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Proposal of 0.5 mg of protein/100 g of processed food as threshold for voluntary declaration of food allergen traces in processed food-A first step in an initiative to better inform patients and avoid fatal allergic reactions : A GA(2)LEN position paper

Authors :
Zuberbier, Torsten
Doerr, Tamara
Aberer, Werner
Alvaro, Montserrat
Angier, Elizabeth
Arasi, Stefania
Arshad, Hasan
Ballmer-Weber, Barbara
Bartra, Joan
Beck, Lisa
Begin, Philippe
Bindslev-Jensen, Carsten
Bislimovska, Jovanka
Bousquet, Jean
Brockow, Knut
Bush, Andrew
Cianferoni, Antonella
Cork, Michael J.
Custovic, Adnan
Darsow, Ulf
Jong, Nicolette
Deleanu, Diana
Del Giacco, Stefano
Deschildre, Antoine
Galvin, Audrey Dunn
Ebisawa, Motohiro
Fernandez-Rivas, Montserrat
Ferrer, Marta
Fiocchi, Alessandro
van Wijk, Roy Gerth
Gotua, Maia
Grimshaw, Kate
Gruenhagen, Josefine
Heffler, Enrico
Hide, Michihiro
Hoffmann-Sommergruber, Karin
Incorvaia, Cristoforo
Janson, Christer
John, Swen Malte
Jones, Carla
Jutel, Marek
Katoh, Norito
Kendziora, Benjamin
Kinaciyan, Tamar
Knol, Edward
Kurbacheva, Oksana
Lau, Susanne
Loh, Richard
Lombardi, Carlo
Mäkelä, Mika
Marchisotto, Mary Jane
Makris, Michael
Maurer, Marcus
Meyer, Rosan
Mijakoski, Dragan
Minov, Jordan
Mullol, Joaquim
Nilsson, Caroline
Nowak-Wegrzyn, Anna
Nwaru, Bright
Odemyr, Mikela
Pajno, Giovanni Battista
Paudel, Sushil
Papadopoulos, Nikolaos G.
Renz, Harald
Ricci, Giampaolo
Ring, Johannes
Rogala, Barbara
Sampson, Hugh
Senna, Gianenrico
Sitkauskiene, Brigita
Smith, Peter Kenneth
Stevanovic, Katarina
Stoleski, Sasho
Szajewska, Hania
Tanaka, Akio
Todo-Bom, Ana
Topal, Fatih Alexander
Valovirta, Erkka
Van Ree, Ronald
Venter, Carina
Woehrl, Stefan
Wong, Gary W. K.
Zhao, Zuotao
Worm, Margitta
HUS Inflammation Center
Department of Dermatology, Allergology and Venereology
University of Helsinki
Publication Year :
2022
Publisher :
Uppsala universitet, Lung- allergi- och sömnforskning, 2022.

Abstract

Background Food anaphylaxis is commonly elicited by unintentional ingestion of foods containing the allergen above the tolerance threshold level of the individual. While labeling the 14 main allergens used as ingredients in food products is mandatory in the EU, there is no legal definition of declaring potential contaminants. Precautionary allergen labeling such as "may contain traces of" is often used. However, this is unsatisfactory for consumers as they get no information if the contamination is below their personal threshold. In discussions with the food industry and technologists, it was suggested to use a voluntary declaration indicating that all declared contaminants are below a threshold of 0.5 mg protein per 100 g of food. This concentration is known to be below the threshold of most patients, and it can be technically guaranteed in most food production. However, it was also important to assess that in case of accidental ingestion of contaminants below this threshold by highly allergic patients, no fatal anaphylactic reaction could occur. Therefore, we performed a systematic review to assess whether a fatal reaction to 5mg of protein or less has been reported, assuming that a maximum portion size of 1kg of a processed food exceeds any meal and thus gives a sufficient safety margin. Methods MEDLINE and EMBASE were searched until 24 January 2021 for provocation studies and case reports in which one of the 14 major food allergens was reported to elicit fatal or life-threatening anaphylactic reactions and assessed if these occurred below the ingestion of 5mg of protein. A Delphi process was performed to obtain an expert consensus on the results. Results In the 210 studies included, in our search, no reports of fatal anaphylactic reactions reported below 5 mg protein ingested were identified. However, in provocation studies and case reports, severe reactions below 5 mg were reported for the following allergens: eggs, fish, lupin, milk, nuts, peanuts, soy, and sesame seeds. Conclusion Based on the literature studied for this review, it can be stated that cross-contamination of the 14 major food allergens below 0.5 mg/100 g is likely not to endanger most food allergic patients when a standard portion of food is consumed. We propose to use the statement "this product contains the named allergens in the list of ingredients, it may contain traces of other contaminations (to be named, e.g. nut) at concentrations less than 0.5 mg per 100 g of this product" for a voluntary declaration on processed food packages. This level of avoidance of cross-contaminations can be achieved technically for most processed foods, and the statement would be a clear and helpful message to the consumers. However, it is clearly acknowledged that a voluntary declaration is only a first step to a legally binding solution. For this, further research on threshold levels is encouraged.

Details

Language :
English
Database :
OpenAIRE
Accession number :
edsair.dedup.wf.001..54c18679793faf62d6bfab71a34efa48