxis. The threshold level, or the dose that triggers an allergic reaction determined by oral food challenges, varies considerably among individuals suffering from food allergies. Moreover, IgE concentration, diversity, or function can only partially explain this variation in threshold; pathogenic effector TH2 cells have also been found to contribute to the eliciting dose. Though very sensitive to cofactors such as physical activity/stress, the threshold is a stable and reproducible feature of an individual's allergy over periods of many months, made clear in the past several years from treatment studies in which repeated threshold determination has been used as a treatment outcome; however, there also seem to be age-related changes at a population level. More routine determination of food allergy thresholds may help patients stratify risk to improve the management of their food allergy. Precautionary allergen labeling, such as "may contain" labels, often causes confusion since they are inconsistent and regularly contain little to trace allergen residues; thus, food products with such labeling may be unnecessarily avoided. Population-based eliciting dose levels have been determined in the literature; patients at lower risk with higher thresholds may be more confident with introducing foods with precautionary allergen labels. Understanding a patient's threshold level could aid in shared decision-making to determine the most suitable treatment options for patients, including the starting dose for oral immunotherapy and/or the use of biologics.
Collapse
Affiliation(s)
- Jennifer C Li
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nancy S Rotter
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Elisabeth S Stieb
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer L Stockbridge
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts
| | - Maria D Theodorakakis
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Wayne G Shreffler
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts.
| |
Collapse
|
2
|
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
|
3
|
Dominguez S, Théolier J, Lizée K, Povolo B, Gerdts J, Godefroy SB. "Vegan" and "plant-based" claims: risk implications for milk- and egg-allergic consumers in Canada. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:74. [PMID: 37620965 PMCID: PMC10464346 DOI: 10.1186/s13223-023-00836-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
The market share of foods carrying labels suggesting absence of animal ingredients has significantly increased in recent years. The purpose of this study was to document the purchasing behaviour of egg- or milk-allergic consumers vis-à-vis food marketed as "vegan" and "plant-based", and to evaluate the associated allergenic risk. A survey was conducted among egg- and milk-allergic consumers and revealed that 86% (margin of error 5.4%; confidence level 95%) would buy "vegan" products, indicating this label may be perceived as a substitute for "free from milk and eggs". To assess the risk posed by these products, 87 prepackaged foods with "vegan" and/or "plant-based" claims purchased in Quebec were tested for milk proteins, and 64 for egg proteins. Overall, 5.7% and 0% occurrence of milk and egg proteins, respectively, were observed, suggesting that the analysed prepackaged foods carrying "vegan" and/or "plant-based" labels pose little risk to egg- or milk-allergic consumers. However, this is likely due to allergen management practices applied by the Canadian manufacturers of the products tested, and should not be attributed to the use of "vegan" or similar labels. Enhanced regulatory requirements for the use of these labels, and an education campaign on their meaning with respect to allergy-related risks, are necessary to better inform and protect egg- and milk-allergic consumers.
Collapse
Affiliation(s)
- Silvia Dominguez
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, 2440 Hochelaga Boulevard, Quebec, QC, 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, 2440 Hochelaga Boulevard, Quebec, QC, G1V 0A6, Canada
| | - Kamila Lizée
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, 2440 Hochelaga Boulevard, Quebec, QC, G1V 0A6, Canada
| | - Beatrice Povolo
- Food Allergy Canada, 505 Consumers Drive, Suite 507, Toronto, ON, M2J 4A2, Canada
| | - Jennifer Gerdts
- Food Allergy Canada, 505 Consumers Drive, Suite 507, Toronto, ON, M2J 4A2, 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, 2440 Hochelaga Boulevard, Quebec, QC, G1V 0A6, Canada
| |
Collapse
|
4
|
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
|
5
|
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
|
6
|
Théolier J, Vatin G, Barrère V, Dominguez S, Godefroy SB. Spent fowl as a source of unintentional egg proteins exposure in Canadian food products. Poult Sci 2022; 101:102003. [PMID: 35841641 PMCID: PMC9289861 DOI: 10.1016/j.psj.2022.102003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022] Open
Abstract
The occurrence of egg proteins in products containing spent fowl manufactured under current practices was studied to assess the risk these food products may pose to egg-allergic consumers and to determine if Precautionary Allergen Labelling (PAL) was recommended. Spent fowl slaughtering and processing operations in 2 Canadian facilities were observed. Raw hen pieces (n = 134), coming from 2 facilities, and intermediate and processed products containing spent fowl (n = 57), coming from one facility, were analyzed using ELISA. All samples tested positive for egg proteins. Raw pieces were tested using a qualitative method (i.e., swabbing); estimated egg proteins concentrations suggest the presence of highly contaminated samples (>600 mg/kg in 2 hen wing samples). Swabbing was found to be efficient for rapid detection of eggs in raw hen pieces, but not for quantification. A comparison between swab and grind results showed that egg proteins concentration is underestimated by at least a factor 2 for whole carcasses and a factor 10 for breast, wings and drumsticks, when using the swab protocol. For intermediate and processed products, quantitative measurements indicate that egg protein levels were below 16 mg/kg. Additionally, 88 water samples from chiller tanks were analyzed and indicate that this step could be the cause of the global contamination observed with an increase in egg protein concentrations overtime during the production schedule. As egg contamination is not adequately controlled under the current good production practices, the use of PAL would be recommended for raw spent fowl products.
Collapse
Affiliation(s)
- Jérémie Théolier
- Food Risk Analysis and Regulatory Excellence Platform, Institute of Nutrition and Functional Foods, Laval University, Québec, Canada.
| | - Gabrielle Vatin
- Food Risk Analysis and Regulatory Excellence Platform, Institute of Nutrition and Functional Foods, Laval University, Québec, Canada
| | - Virginie Barrère
- Food Risk Analysis and Regulatory Excellence Platform, Institute of Nutrition and Functional Foods, Laval University, Québec, Canada
| | - Silvia Dominguez
- Food Risk Analysis and Regulatory Excellence Platform, Institute of Nutrition and Functional Foods, Laval University, Québec, Canada
| | - Samuel Benrejeb Godefroy
- Food Risk Analysis and Regulatory Excellence Platform, Institute of Nutrition and Functional Foods, Laval University, Québec, Canada
| |
Collapse
|
7
|
Manny E, Dominguez SA, Barrère V, Théolier J, Godefroy SB. Allergen action levels for food industries as risk management tools for a better use of precautionary Allergen labelling. Food Control 2022. [DOI: 10.1016/j.foodcont.2021.108773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
8
|
Soon JM, Abdul Wahab IR. Global food recalls and alerts associated with labelling errors and its contributory factors. Trends Food Sci Technol 2021. [DOI: 10.1016/j.tifs.2021.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
9
|
Shelver WL, McGarvey AM, Yeater KM. Performance of allergen testing in a survey of frozen meals and meals ready-to-eat (MREs). Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2021; 38:1249-1259. [PMID: 34014811 DOI: 10.1080/19440049.2021.1914870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/28/2021] [Indexed: 01/29/2023]
Abstract
A 7-plex immunoassay capable of detecting cashew, egg, hazelnut, milk, peanut, shrimp, and soy allergens was used to screen meals ready-to-eat (MREs) and frozen meals that contained meat or poultry. The same food matrices were also evaluated using single individual allergen immunoassays. Multiplex and single allergen test results were compared with the allergen declared on the food label, which was considered the standard. For both the frozen meals (n = 113) and MREs (n = 24) each analytical method failed to detect allergens that were declared on product labels, but only in frozen meals were allergens detected that were not declared on the label. Undeclared allergens were detected for egg in 1.8% (2/113) and for soy in 7.1% (8/113) of frozen meals. Labelled allergens were not detected in 0.9% (1/113) of milk, 4.4% (5/113) of egg, and 15% (17/113) of soy allergens in frozen meals. Assay performance for evaluating allergens in MREs was poor.
Collapse
Affiliation(s)
- Weilin L Shelver
- USDA Agricultural Research Service, Biosciences Research Laboratory, Edward T. Schafer Agricultural Research Center, Fargo, North Dakota, U.S.A
| | - Amy M McGarvey
- USDA Agricultural Research Service, Biosciences Research Laboratory, Edward T. Schafer Agricultural Research Center, Fargo, North Dakota, U.S.A
| | - Kathleen M Yeater
- Plains Area Administrative Office, USDA Agricultural Research Service, Fort Collins, Colorado, U.S.A
| |
Collapse
|
10
|
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
|
11
|
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
|