Abstract
Regional and national legislation mandates the disclosure of “priority” allergens when present as an ingredient in foods, but this does not extend to the unintended presence of allergens due to shared production facilities. This has resulted in a proliferation of precautionary allergen (“may contain”) labels (PAL) that are frequently ignored by food-allergic consumers. Attempts have been made to improve allergen risk management to better inform the use of PAL, but a lack of consensus has led to variety of regulatory approaches and nonuniformity in the use of PAL by food businesses. One potential solution would be to establish internationally agreed “reference doses,” below which no PAL would be needed. However, if reference doses are to be used to inform the need for PAL, then it is essential to characterize the hazard associated with these low-level exposures. For peanut, there are now published data relating to over 3000 double-blind, placebo-controlled challenges in allergic individuals, but a similar level of evidence is lacking for other priority allergens. We present the results of a rapid evidence assessment and meta-analysis for the risk of anaphylaxis to a low-level allergen exposure for priority allergens. On the basis of this analysis, we propose that peanut can and should be considered an exemplar allergen for the hazard characterization at a low-level allergen exposure.
Highlights
In this rapid evidence assessment and meta-analysis, we found no evidence to suggest that other priority allergens can result in a higher rate of anaphylaxis at low doses of allergen exposure, compared with peanut (Table V)
We did not identify any cases of anaphylaxis at ED05 levels that were refractory to treatment
For many of the reports included in this analysis, a significant proportion of anaphylaxis reactions were not treated with epinephrine/adrenaline
Summary
TREE NUTS Three studies were identified in which nut-allergic patients underwent a formal FC to a range of tree nuts.
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