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Fierro V, Mazzuca C, Urbani S, Dahdah L, Calandrelli V, Valluzzi RL, Giulio D. Perspectives in precautionary allergen labelling of prepackaged foods after the FAO/WHO consultation. Curr Opin Allergy Clin Immunol 2024; 24:166-170. [PMID: 38547411 DOI: 10.1097/aci.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of the perspectives regarding precautionary allergen labelling (PAL) of prepackaged foods following the consultation conducted by the Food and Agriculture Organization (FAO) and the WHO. RECENT FINDINGS The FAO/WHO consultation provided a comprehensive assessment of the current status and practices of PAL implementation worldwide. One of the key findings highlighted by the Expert Committee was the need for improvement in existing PAL systems. It was noted that many countries lacked uniformity in PAL practices, leading to inconsistencies in labelling and potentially misleading information for consumers. Furthermore, the consultation emphasized the importance of PAL being risk-based, taking into account both the amount and frequency of unintended allergen presence (UAP) in food products. SUMMARY The FAO/WHO consultation shed light on various perspectives and challenges associated with PAL of prepackaged foods. Key findings emphasized the need for improvement in existing PAL systems, including the adoption of a risk-based approach, standardized regulations, and enhanced transparency. Moving forward, collaborative efforts between regulatory agencies, food manufacturers, and consumer advocacy groups will be essential in developing effective PAL strategies that prioritize consumer safety and well being.
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Affiliation(s)
- Vincenzo Fierro
- Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome
| | - Carmen Mazzuca
- Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome
| | - Sara Urbani
- Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome
| | - Lamia Dahdah
- Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome
| | | | | | - Dinardo Giulio
- Department of Women, Children, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
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Dinardo G, Fierro V, Del Giudice MM, Urbani S, Fiocchi A. Food-labeling issues for severe food-allergic consumers. Curr Opin Allergy Clin Immunol 2023; 23:233-238. [PMID: 37185828 DOI: 10.1097/aci.0000000000000902] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW Food label represent the primary and only source of information before consuming a food product. Deputy government agencies on five continents require allergenic ingredients to be declared when used in prepackaged foods to assist patients in identifying allergenic foods and to help them to choose wisely. Unfortunately, the mandatory allergen list and legislation regarding food labels and reference doses is not uniform and varies by country. This may add difficulties to food-allergic patients, especially those with severe food allergy. RECENT FINDINGS A new definition of food allergy severity (the DEFASE grid, developed by the World Allergy Organization), aims to assist clinicians in the identification of the at-risk patients. The FASTER ACT and Natasha's Laws has made important improvements such as the entry of sesame as a major allergen in the United States, and increased evidence of allergens on the food label within prepackaged for direct sale (PPDS) in the UK. The recent introduction of Vital 3.0 brought important new features such as an updated reference doses for many foods. SUMMARY Currently, there are still considerable differences regarding food labels in different countries. Growing public and scientific attention to the problem promises to increase the food safety for allergens. Among the next improvements, we expect a reconsideration of the food reference doses, a harmonization of the food oral challenge process, and the promulgation of regulatory rules for the precautionary labeling.
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Affiliation(s)
- Giulio Dinardo
- University of Campania Luigi Vanvitelli: Universita degli Studi della Campania Luigi Vanvitelli, Naples
| | - Vincenzo Fierro
- Bambino Gesu Pediatric Hospital: Ospedale Pediatrico Bambino Gesu, Rome, Italy
| | | | - Sara Urbani
- Bambino Gesu Pediatric Hospital: Ospedale Pediatrico Bambino Gesu, Rome, Italy
| | - Alessandro Fiocchi
- Bambino Gesu Pediatric Hospital: Ospedale Pediatrico Bambino Gesu, Rome, Italy
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Bjelac J, Abrams EM, Iglesia EGA. Food allergies on vacation-there and back again. Ann Allergy Asthma Immunol 2023; 130:438-443. [PMID: 36690205 DOI: 10.1016/j.anai.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Food allergy is an important public health concern that affects all facets of life, and travel is no exception. We sought to provide a scoping review regarding the literature pertaining to management of FA while traveling. DATA SOURCES Medline and Embase were queried for English-language articles published in the last 20 years containing "food allergy" and "travel". STUDY SELECTIONS The search produced 83 references which were reviewed. After removal of duplicates and irrelevant material, 23 references that discussed travel and FA remained, 13 of which were conference abstracts published as supplemental material. RESULTS Priorities for consideration by patient-families and their allergist-immunologist include concern for reactions away from home, proximity to emergency medical services, risk for various methods of travel including potential for cross-contact exposure resulting in symptoms, and considerations for international travel including language barriers. CONCLUSION Patients with FA must use careful planning and preparation to ensure access to safe food and emergency medications at all times while away from home.
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Affiliation(s)
- Jaclyn Bjelac
- Food Allergy Center of Excellence, Center for Pediatric Allergy and Immunology, Cleveland Clinic, Cleveland, Ohio.
| | - Elissa M Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Edward G A Iglesia
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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López-Calvo R, Hidalgo-Víquez C, Mora-Villalobos V, González-Vargas M, Alvarado R, Peña-Vásquez M, Barboza N, Redondo-Solano M. Analysis of knowledge, attitude, and practices (KAP) regarding food allergies in social network users in Costa Rica. Food Control 2022. [DOI: 10.1016/j.foodcont.2022.109031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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]
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Fiocchi A, Risso D, DunnGalvin A, González Díaz SN, Monaci L, Fierro V, Ansotegui IJ. Food labeling issues for severe food allergic patients. World Allergy Organ J 2021; 14:100598. [PMID: 34703523 PMCID: PMC8503658 DOI: 10.1016/j.waojou.2021.100598] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/30/2021] [Accepted: 09/20/2021] [Indexed: 01/22/2023] Open
Abstract
Food allergy carries high importance and responsibility, affecting an estimated 220 million people worldwide. It is a frequent cause of food-induced anaphylaxis, a life-threatening condition requiring a toll of about one death per 50 million people a year worldwide. In order to help patients to identify allergenic foods and thus avoid anaphylactic reactions, 66 countries over the 5 continents require by law that allergenic ingredients must be declared when used in prepackaged foods. Unfortunately, the mandatory allergen list is not uniform, but varies among different countries. The widespread adoption of Precautionary Allergen Labeling (PAL) results in a proliferation of unregulated PALs with different informative statements. In this situation, the need of a scientific consensus on the definition of food allergy and the identification of a tolerable risk with routinely used detection assays, considering not only the eliciting dose but also the food source, is urgent. The aim of this manuscript is: 1) to draw a picture of the global situation in terms of PALs, and 2) to highlight new approaches that could aid in tackling the problem of regulating the labeling of allergens. These include the Voluntary Incidental Trace Allergen Labelling (VITAL) system, which intersects reference doses and labelling decisions, and a direct quantification of trace amounts of allergens at lower limit of detection (LOD) levels in the food itself through proteomics. We here highlight how, although with some limitations, the steady advances in proteomic approaches possess higher sensitivity than the recommended VITAL reference doses, allowing the identification of allergens at much lower LOD levels than VITAL. Considering that each assay used to detect allergen in food products carries method-specific issues, a more comprehensive and harmonized approach implementing both quantitative and qualitative methods could help overcoming the risk stratification approach and the overuse of PALs, offering promise as the field moves forward towards improving consumers' quality of life.
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Affiliation(s)
- Alessandro Fiocchi
- Translational Research in Pediatric Specialities Area, Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Davide Risso
- Soremartec Italia Srl, Ferrero Group, Alba, CN, Italy
| | - Audrey DunnGalvin
- School of Applied Psychology, University College Cork, Ireland
- Faculty of Paediatrics, Sechenov University, Moscow, Russia
| | - Sandra N. González Díaz
- Autonomous University of Nuevo León, Faculty of Medicine and University Hospital “Dr. José Eleuterio González”, Monterrey, Nuevo León, Mexico
| | - Linda Monaci
- Institute of Sciences of Food Production (ISPA), National Research Council of Italy (CNR), Via G. Amendola 122/O, Bari, 70126, Italy
- MoniQA Association, Güssing, Vienna, 7540, Austria
| | - Vincenzo Fierro
- Translational Research in Pediatric Specialities Area, Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology at Hospital Quironsalud Bizkaia in Bilbao, Spain
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Meima MY, Remington BC, Blom WM, Baumert JL, Taylor SL, Jeffery B, Robert MC, Houben GF, Lucas Luijckx NB. Methods to determine the risk of unintended allergen presence related to the dispersion of allergenic food particles in food production areas. Food Control 2021. [DOI: 10.1016/j.foodcont.2020.107850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Venter C, Sicherer SH, Greenhawt M. Management of Peanut Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 7:345-355.e2. [PMID: 30717865 DOI: 10.1016/j.jaip.2018.10.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 01/14/2023]
Abstract
Peanut allergy is a growing public health concern in westernized countries. Peanut allergy is characterized as an often severe and lifelong allergy, which can have detrimental effects on quality of life and trigger anxiety. Although multiple therapeutic options are emerging, the focus of current management strategies is strict peanut avoidance and carriage of self-injectable epinephrine. The greatest risk of reacting to peanut comes from direct ingestion, whereas casual skin contact or airborne exposure is highly unlikely to provoke significant symptoms. Patients and families must be educated about how to best execute strict peanut avoidance through careful label reading as well as how to understand and address likely and unlikely risk with regard to peanut exposure in public, in particular when dining outside of the home and for children attending school or child care. This review discusses the risk of exposure in public such as at school or on an airplane and how such risk can be abated, situations and scenarios when dining out of the house that may pose more risks than others, the essentials of US and EU label reading laws with particular emphasis on precautionary labeling and the risk implied by such, quality of life and psychosocial issues that may affect the peanut allergic individual and family, and a discussion of how risk may differ and evolve based on the patient's age.
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Affiliation(s)
- Carina Venter
- Section of Allergy and Immunology, Children's Hospital Colorado, Food Challenge and Research Unit, University of Colorado School of Medicine, Aurora, Colo; The David Hide Asthma and Allergy Research Centre, Newport, Isle of Wight, United Kingdom.
| | - Scott H Sicherer
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai and the Jafee Food Allergy Institute, New York, NY
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, Food Challenge and Research Unit, University of Colorado School of Medicine, Aurora, Colo
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Frith K, Katelaris CH. Current perspectives on peanut allergy. Intern Med J 2020; 49:1480-1487. [PMID: 31808255 DOI: 10.1111/imj.14658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 12/18/2022]
Abstract
Peanut allergy is increasingly prevalent and for most patients is a life-long condition, with the potential to cause life-threatening reactions. Accurate diagnosis and appropriate management are essential to minimise risks due to accidental peanut exposure. Current management strategies focus on strict allergen avoidance and access to emergency medicines to treat potential reactions; however, active approaches are an area of intense research. Promising new methods of food allergen immunotherapy are set to change the approach to managing peanut allergic patients in the near future.
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Affiliation(s)
- Katie Frith
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital and University of New South Wales, Sydney, New South Wales, Australia
| | - Constance H Katelaris
- Department of Immunology, Campbelltown Hospital and Western Sydney University, Sydney, New South Wales, Australia
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Capucilli P, Wang KY, Spergel JM. Food reactions during avoidance: Focus on peanut. Ann Allergy Asthma Immunol 2020; 124:459-465. [PMID: 32001367 DOI: 10.1016/j.anai.2020.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Peanut allergy has historically been difficult to manage, with most cases persisting into adulthood. Novel therapies for peanut allergy treatment are on the horizon, yet allergists must maintain a robust understanding of the risks and benefits of the current standard of therapy, avoidance diet. DATA SOURCES A comprehensive literature search using PubMed of reviews and clinical articles was performed. STUDY SELECTIONS Articles discussing peanut or other food-related allergic reactions, accidental exposures or anaphylaxis pertinent to avoidance diet or comparative to oral immunotherapy trials were selected. RESULTS Peanut remains a leading allergen associated with accidental ingestions responsible for food-related reactions, both mild and severe. Fatal reactions, however, are rare and measures such as anaphylaxis plans can significantly decrease the risk of accidental anaphylaxis. Patients may over estimate situations thought to increase risk for reactions to peanut, such as inhalation or contact through skin. In oral immunotherapy trials, the rate of anaphylaxis secondary to treatment was significantly higher than avoidance practices. CONCLUSION Clinicians should continue to discuss avoidance as a viable option for long-term peanut allergy management and empower patients to differentiate relevant situations in which accidental reactions might occur.
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Affiliation(s)
- Peter Capucilli
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Kathleen Y Wang
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jonathan M Spergel
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
Purpose of Review We reviewed the existing evidence base to desensitisation for food allergy, applying the Grading of Recommendations, Assessment, Development and Evaluation approach to discuss whether desensitisation is likely to become part of routine treatment for patients with food allergy. Recent Findings Desensitisation for food allergy to peanut, egg and cow’s milk is efficacious, but whether such interventions are cost-effective is less clear, due to the issues over a sustained desensitisation effect and the increase in allergic reactions occurring in patients on treatment. Few studies have assessed the change in health-related quality of life associated with treatment, and most have not considered discordance between parent-reported changes in health-related quality of life (HRQL) outcomes compared to those of the patients themselves; none to date have controlled for the improvement in HRQL occurring after initial challenge which will confound outcomes. Summary The lack of longer-term safety and cost-effectiveness data, as well as an absence of current consensus in the reporting of patient-relevant outcomes, must be addressed in order to be able to recommend the introduction of desensitisation as a routine treatment in healthcare systems.
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Affiliation(s)
- Bettina Duca
- Section of Paediatrics (Allergy and Infectious Diseases), Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Nandinee Patel
- Section of Paediatrics (Allergy and Infectious Diseases), Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Paul J Turner
- Section of Paediatrics (Allergy and Infectious Diseases), Imperial College London, Norfolk Place, London, W2 1PG, UK.
- Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, Australia.
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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]
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Venter C, Groetch M, Netting M, Meyer R. A patient-specific approach to develop an exclusion diet to manage food allergy in infants and children. Clin Exp Allergy 2018; 48:121-137. [DOI: 10.1111/cea.13087] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 12/19/2022]
Affiliation(s)
- C. Venter
- Children's Hospital Colorado; University of Colorado; Aurora CO USA
| | - M. Groetch
- Icahn School of Medicine at Mount Sinai; Jaffe Food Allergy Institute; New York NY USA
| | - M. Netting
- Healthy Mothers Babies and Children's Theme; South Australian Health & Medical Research Institute; Adelaide SA Australia
- Discipline of Paediatrics; School of Medicine; University of Adelaide; Adelaide SA Australia
- Nutrition Department; Women's and Children's Health Network; Adelaide SA Australia
| | - R. Meyer
- Department Paediatrics; Imperial College; London UK
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Zurzolo GA, Peters RL, Koplin JJ, de Courten M, Mathai ML, Allen KJ. Are food allergic consumers ready for informative precautionary allergen labelling? Allergy Asthma Clin Immunol 2017; 13:42. [PMID: 29033984 PMCID: PMC5628481 DOI: 10.1186/s13223-017-0214-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/04/2017] [Indexed: 01/27/2023] Open
Abstract
Precautionary allergen labelling (PAL) has resulted in consumer confusion. Previous research has shown that interpretive labels (using graphics, symbols, or colours) are better understood than the traditional forms of labels. In this study, we aimed to understand if consumers would use interpretive labels (symbol, mobile phone application and a toll-free number) with or without medical advice that was advocated by the food industry rather than the normal PAL. This is relevant information for industry and clinicians as it provides an insight into the food allergic perception regarding PAL.
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Affiliation(s)
- Giovanni A Zurzolo
- Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, Melbourne, Australia.,Centre for Food & Allergy Research, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Rachel L Peters
- Centre for Food & Allergy Research, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Jennifer J Koplin
- Centre for Food & Allergy Research, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Maximilian de Courten
- Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Michael L Mathai
- Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, Melbourne, Australia.,Centre for Food & Allergy Research, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Katrina J Allen
- Centre for Food & Allergy Research, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Melbourne, Australia.,Institute of Inflammation and Repair, University of Manchester, Manchester, UK
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Food labeling issues in patients with severe food allergies: solving a hamlet-like doubt. Curr Opin Allergy Clin Immunol 2017; 17:204-211. [DOI: 10.1097/aci.0000000000000362] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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