Probabilistic risk assessment for milk in dark chocolate, cookies and other baked goods with PAL sold in Canada

Unexpected Cow's Milk Proteins in a "Vegan" Easter Egg as a Cause of Anaphylaxis

BACKGROUND

Cow's milk is the most frequent cause of food allergies in children, with caseins and β-lactoglobulin being considered the main allergens. Concerningly, numerous international agencies have highlighted a growing risk of allergic reactions in milk-allergic individuals after the consumption of products labelled as "vegan".

OBJECTIVES

We describe the case of a 3.5-year-old boy with a history of a food allergy to milk who complained of anaphylactic clinical symptoms after eating a vegan Easter egg. The aim of this study was to confirm the cause of the clinical symptoms, searching for the possible presence of milk proteins in the vegan chocolate.

METHODS

An experimental approach based on electrophoretic (SDS-PAGE) and immunoenzymatic techniques (ELISA) was applied.

RESULTS

SDS-PAGE indicated the presence of milk proteins, which was confirmed and quantified via ELISA (3034 ± 115 mg/kg).

CONCLUSIONS

The data obtained demonstrate that the severe clinical symptoms were due to the unexpected presence of milk proteins in a vegan product, underlining the critical need for rigorous allergen quality control throughout the food industry.

Quantitative food allergen risk assessment: Evolving concepts, modern approaches, and industry implications

Food safety is crucially linked to the food system, ensuring safe production, handling, and distribution to protect public health. Food allergy has been considered as a public health and food safety issue. Despite being widely regarded as a prevailing strategy for managing food allergies, strict food avoidance faces challenges due to allergen cross-contact in the food supply chain and the potential for inaccurate allergen labeling. Hence, a scientific approach to assess allergen risk in this context is imperative. In this review, a novel approach to managing food allergies, referred to as quantitative food allergen risk assessment, is presented. This discussion covered the evolving concepts and modern analytical approaches. Moreover, this review delves into the current application of quantitative food allergen risk assessment. Finally, a valuable tool for food allergen risk assessment in the food industry, Voluntary Incidental Trace Allergen Labelling (VITAL), was introduced. The establishment of a globally harmonized and standardized quantitative food allergen risk assessment framework could facilitate the promotion of international harmonization of allergen labeling, support food allergic consumers in making safe food choices, and safeguard the health of allergic individuals across various regions and ethnicities. The implementation of food allergen risk assessment could ensure both food supply chain safety and guide the establishment of acceptable allergen cross-contact levels, enhancing food safety and bolstering the integrity and sustainability of the food system.

Precision risk assessment in wheat allergy: Leveraging advanced quantitative models for safer food consumption

Food allergy is a significant public health concern and food safety issue. Deriving from classical toxicology principle, the food allergen risk assessment has been considered a science-based strategy to identify, quantify, and manage the food allergy risks as such risk represent a significant food safety. Moreover, the implication of the precautionary allergen labeling in most jurisdictions is voluntary, resulting potential risk to allergic consumers. In this study, a quantitative risk assessment technique was employed to evaluate the risk of wheat allergy in prepackaged foods. The assessment utilized probabilistic models, including the lognormal, Weibull, Gamma distributions, and Bayesian model averaging. The predicted allergic reactions were determined to be 682, 854, 677, and 721 incidents per 10,000 eating occasions within wheat allergic population, respectively. The findings of this study revealed that the consumption of prepackaged foods containing gluten without wheat/gluten summary (i.e., ingredient) labeling would potentially pose the risk of allergic reactions to wheat allergic individuals. The utilization of quantitative risk assessment methodology at different points of the food system facilitates alleviating unnecessary concerns to stakeholders while maintaining a reasonable knowledge of allergy risk and providing valuable guidance in formulating effective management strategies to mitigate the risk of food allergies, thereby contributing to the overall safety of the sustainable food system.

Simulated use of thresholds for precautionary allergen labeling: Impact on prevalence and risk

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.

"Vegan" and "plant-based" claims: risk implications for milk- and egg-allergic consumers in Canada

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.

Precautionary Allergen Labeling: What Advice Is Available for Health Care Professionals, Allergists, and Allergic Consumers?

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.

Cow's milk and egg protein threshold dose distributions in children tolerant to beef, baked milk, and baked egg

BACKGROUND

The use of eliciting doses (EDs) for food allergens is necessary to inform individual dietary advice and food allergen risk-management. The Eliciting Dose 01 (ED01) for milk and egg, calculated from populations of allergic subjects undergoing oral food challenges (OFCs), are 0.2 mg total protein. The respective Eliciting Dose 05 (ED05) is 2.4 mg for milk and 2.3 mg for egg. As about 70% children allergic to such foods may tolerate them when baked, we sought to verify the EDs of that subpopulation of milk and egg-allergic children.

METHODS

We retrospectively assessed consecutive OFC for fresh milk and egg between January 2018 and December 2020 in a population of baked food-tolerant children.

RESULTS

Among 288 children (median age 56 - IQR 36-92.5 months, 67.1% male) included, 87 (30.2%) returned positive OFC results, 38 with milk and 49 with egg. The most conservative ED01 was 0.3 mg total protein (IQR 0.03-2.9) for milk and 14.4 mg total protein (IQR 3.6-56.9) for egg. The respective ED05 was 4.2 (IQR 0.9-19.6) mg for milk and 87.7 (IQR 43-179) mg for egg. Such thresholds are, respectively, 1.5 (milk ED01), 1.75 (milk ED05), 72 (egg ED01), and 38.35 (egg ED05) times higher than the currently used thresholds.

CONCLUSIONS

The subpopulation of children allergic to milk and egg, but tolerant to baked proteins, displays higher reactivity thresholds than the general population of children allergic to milk and egg. Their risk stratification, in both individual and population terms, should consider this difference. In baked milk-tolerant children, milk causes reactions at lower doses than egg in our group of egg-tolerant children. This could be associated with the relative harmlessness of egg compared with milk in the determinism of fatal anaphylactic reactions in children.

Spent fowl as a source of unintentional egg proteins exposure in Canadian food products

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.