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Cabanillas B. Special Issue "Molecular and Cellular Advances in Atopic Diseases". Int J Mol Sci 2024; 25:4856. [PMID: 38732073 PMCID: PMC11084155 DOI: 10.3390/ijms25094856] [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: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Atopic diseases, which currently affect around one billion people worldwide, are experiencing a rising prevalence [...].
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Affiliation(s)
- Beatriz Cabanillas
- Department of Allergy, Instituto de Investigacion Biosanitaria Hospital 12 de Octubre (imas12), Avenida de Cordoba s/n, 28041 Madrid, Spain
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Torheim LE, Fadnes LT. Legumes and pulses - a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2024; 68:10484. [PMID: 38571918 PMCID: PMC10989235 DOI: 10.29219/fnr.v68.10484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 05/17/2023] [Accepted: 01/03/2024] [Indexed: 04/05/2024] Open
Abstract
Consumption of legumes and pulses is associated with various health outcomes. Therefore, when updating the Nordic Nutrition Recommendations (NNR), summarizing the best available evidence on key health outcomes regarded as relevant for the Nordic and Baltics related to the consumption of legumes was essential. The aim of this scoping review was to evaluate the updated evidence on the effect of the consumption of legumes and pulses on various health outcomes, as well as their dose-response relationship in updated systematic reviews and meta-analyses. The scoping review is built on a de novo systematic review published in 2023 and additional searches on the consumption of legumes and pulses and its various health outcomes, including cardiovascular disease (CVD), cancer, type 2 diabetes, and obesity. Current available evidence shows that the consumption of legumes and pulses is associated with a lower risk of several cancers (evidence: low-moderate), and lower all-cause mortality (evidence: moderate). The associations with CVDs are neutral or inverse, with studies generally showing favourable changes in biomarkers for CVDs. Legume consumption is associated with a lower risk of obesity (evidence: low). For type 2 diabetes, no association was found with incidence, but trials on consumption of legumes and pulses and biomarkers generally indicated protective effects. Overall, the current evidence supports dietary recommendations to increase the consumption of legumes and pulses.
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Affiliation(s)
- Liv Elin Torheim
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Lars T. Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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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.
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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.
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Fadnes LT, Balakrishna R. Nuts and seeds - a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2024; 68:10483. [PMID: 38370112 PMCID: PMC10870978 DOI: 10.29219/fnr.v68.10483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 08/29/2022] [Accepted: 01/03/2024] [Indexed: 02/20/2024] Open
Abstract
Background Nuts and seeds have been part of diets in most of the world for millenniums, and they have also been consumed in the Nordic and Baltic countries for centuries. Consumption of nuts and seeds is linked with various health outcomes. Therefore, when updating the Nordic Nutrition Recommendations (NNR), summarizing the best evidence on key health outcomes from the consumption of nuts and seeds is essential. Objectives This study aims to evaluate the updated evidence on the consumption of nuts and seeds and health outcomes regarded relevant for the Nordic and Baltic countries, as well as their dose-response relationship presented in updated systematic reviews and meta-analyses. Method The scoping review is built on a de novo systematic review and an umbrella review published in 2022 on the consumption of nuts and seeds and its various health outcomes, including cardiovascular disease and diabetes. Results Intake of nuts and seeds is associated with a lower risk of cardiovascular diseases, with evidence assessed as probable. This conclusion is mirrored by evidence from trials on biomarkers for chronic diseases. An intake of a serving of nuts of 28-30 g/day compared to not eating nuts is estimated to translate into approximately 20% relative reduction in the risks of cardiovascular disease and premature deaths. For cancers, consumption of a serving of nuts is inversely associated with cancer mortality. However, for type 2 diabetes, there are mixed and inconclusive results. Additionally, there are inverse associations between nut consumption and respiratory and infectious disease mortality. Allergies for nuts are seen among 1-2% of the population. Conclusion Overall, the current evidence supports dietary recommendations to increase nut consumption to a serving of nuts and seeds per day for people without allergies to these foods.
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Affiliation(s)
- Lars T. Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Rajiv Balakrishna
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Aljameel GM, AlSedairy SA, Binobead MA, Alhussain MH, Bin Obaid MA, Al-Harbi LN, Alshammari GM, Arzoo S. Awareness of Food Allergies and Allergens on the Menus of Restaurants and Cafes among Saudi Female University Students. Healthcare (Basel) 2023; 11:healthcare11091259. [PMID: 37174801 PMCID: PMC10178210 DOI: 10.3390/healthcare11091259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/16/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Exposure to allergens could be life-threatening for people with food allergies. Restaurants and cafes are challenging environments for accommodating food allergies. This study aimed to measure King Saud University female students' awareness about food allergens on restaurants' and cafes' menus. This cross-sectional study was conducted on 379 students aged 18 years and above. A paper-based questionnaire was used, which comprised 16 questions related to the definition of food allergies, food allergens, and food allergy symptoms; the definition and prevention of cross-contact of food allergies; emergency treatment procedures for food allergies; strategies for the prevention of food allergy reactions; customer expectations towards restaurants; and preventive measures taken for food allergies. The results indicate that the overall average score of food allergen awareness was 10.90, which falls in the higher range. Furthermore, female students in the age groups of 23 to 27 years and 33 to 37 years had higher levels of awareness than female students in the age group of 18 to 22 years. The results also showed that the level of awareness among science college and health college students was statistically significantly higher (p < 0.05) than that among humanities college students. Post-graduate students also showed a higher level of awareness of food allergens than bachelor's students. These findings also indicate that listing all allergens in the restaurants and cafes' menus statistically significantly (p < 0.05) increased the level of awareness of female students about food allergens on restaurants' and cafes' menus, compared to restaurants and cafes that do not list all allergens on their menus. In general, female students at King Saud University showed a high level of awareness about food allergies on restaurants' and cafes' menus. The study recommends assessing the impact of awareness of female students with and without food allergies on their practices and behaviors.
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Affiliation(s)
- Ghzail M Aljameel
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Sahar Abdulaziz AlSedairy
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Manal Abdulaziz Binobead
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Maha H Alhussain
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Manar Abdulaziz Bin Obaid
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Laila Naif Al-Harbi
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ghedeir M Alshammari
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Shaista Arzoo
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
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Versluis A, Le TM, Houben GF, Knulst AC, Van Os-Medendorp H. Accidental allergic reactions to food in adolescents and adults: An overview of the factors involved and implications for prevention. FRONTIERS IN ALLERGY 2023; 4:1062049. [PMID: 36970066 PMCID: PMC10036762 DOI: 10.3389/falgy.2023.1062049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
Accidental allergic reactions to food are one of the major problems in adult patients diagnosed with food allergy. Such reactions occur frequently, are often severe and are associated with higher medical and non-medical costs. The aim of this Perspective is to provide insight into the different factors involved in the occurrence of accidental allergic reactions and to present an overview of practical implications for effective preventive measures. Several factors affect the occurrence of accidental reactions. These factors are related to the patient, health care, or food. The most important patient-related factors are age, social barriers to disclosing their allergy and non-adherence to the elimination diet. With regards to healthcare, the degree to which clinical practice is tailored to the individual patient is an important factor. The major food-related factor is the absence of adequate precautionary allergen labeling (PAL) guidelines. Since many factors are involved in accidental allergic reactions, different preventive strategies are needed. It is highly recommended that health care be tailored to the individual patient, with regard to education about the elimination diet, support on behavioral and psychosocial aspects, usage of shared decision-making and taking into account health literacy. In addition, it is crucial that steps are taken to improve policies and guidelines for PAL.
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Affiliation(s)
- Astrid Versluis
- Department of Dermatology and Allergology, University Medical Centre Utrecht, University Utrecht, Utrecht, Netherlands
- Correspondence: Astrid Versluis Harmieke Van Os-Medendorp
| | - Thuy-My Le
- Department of Dermatology and Allergology, University Medical Centre Utrecht, University Utrecht, Utrecht, Netherlands
- Center for Translational Immunology, University Medical Centre Utrecht, University Utrecht, Utrecht, Netherlands
| | - Geert F. Houben
- Center for Translational Immunology, University Medical Centre Utrecht, University Utrecht, Utrecht, Netherlands
- TNO, Netherlands Organization for Applied Scientific Research, Utrecht, Netherlands
| | - André C. Knulst
- Department of Dermatology and Allergology, University Medical Centre Utrecht, University Utrecht, Utrecht, Netherlands
- Center for Translational Immunology, University Medical Centre Utrecht, University Utrecht, Utrecht, Netherlands
| | - Harmieke Van Os-Medendorp
- School of Health, Saxion University of Applied Sciences, Enschede, Netherlands
- Correspondence: Astrid Versluis Harmieke Van Os-Medendorp
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Balakrishna R, Bjørnerud T, Bemanian M, Aune D, Fadnes LT. Consumption of Nuts and Seeds and Health Outcomes Including Cardiovascular Disease, Diabetes and Metabolic Disease, Cancer, and Mortality: An Umbrella Review. Adv Nutr 2022; 13:2136-2148. [PMID: 36041171 PMCID: PMC9776667 DOI: 10.1093/advances/nmac077] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/28/2022] [Accepted: 07/26/2022] [Indexed: 01/29/2023] Open
Abstract
Consumption of nuts and seeds is associated with a range of health outcomes. Summarizing the best evidence on essential health outcomes from the consumption of nuts is essential to provide optimal recommendations. Our objective is to comprehensively assess health outcome associations related to the consumption of nuts and seeds, using a culinary definition including tree nuts and peanuts (registered in PROSPERO: CRD42021258300). Health outcomes of interest include cardiovascular disease, cancer, diabetes, obesity, respiratory disease, mortality, and their disease biomarkers. We present associations for high compared with low consumption, per serving, and dose-response relations. MEDLINE, Embase, Cochrane, and Epistemonikos were searched and screened for systematic reviews and meta-analyses. Evidence was extracted from 89 articles on the consumption of nuts and relevant health outcomes, including 23 articles with meta-analysis on disease and mortality, 66 articles on biomarkers for disease, and 9 articles on allergy/adverse outcomes. Intake of nuts was associated with reduced risk of cardiovascular diseases and related risk factors, with moderate quality of evidence. An intake of 28 g/d nuts compared with not eating nuts was associated with a 21% RR reduction of cardiovascular disease (including coronary heart disease incidence and mortality, atrial fibrillation, and stroke mortality), an 11% risk reduction of cancer deaths, and 22% reduction in all-cause mortality. Nut consumption was also inversely associated with mortality from respiratory diseases, infectious diseases, and diabetes; however, associations between nut consumption and diabetes incidence were mixed. Meta-analyses of trials on biomarkers for disease generally mirrored meta-analyses from observational studies on cardiovascular disease, cancers, and diabetes. Allergy and related adverse reactions to nuts were observed in 1-2% of adult populations, with substantial heterogeneity between studies. Overall, the current evidence supports dietary recommendations to consume a handful of nuts and seeds per day for people without allergies to these foods.
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Affiliation(s)
- Rajiv Balakrishna
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | | | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Department of Nutrition, Oslo New University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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Lopes JF, Carvalho MDA, Machado NC. Labeling food allergens in the packaged food pyramid groups in Brazil: analysis of descriptions, ambiguities, and risks. REVISTA PAULISTA DE PEDIATRIA 2022; 40:e2021079. [PMID: 35703721 PMCID: PMC9190470 DOI: 10.1590/1984-0462/2022/40/2021079in] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/24/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate allergenic labeling components of packaged foods for "What is the quality of food labels?" and "What is the group of Brazilian Food Pyramid that 'May contain' is predominant?." METHODS The photographs of 916 products were obtained, of which 518 were analyzed. Data from each label were evaluated according to Brazilian Food Pyramid Groups (i.e., Cereals, Fruits, & Vegetables; Soybean & products; Milk & dairy products; Meat & eggs; Fats & oils; and Sugars & sweets). Ten items were analyzed in each label, namely, the presence of a list of ingredients, alert phrase for allergy sufferers, grouping of the alert phrase, phrase location, uppercase phrase, the phrase in bold, the color of alert phrase contrasting to the background, adequate font size, do not claim the absence for any allergen with the ingredients, and others factors that make it difficult to read. For the second question, a structured questionnaire was completed, and products were classified into two categories, namely, "Contain" and "May contain." RESULTS The quality of the label was appropriate, and 69% of packaged foods had at least one allergen. The information "May contain" were higher in cow's milk (Cereals and Meat & eggs), soy (Soybean & products), and egg protein (Cereals). Soybean & products were the highest insecurity group. CONCLUSIONS Brazilian health professionals can count on good-quality labeling of packaged products. Consequently, they could promote patients' and parents/caregivers' education to consult the labels and manage the risks in processed foods about precautionary allergen labeling. Soybean & products were the most significant insecurity for food choices between Brazilian Pyramid Groups.
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Versluis A, Le T, Erp FCV, Blankestijn MA, Houben GF, Knulst AC, Os‐ Medendorp HV. Low dietary adherence after a positive food challenge in food allergic adults. Clin Transl Allergy 2022; 12:e12119. [PMID: 35218325 PMCID: PMC8855678 DOI: 10.1002/clt2.12119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/16/2022] [Accepted: 01/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background After a positive food challenge (FC), patients receive dietary advice regarding avoidance of the culprit food. We examined the frequency and variables associated with dietary adherence after a positive FC in adults. Methods In this prospective daily practice study, adults with a positive FC were included. After every FC, dietary advice was given consisting of three options: (1) strict avoidance, (2) avoidance but products with precautionary allergen labelling (PAL) allowed and (3) (small) amounts allowed. Questionnaires about dietary adherence and associated variables were completed prior to and 6 months after the FC(s). Results 41 patients (with 58 positive FCs) were included. Overall, patients adhered to the advised diet after 31% of the FCs. After 33 FCs, the advice was strict avoidance, whereof 82% followed a less strict diet. After 16 FCs, the advice was avoidance but products with PAL allowed, whereof 19% followed a less strict and 25% a stricter diet. In 9 FCs with the least strict advice, “(small) amounts allowed’’, 67% followed a stricter diet. Three variables were associated with adherence: misremembering dietary advice, impaired health‐related quality of life (HRQL) on domain “Emotional impact’’ and the need for dietary change after the FC. Conclusion After one third of the positive FCs, patients adhered to the dietary advice. Variables associated with adherence were misremembering dietary advice, impaired HRQL on domain “Emotional impact’’ and the need for dietary change after the FC. It seems important that healthcare professionals should more frequently apply adherence‐enhancing strategies to improve dietary adherence.
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Affiliation(s)
- Astrid Versluis
- Department of Dermatology/Allergology University Medical Centre Utrecht University Utrecht Utrecht The Netherlands
| | - Thuy‐My Le
- Department of Dermatology/Allergology University Medical Centre Utrecht University Utrecht Utrecht The Netherlands
| | - Francine C. van Erp
- Department of Dermatology/Allergology University Medical Centre Utrecht University Utrecht Utrecht The Netherlands
| | - Mark A. Blankestijn
- Department of Dermatology/Allergology University Medical Centre Utrecht University Utrecht Utrecht The Netherlands
| | - Geert F. Houben
- TNO, Netherlands Organization for Applied Scientific Research Utrecht The Netherlands
| | - André C. Knulst
- Department of Dermatology/Allergology University Medical Centre Utrecht University Utrecht Utrecht The Netherlands
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Lopes JF, Carvalho MDA, Machado NC. Rotulagem de alérgenos alimentares em alimentos embalados segundo grupos alimentares da pirâmide brasileira: análise da descrição, riscos e ambiguidades. REVISTA PAULISTA DE PEDIATRIA 2022. [DOI: 10.1590/1984-0462/2022/40/2021079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo: Avaliar os componentes alergênicos da rotulagem de alimentos embalados e responder “Qual é a qualidade da rotulagem?” e “Qual é o grupo de alimentos em que a expressão ‘Pode conter’ é predominante?”. Métodos: Foram obtidas fotografias de 916 produtos, dos quais 518 foram analisados. Os dados dos rótulos foram avaliados de acordo com os grupos da pirâmide alimentar brasileira (Cereais, Frutas & Vegetais; Soja & Derivados; Leite & Laticínios; Carne & Ovos; Gorduras & Óleos; Açúcares & Doces). Dez itens foram analisados nos rótulos: presença de lista de ingredientes; frase de alerta para alérgicos; frase de alerta; local da frase; frase em letras maiúsculas; frase em negrito; a cor da frase de alerta contrastando com o fundo; tamanho de fonte adequado; não alegar ausência de qualquer alérgeno; outros fatores de difícil leitura. Para a segunda questão, foi respondido questionário estruturado, e os produtos classificados em categorias: “Contém” e “Pode conter”. Resultados: A qualidade do rótulo foi adequada e 69% dos alimentos embalados continham pelo menos um alérgeno. A informação “Pode conter” foi mais identificada em: proteína do leite (Cereais e Carnes e ovos), soja (Soja & derivados) e proteína do ovo (Cereais). Soja e derivados foi o grupo alimentar de maior insegurança. Conclusões: Profissionais de saúde podem contar com rotulagem de boa qualidade dos produtos embalados e, consequentemente, promover a educação de pais/cuidadores para consultar os rótulos e gerenciar os riscos em alimentos processados. Soja e produtos são os alimentos com maior insegurança entre os Grupos da Pirâmide Brasileira.
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Beer and Allergens. BEVERAGES 2021. [DOI: 10.3390/beverages7040079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Food allergies are an important global health concern, with many countries following the World Health Organisation’s guidelines with regards to due labelling of foods and, as such, providing forewarning about the presence of potential allergens to potential consumers. While for some produce, the link to specific allergens might be very clear to most consumers, this is not the case for all produce. People with specific food-related allergies usually know what to look out for, but occasionally, unexpected allergens are present in trusted produce. Beer is known to most to contain barley, which will contain gluten-like proteins that can cause allergic reactions in some people. Similarly, beer might contain sulphites and other potential allergens traditionally associated with beers. This review aims to examine a wide range of allergens that have entered the beer production process in recent years. As a result, examples of beers that contain one or more of the 14 EU-UK listed allergens are described, different allergen regulations in different countries are emphasised and their impact explained, and a number of case studies involving allergic reactions following exposure to and the ingestion of beer are highlighted.
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Alghafari WT, Attar AA, Alghanmi AA, Alolayan DA, Alamri NA, Alqarni SA, Alsahafi AM, Arfaoui L. Responses of consumers with food allergy to the new allergen-labelling legislation in Saudi Arabia: a preliminary survey. Public Health Nutr 2021; 24:5941-5952. [PMID: 34108066 DOI: 10.1017/s1368980021002500] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Preventing a food allergy reaction depends primarily on eliminating allergens from the diet. In October 2019, the Saudi Food and Drug Authority (SFDA) introduced new legislation requiring food establishments providing and selling non-prepacked foods to state the presence of the top fourteen food allergens on their menus. The current study aimed to assess the allergen-labelling knowledge, practices, preferences and perceptions towards the new SFDA allergen-labelling legislation among consumers with food allergy in Saudi Arabia. DESIGN Observational cross-sectional study using an online questionnaire. SETTING Saudi Arabia; February - March 2020. PARTICIPANTS Residents of Saudi Arabia with food allergy (n 427), aged 18-70 years. RESULTS Among participants, only 28·1 % knew that there were governmental regulations in Saudi Arabia regarding food-allergen labelling and approximately two-thirds (67 %) check labels on prepacked food products for allergens. The majority of the participants preferred food products carrying safety statements (84·1 %) and symbols (80·1 %). A total of 47·1 % were aware that regulations in Saudi Arabia require allergens to be declared in ingredient lists, while 51·3 % were aware that advisory allergen labelling is not required by law. Only 26·2 % were aware of the new SFDA legislation regarding provision of allergen information by food establishments. However, the majority (94·4 %) were supportive of the new legislation, and most of them were more likely to eat at restaurants that reported allergen information for food items on the menu. CONCLUSIONS The new SFDA food allergen-labelling legislation needs to be more widely and effectively disseminated to increase the level of awareness among adults with food allergy in Saudi Arabia.
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Affiliation(s)
- Wejdan T Alghafari
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80215, Jeddah21589, Saudi Arabia
| | - Atheer A Attar
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80215, Jeddah21589, Saudi Arabia
| | - Afnan A Alghanmi
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80215, Jeddah21589, Saudi Arabia
| | - Danah A Alolayan
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80215, Jeddah21589, Saudi Arabia
| | - Nehal A Alamri
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80215, Jeddah21589, Saudi Arabia
| | - Sara A Alqarni
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80215, Jeddah21589, Saudi Arabia
| | - Athear M Alsahafi
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80215, Jeddah21589, Saudi Arabia
| | - Leila Arfaoui
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80215, Jeddah21589, Saudi Arabia
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Hicks A, Palmer C, Bauer M, Venter C. Accidental ingestions to known allergens by food allergic children and adolescents. Pediatr Allergy Immunol 2021; 32:1718-1729. [PMID: 34091961 DOI: 10.1111/pai.13573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/27/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Accidental ingestions (AI) of food allergens in children compared with adolescents with food allergies are poorly characterized. It is suggested that AIs are higher in adolescents than children and that their reactions may be more severe, presumptively due, at least in part, to increased risk-taking behavior. We compared reported AIs in children versus adolescents. METHODS An online cross-sectional survey was distributed to parents of children with food allergies via Twitter, food allergy advocacy groups in the UK, South Africa, and Australia, and locally at Children's Hospital Colorado. RESULTS Of 558 respondents, 105 were parents of adolescents, and 453 had children <12 years. 73% (341) reported an AI since diagnosis, with 85% of adolescents having had an AI versus 70% of children (p = 0.0058). The annualized rate of AI was significantly lower in the adolescent population at 0.21 versus 0.53 in children (p = <0.0001). Although adolescents reported fewer severe reactions (2% vs. 16%, p = 0.0283), more adolescents required epinephrine administered by a medical professional for their most severe AI, (48% vs. 24%, p = 0.0378). Comparison of the two age groups is limited by the fact that many AIs in the adolescent group occurred prior to age 12. There was no significant difference between the groups as to where the food was consumed or the type of food. There was a significant difference in accidental ingestions in patients in all age groups with more than one reported food allergy; 78% of those with more than one food allergy reported a prior history of at least one accidental ingestion, compared with 59% in those with a single food allergy (p < 0.0001). Regional differences were also noted with respondents in the United States reporting 0.3 accidental ingestions a year, 0.4 in the UK, and 0.5 in other countries (p = 0.0455). The number of reactions was, on average, 27% lower (95% CI: 40, 11%) in the United States compared with the UK (p = 0.0019). CONCLUSION The number of severe reactions, and epinephrine need, differs in children compared with adolescents, although many of the reported reactions in both groups occurred before the age of 12. There were also regional differences with the United States reporting a lower number of AIs and less AIs per year than the other participating regions, as well as increased rates of AI in participants with more than one food allergy. Further characterization of the differences in AIs between children and adolescents, as well as between regions, is needed to assist with more patient-centered anticipatory guidance.
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Affiliation(s)
- Allison Hicks
- Department of Pediatrics, Section of Allergy and Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Children's Hospital Colorado, Aurora, Colorado, USA
| | - Claire Palmer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Maureen Bauer
- Department of Pediatrics, Section of Allergy and Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Children's Hospital Colorado, Aurora, Colorado, USA
| | - Carina Venter
- Department of Pediatrics, Section of Allergy and Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Children's Hospital Colorado, Aurora, Colorado, USA
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14
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Muraro A, Sublett JW, Haselkorn T, Nilsson C, Casale TB. Incidence of anaphylaxis and accidental peanut exposure: A systematic review. Clin Transl Allergy 2021; 11:e12064. [PMID: 34708943 PMCID: PMC8694181 DOI: 10.1002/clt2.12064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/14/2021] [Accepted: 08/28/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Peanut allergy (PA), a common food allergy, is increasing in prevalence and is associated with high rates of anaphylaxis. Prevalence of food-related anaphylaxis is higher in children and adolescents than in adults, and the pediatric incidence is increasing. We conducted a systematic literature review and meta-analysis to determine the incidence of peanut-induced anaphylaxis in children and/or adolescents with PA. METHODS Literature searches were conducted using the PubMed database and through supplemental methods. Eligible articles for inclusion were peer-reviewed studies published in English that reported the incidence of anaphylaxis in pediatric PA using the 2006 National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network criteria, sample size, and follow-up duration. Incidence rates were calculated as person-years at risk or a crude incidence rate was calculated. Meta-analyses of pooled data were conducted using the I2 statistic as the measure of heterogeneity. RESULTS A total of 830 citations were screened; 8 met the study inclusion criteria and were selected for review. Pooled meta-analysis estimates of the incidence of (1) anaphylaxis among children/adolescents with food allergies, (2) anaphylaxis among children/adolescents with PA, and (3) accidental exposure to peanuts among children/adolescents with PA were 3.72 cases per 100 person-years (95% confidence interval [CI] = 2.35, 5.10), 2.74 cases per 100 person-years (95% CI = 1.42, 4.05), and 12.28 cases per 100 person-years (95% CI = 11.51, 13.05), respectively. CONCLUSIONS The risks of anaphylaxis among children with food allergies and those with PA contribute to the serious overall burden of PA and food allergy for children and their families.
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Affiliation(s)
- Antonella Muraro
- Department of Woman and Child Health, Food Allergy Referral Centre Veneto Region, Padua University Hospital, Padua, Italy
| | | | | | - Caroline Nilsson
- Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Thomas B Casale
- Food Allergy Research and Education (FARE), University of South Florida, Tampa, Florida, USA
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15
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Sesame as an allergen in Lebanese food products: Occurrence, consumption and quantitative risk assessment. Food Chem Toxicol 2021; 156:112511. [PMID: 34391860 DOI: 10.1016/j.fct.2021.112511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/19/2021] [Accepted: 08/11/2021] [Indexed: 12/19/2022]
Abstract
Despite the intensive use of sesame in the Middle Eastern diet, studies on this allergen in this region are lacking. A survey on the occurrence of sesame in Lebanese food products that did not contain this allergen as an ingredient, a food consumption survey conducted in Beirut schools, and the most recent sesame eliciting dose estimates were used to build a probabilistic risk assessment model providing estimates of sesame-induced allergic reactions per eating occasion and per week in Lebanese children and adolescents. Of 1270 food samples analysed, 34% contained sesame proteins (0.44-3392 mg kg-1). Sesame was detected in 47% of unlabeled bulk samples, 43% of samples with PAL, and 27% of samples without PAL. "Sfouf" had the highest concentration of sesame proteins (mean 549 mg kg-1), highest mean exposure per eating occasion (78 mg sesame proteins for children and 103 mg sesame proteins for adolescents), and posed the highest predicted risk per eating occasion (>20%) and per week (>13% individuals predicted in simulation experience at least 1 reaction). Bakery products (notably "sfouf") may pose a serious risk to sesame-allergic children and adolescents in Lebanon. Enhanced guidance on the use of PAL is needed to better protect allergic consumers.
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16
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Holleman BC, van Os-Medendorp H, van den Bergh H, van Dijk LM, Linders YFM, Blom WM, Verhoeckx KCM, Michelsen-Huisman A, Houben GF, Knulst AC, Lentz LR. Poor understanding of allergen labelling by allergic and non-allergic consumers. Clin Exp Allergy 2021; 51:1374-1382. [PMID: 34288165 PMCID: PMC8519062 DOI: 10.1111/cea.13975] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Abstract
Background Understanding consumers’ interpretation of allergy information is crucial for effective food safety policies. We evaluated consumer understanding of allergy information on foods in controlled, experimental studies. Method Using 18 packaged foods, we evaluated consumer understanding of information about allergens in two experiments: First, a comparison of foods with no stated allergen versus allergen as a stated ingredient versus a precautionary allergen label (PAL); second, a comparison of three common variants of PAL. In each experiment, consumers with and without self‐reported food allergy were asked to estimate the risk of allergic reaction and to rate the comprehensibility of the allergen information. In the second experiment, consumers were also asked which form of PAL they preferred. Results Risk of reaction was assessed as high and low for foods with the allergen stated as ingredient, or without any mention of allergen. However, risk assessment for PAL varied and was judged as higher by non‐allergic than allergic participants (82% vs. 58%, p < .001). Understanding of risk associated with PAL also varied by health literacy (p < .001). Both allergic and non‐allergic consumers judged all forms of allergy information to be unclear, especially products with no allergy information for non‐allergic consumers. Products with a ‘Produced in a Factory’ PAL were perceived as less risky than ‘May contain’ or ‘Traces of’ PALs (p < .001), less than 40% of participants judged PAL information to be comprehensible, and participants preferred ‘May contain’ over the other PALs. Conclusion Both allergic and non‐allergic consumers find allergen information difficult to interpret on packaged foods and misunderstand PAL, incorrectly distinguishing different risk levels for different PAL wording. Clearer allergy information guidelines are called for, and the use of only one PAL wording is recommended.
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Affiliation(s)
- Bregje C Holleman
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - Harmieke van Os-Medendorp
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,The Netherlands Organization for Applied Scientific Research TNO, Utrecht, The Netherlands
| | - Huub van den Bergh
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - Liselotte M van Dijk
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - Yvette F M Linders
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - W Marty Blom
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Saxion University of Applied Science, School of Health, Deventer, The Netherlands
| | - Kitty C M Verhoeckx
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anouska Michelsen-Huisman
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geert F Houben
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Saxion University of Applied Science, School of Health, Deventer, The Netherlands
| | - André C Knulst
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Leo R Lentz
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
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17
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Mandracchia F, Llauradó E, Valls RM, Tarro L, Solà R. Evaluating Mediterranean Diet-Adherent, Healthy and Allergen-Free Meals Offered in Tarragona Province Restaurants (Catalonia, Spain): A Cross-Sectional Study. Nutrients 2021; 13:nu13072464. [PMID: 34371970 PMCID: PMC8308532 DOI: 10.3390/nu13072464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/21/2022] Open
Abstract
Restaurant meal consumption has increased substantially, but the ability of restaurants to adhere to guidelines for the Mediterranean diet, healthiness and food allergen management is a challenge. This cross-sectional study aims to assess the Mediterranean diet adherence, healthiness, nutritional quality and food allergen management of meals at restaurants in the Tarragona province (Catalonia, Spain). Primary outcomes included adherence to criteria for the Mediterranean diet (AMed) and gluten management (SMAP), nutritional quality of dishes indicated by a green traffic light rating, meal nutrient content and allergen-free options. Secondary outcomes included restaurant staff knowledge about the Mediterranean diet and food allergens. Forty-four restaurants and 297 dishes were analysed. The restaurants fulfilled an average (mean ± SD) of 5.1 ± 1.6 of 9 compulsory AMed criteria and 12.9 ± 2.8 of 18 SMAP criteria. Dishes were mainly rated green for sugar (n = 178/297; 59.9%) but not for energy (n = 23/297; 7.7%) or total fat (n = 18/297; 6.1%). Waiters and cooks received passing scores for food allergen knowledge (5.8 ± 1.7 and 5.5 ± 1.5 out of 10 points, respectively). Restaurants partially met the AMed and SMAP criteria. Increasing fibre and decreasing saturated fat content are necessary to improve consumers’ adherence to healthy diets. For restaurant staff, training courses should be considered to improve their food allergen management.
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Affiliation(s)
- Floriana Mandracchia
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (E.L.); (R.M.V.); (R.S.)
| | - Elisabet Llauradó
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (E.L.); (R.M.V.); (R.S.)
| | - Rosa Maria Valls
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (E.L.); (R.M.V.); (R.S.)
| | - Lucia Tarro
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (E.L.); (R.M.V.); (R.S.)
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain
- Correspondence: ; Tel.: +34-977-758-920
| | - Rosa Solà
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (E.L.); (R.M.V.); (R.S.)
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
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18
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Carucci L, Coppola S, Luzzetti A, Voto L, Giglio V, Paparo L, Nocerino R, Berni Canani R. Immunonutrition for Pediatric Patients With Cow's Milk Allergy: How Early Interventions Could Impact Long-Term Outcomes. FRONTIERS IN ALLERGY 2021; 2:676200. [PMID: 35386962 PMCID: PMC8974760 DOI: 10.3389/falgy.2021.676200] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/18/2021] [Indexed: 12/25/2022] Open
Abstract
Cow's milk allergy (CMA) is one of the most common food allergies and one of the main causes of food-induced anaphylaxis in the pediatric age. Moreover, up to 45% of CMA children develop other atopic manifestations later in life, a phenomenon commonly named atopic march. Thus, CMA imposes a significant cost to health care systems as well as to families, and has emerged as one of the most expensive allergic diseases. The immunonutrition strategy builds its foundation on the ability of selected dietary factors to modulate immune system development and function. Recent studies highlighted the potential of immunonutrition in the management of CMA. This review is focused on the mechanisms and long-term clinical outcomes of the immunonutrition approach in children with CMA.
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Affiliation(s)
- Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
- *Correspondence: Laura Carucci
| | - Serena Coppola
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Anna Luzzetti
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Luana Voto
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Veronica Giglio
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Lorella Paparo
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Rita Nocerino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
- Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy
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19
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Arasi S, Mennini M, Cafarotti A, Fiocchi A. Omalizumab as monotherapy for food allergy. Curr Opin Allergy Clin Immunol 2021; 21:286-291. [PMID: 33769312 DOI: 10.1097/aci.0000000000000744] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW To familiarize the reader with the most recent insights in the use of Omalizumab (monoclonal anti-immunoglobulin E) monotherapy in the treatment of patients with severe food allergy. RECENT FINDINGS The current data from early stage clinical trials show that Omalizumab may be safe and effective by itself in providing desensitization to one or several foods without requiring allergen exposure. SUMMARY In the near future, advances in knowledge will guide the adoption and implementation of any new therapy for food allergy and allow the development of a personalized treatment tailored on the specific patient's profile.
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Affiliation(s)
- Stefania Arasi
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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20
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Food Allergy in Restaurants Work Group Report. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:70-74. [PMID: 31950913 DOI: 10.1016/j.jaip.2019.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 11/22/2022]
Abstract
Individuals with food allergy are at risk for accidental exposures, potentially resulting in allergic reactions that may cause significant morbidity and mortality. Dining out, including restaurants or take-out, account for a large proportion of severe reactions. Errors due to gaps in knowledge or miscommunication can easily occur on behalf of food-allergic individuals or restaurant staff, resulting in accidental exposures and allergic reactions. Improved legislation, training of restaurant staff, and practitioner-guided education are recommended to reinforce patient safety and prevent severe allergic reactions. This Work Group Report provides guidance with specific practices that practitioners may recommend, and that patients and restaurant staff may employ, for prevention and treatment of food-allergic reactions in restaurants.
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21
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Harari R, Toren O, Tal Y, Ben-Porat T. Food allergy safety: a descriptive report of changing policy in a single large medical center. Isr J Health Policy Res 2021; 10:32. [PMID: 33941273 PMCID: PMC8091511 DOI: 10.1186/s13584-021-00466-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background Food allergy can result in life-threatening anaphylaxis and is considered an increasing public health burden. Hospitalized patients are dependent on the hospital menu to meet their nutritional needs; thus, errors in the meals provided can have a substantial impact on patients’ health outcomes. In Israel, no specific policy protocol exists to ensure food allergy safety in the setting of a hospital foodservice system. Objectives This paper has two aims: 1) to provide an in-depth review of food allergy as a major public health concern and 2) to report actions taken in a single large medical center, as an ongoing project that aimed to ensure patients’ safety, and which ended in developing policy on this matter. Results During the years 2017–2019, we initiated several interventions with the goal of achieving food allergy safety and ensuring quality of care for patients with food allergies at Hadassah Hebrew University Medical Center. These included integrating food management safety into the computerized foodservice system, highlighting labels on patients’ food trays, introducing safety checks into the process of food delivery to hospitalized patients; and ensuring the nutritional requirements of patients with allergy restrictions. Moreover, changes were made in specialized menus for patients with various types of food allergy, and specific procedures were implemented regarding enteral feeding, to prevent accidental allergen exposure. All the procedures were incorporated into a written protocol that applies to all hospital employees, and the staff received the relevant training. Conclusions Our experience suggests that methods for food allergy safety should be promoted, and that an established policy and suitable set of guidelines on this matter is required. This clearly mandates collaboration between the various sectors of the hospital, including management and the computer department; and the medical, nursing, dietetics and kitchen staffs. Furthermore, routine ongoing knowledge training programs for medical teams and kitchen staff are crucial for such implementational changes. In a technological world, computerized systems delivering food to hospitalized patients must be adapted such as to create a uniformly safe food environment of healthcare systems, and developing a suitable policy should be prioritized accordingly by hospitals across Israel, with collaboration and synergy between institutions management and the departments of nutrition and patient safety and risk management.
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Affiliation(s)
- Rivki Harari
- Department of Diet and Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Orly Toren
- Department of Patient Safety and Risk Management, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yuval Tal
- Allergy and Clinical Immunology Unit, Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tair Ben-Porat
- Department of Diet and Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. .,Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel.
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22
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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.
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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
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23
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Blom WM, van Dijk LM, Michelsen-Huisman A, Houben GF, Knulst AC, Linders YFM, Verhoeckx KCM, Holleman BC, Lentz LR. Allergen labelling: Current practice and improvement from a communication perspective. Clin Exp Allergy 2021; 51:574-584. [PMID: 33440035 PMCID: PMC8048984 DOI: 10.1111/cea.13830] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/15/2020] [Accepted: 12/30/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Allergen information on product labels is crucial in food allergy management, though inadequacy in current labelling practices is one of the major causes for accidental reactions upon consuming prepacked food products. OBJECTIVE This study analyses current status of communicating allergen information on food labels and provides practical recommendations for improving the label format based on communication theory. METHODS Product labels (N 288) of seven food categories from private label products and brands were obtained at three retailers in the Netherlands. Information regarding the 14 EU-regulated allergens was evaluated by the frequency of emphasizing allergens in the ingredient list, use of precautionary allergen labelling (PAL), icons and an allergen information section. Effectiveness of communication was assessed evaluating readability and findability of information on allergens using principles of Gestalt and Cognitive Load theories. RESULTS As requested by EU regulation 1169/2011, emphasizing allergens in the ingredient list was almost 100%, all other presentations of information on allergens on labels was highly diverse. A separate allergen information section was present on most private label products. This section could, but not necessarily did, repeat allergens from the ingredient list and/or give a PAL. Brands often provided a PAL at the end of the ingredient list. Part of the products displayed an icon at different locations of the label. Label background, a lack of cohesion and variation in location of topics hamper the identification of relevant information on allergens by (allergic) consumers. Recommendations include a standardized order for mandatory and voluntary topics on the label and a separate allergen information section. CONCLUSION AND CLINICAL RELEVANCE Overall, consumers encounter a wide and inconsistent range in ways of presentation of allergen information on labels. Standardization according to basic design principles can improve usability and support safe food purchases for allergic consumers.
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Affiliation(s)
- W Marty Blom
- TNO, The Netherlands Organisation of Applied Scientific Research, Utrecht, The Netherlands.,Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Liselotte M van Dijk
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - Anouska Michelsen-Huisman
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geert F Houben
- TNO, The Netherlands Organisation of Applied Scientific Research, Utrecht, The Netherlands.,Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - André C Knulst
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Yvette F M Linders
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - Kitty C M Verhoeckx
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bregje C Holleman
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - Leo R Lentz
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
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Assessment of the effects of a work-related allergy to seafood on the reduction of earning capacity in the context of BK No. 5101. Allergol Select 2021; 5:33-44. [PMID: 33493250 PMCID: PMC7814778 DOI: 10.5414/al0db380e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/11/2020] [Indexed: 12/26/2022] Open
Abstract
Fish, crustaceans, and mollusks are among the most potent allergenic foods of animal origin and are thus important triggers of work-related immediate-food allergies. In Germany, work-related seafood allergies are of great importance in the fishing and processing industries as well as in the areas of food preparation, food control, and food sales. There is no causal therapy of seafood allergy, only the strict and lifelong avoidance of allergens remains. The following recommendations serve to assess the impact of a seafood allergy with regard to the work opportunities ended by it for the assessment of the reduction of earning capacity (MdE (German for Minderung der Erwerbsfähigkeit)) in the context of the occupational disease number 5101 of the Annex to the German regulation for occupational diseases. As a special feature of work-related seafood allergy with regard to insurance law aspects, it must be taken into account that there is a potential risk of systemic reaction with subsequent multi-organ involvement. For the estimation of MdE in the general labor market, the impact of a seafood allergy can therefore be assessed, depending on its clinical severity, as generally “mild” to “severe” in justified individual cases.
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Oriel RC, Waqar O, Sharma HP, Casale TB, Wang J. Characteristics of Food Allergic Reactions in United States Restaurants. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1675-1682. [PMID: 33338685 DOI: 10.1016/j.jaip.2020.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Food allergic reactions of varying severity occur in restaurants. Studies to date have shown that there are gaps in knowledge of and communication between restaurant staff and food allergic individuals. OBJECTIVE We sought to characterize allergic reactions in restaurants to better inform the restaurant industry, food allergic individual, and allergist so that mitigation strategies can be implemented. METHODS Data collected over a 2-year period from 2822 individuals in the Food Allergy Research & Education registry were analyzed using descriptive statistics. RESULTS Dining out accounted for the second most common location for a food allergic reaction, after one's home, and many were severe with 28.0% requiring 1 dose and 6.2% requiring 2 doses of epinephrine. Cafes, fast food establishments, and Asian restaurants were frequently implicated sites. Peanut, tree nuts, and milk were the most common inciting allergens, and tree nuts resulted in the most common use of epinephrine. Of the allergic reactions, 53.9% occurred despite conveyance of food allergy to restaurant staff, 26.6% occurred when allergens were declared on the menu, and 13.7% occurred when allergens were declared on the menu and restaurant staff were informed of a food allergy. CONCLUSIONS Allergic reactions in restaurants are common and can be severe. Findings presented here underscore the need for restaurant staff training and mandatory declaration of allergenic ingredients in meals. This updated knowledge will help support advocacy efforts and inform patients, allergists, and the restaurant industry on best practices for dining out to improve the quality of life for food allergic individuals.
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Affiliation(s)
- Roxanne C Oriel
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Omar Waqar
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hemant P Sharma
- Division of Allergy and Immunology, Department of Pediatrics, Children's National Health System, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Thomas B Casale
- Division of Allergy and Immunology, Department of Medicine, University of South Florida, Tampa, FL; Food Allergy Research & Education (FARE), Mclean, VA
| | - Julie Wang
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
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Blom WM, van Os-Medendorp H, Bijlsma S, van Dijk A, Kruizinga AG, Rubingh C, Michelsen-Huisman AD, Knulst AC, Houben GF. Allergen risk assessment: Food intake levels of the general population represent those of food allergic patients. Food Chem Toxicol 2020; 146:111781. [DOI: 10.1016/j.fct.2020.111781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/01/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
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Can we define a level of protection for allergic consumers that everyone can accept? Regul Toxicol Pharmacol 2020; 117:104751. [PMID: 32763252 DOI: 10.1016/j.yrtph.2020.104751] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 01/01/2023]
Abstract
Substantial progress has been made in characterising the risk associated with exposure to allergens in food. However, absence of agreement on what risk is tolerable has made it difficult to set quantitative limits to manage that risk and protect allergic consumers effectively. This paper reviews scientific progress in the area and the diverse status of allergen management approaches and lack of common standards across different jurisdictions, including within the EU. This lack of regulation largely explains why allergic consumers find Precautionary Allergen Labelling confusing and cannot rely on it. We reviewed approaches to setting quantitative limits for a broad range of food safety hazards to identify the reasoning leading to their adoption. This revealed a diversity of approaches from pragmatic to risk-based, but we could not find clear evidence of the process leading to the decision on risk acceptability. We propose a framework built around the criteria suggested by Murphy and Gardoni (2008) for approaches to defining tolerable risks. Applying these criteria to food allergy, we concluded that sufficient knowledge exists to implement the framework, including sufficient expertise across the whole range of stakeholders to allow opinions to be heard and respected, and a consensus to be achieved.
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DunnGalvin A, Roberts G, Schnadt S, Astley S, Austin M, Blom WM, Baumert J, Chan CH, Crevel RWR, Grimshaw KEC, Kruizinga AG, Regent L, Taylor S, Walker M, Mills ENC. Evidence-based approaches to the application of precautionary allergen labelling: Report from two iFAAM workshops. Clin Exp Allergy 2020; 49:1191-1200. [PMID: 31325393 DOI: 10.1111/cea.13464] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/27/2019] [Accepted: 07/05/2019] [Indexed: 12/11/2022]
Abstract
Food allergy is a major public health concern with avoidance of the trigger food(s) being central to management by the patient. Food information legislation mandates the declaration of allergenic ingredients; however, the labelling of the unintentional presence of allergens is less defined. Precautionary allergen labelling (PAL) was introduced by the food industry to help manage and communicate the risk of reaction from the unintended presence of allergens in foods. In its current form, PAL is counterproductive for consumers with food allergies as there is no standardized approach to applying PAL. Foods with a PAL often do not contain the identified food allergen while some products without a PAL contain quantities of common food allergens that are capable of inducing an allergic reaction. Integrated Approaches to Food Allergen and Allergy Risk Management (iFAAM) was an EU-funded project that aimed to improve the management of food allergens by the food industry for the benefit of people with food allergies. Within iFAAM, a clinically validated tiered risk assessment approach for food allergens was developed. Two cross-stakeholder iFAAM workshops were held on 13-14 December 2016 and 19-20 April 2018. One of the objectives of these workshops was to develop a proposal to make PAL effective for consumers. This paper describes the outcomes from these workshops. This provides the basis for the development of more informative and transparent labelling that will ultimately improve management and well-being in consumers with food allergy.
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Affiliation(s)
- Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Graham Roberts
- University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - Sabine Schnadt
- German Allergy and Asthma Association (DAAB), Mönchengladbach, Germany
| | | | | | - W Marty Blom
- The Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - Joseph Baumert
- Food Allergy Research and Resource Programme, University of Nebraska, Lincoln, NE, USA
| | - Chun-Han Chan
- Food Allergy and Intolerance Branch, Food Standards Agency, London, UK
| | | | | | - Astrid G Kruizinga
- The Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands
| | | | - Stephen Taylor
- Food Allergy Research and Resource Programme, University of Nebraska, Lincoln, NE, USA
| | - Michael Walker
- Laboratory of the Government Chemist, LGC, Teddington, UK
| | - E N Clare Mills
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, The University of Manchester, Manchester, UK
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Fierstein JL, Brown D, Gupta R, Bilaver L. Understanding Food-Related Allergic Reactions Through a US National Patient Registry. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:206-215.e1. [PMID: 32841746 DOI: 10.1016/j.jaip.2020.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/24/2020] [Accepted: 08/05/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although previous studies have focused on unintentional food-related allergic reactions, few have explored the motivation of intentional exposure to a known food allergen, independent of oral food challenges and/or oral immunotherapy. Still, data on the frequency and context of food-related allergic reactions remain sparse. OBJECTIVE To identify the frequency and context of food-related allergic reactions among children and adults. METHODS We analyzed surveys from the Patient Registry established by Food Allergy Research and Education. Multivariable logistic regression evaluated characteristics associated with having frequent food-related allergic reactions as well as intentional food-related allergic reactions. RESULTS Over one-third of 4075 (37.7%) respondents reported having more than 1 food-related allergic reaction per year, and 12.8% reported having 1 reaction per year. Of the 3054 respondents who completed the most recent reaction survey, 9.9% of food allergen exposures were classified as intentional, 82.1% as unintentional, and 4.8% as medically related. Among children with intentional exposures, the most common reason was that the child had never had a serious reaction (50.0%), and among adults, it was the decision to take the risk anyway (47.8%). Cross-contamination was the most commonly cited reason for unintentional exposure (children: 24.1%; adults: 32.2%). CONCLUSION Among patients in a national food allergy registry, reports of food-related allergic reactions were common, and a non-negligible number of intentional reactions were reported. Our findings indicate the need for research on reactions in and out of the emergency department as well as intentional risk-taking behavior.
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Affiliation(s)
- Jamie L Fierstein
- Center for Food Allergy & Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Dannielle Brown
- Center for Food Allergy & Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ruchi Gupta
- Center for Food Allergy & Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Academic General Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
| | - Lucy Bilaver
- Center for Food Allergy & Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Remington BC, Blom WM, Bassa B, Koppelman SJ. Risk of shared equipment in restaurants for consumers with peanut allergy: a simulation for preparing Asian foods: A simulation for preparing Asian foods. Ann Allergy Asthma Immunol 2020; 125:543-551.e6. [PMID: 32763340 DOI: 10.1016/j.anai.2020.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Allergic reactions to meals consumed outside the home are common and can be severe and sometimes fatal. OBJECTIVE To quantify the risk reduction potentially achieved by increasing an individual's threshold sensitivity to peanut (such as by means of immunotherapy) in scenarios of peanut exposure through shared kitchen materials in a restaurant setting. METHODS Three versions of popular peanut-containing sauces were selected to represent common ingredients used in Asian cooking. Different combinations of utensils, equipment, sauces, and test conditions were prepared by a professional chef, with or without common cleaning procedures, to represent normal daily practice. Residue amounts of peanut-containing material on kitchen equipment and utensils were measured and used for quantitative risk assessment to model the risk reduction associated with increasing an individual's threshold. RESULTS Shared utensils had mean residue amounts of 23 to 1519 mg peanut protein (no cleaning) and 3 to 82 mg peanut protein (after water rinse). Shared woks and pans had up to 20 mg peanut protein after rinsing. Individuals who reach a threshold of 300 mg peanut protein have a predicted relative risk reduction of 94.9% to greater than 99.99% with brief cleaning. With no cleaning, relative risk reductions were 63.5% to 91.1% for individuals with a baseline threshold of less than or equal to 100 mg peanut protein who reach a threshold of 300 mg peanut protein, increasing to 91% to 99.7% when reaching a threshold value of 1000 mg peanut protein. CONCLUSION In all shared kitchen material scenarios that we studied, achieving an eliciting dose of 300 or 1000 mg peanut protein seems clinically relevant for the peanut-allergic population.
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Affiliation(s)
- Benjamin C Remington
- Netherlands Organisation for Applied Scientific Research (TNO), Utrecht, The Netherlands; Food Allergy Research and Resource Program, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - W Marty Blom
- Netherlands Organisation for Applied Scientific Research (TNO), Utrecht, The Netherlands
| | | | - Stef J Koppelman
- Food Allergy Research and Resource Program, University of Nebraska-Lincoln, Lincoln, Nebraska.
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Schworer SA, Kim EH. Sublingual immunotherapy for food allergy and its future directions. Immunotherapy 2020; 12:921-931. [PMID: 32611211 DOI: 10.2217/imt-2020-0123] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Food allergy is an important medical problem with increasing prevalence throughout the world. Different approaches of food immunotherapy are being investigated including oral, epicutaneous and sublingual routes. Sublingual immunotherapy (SLIT) for food allergy involves placement of glycerinated allergen under the tongue daily to achieve allergen-specific desensitization. SLIT has been studied in the treatment of hazelnut, peach, apple, milk and peanut allergies with substantial focus on the treatment of peanut allergy. Phase II studies have shown SLIT for treatment of peanut allergy increases the tolerated dose of peanut by a substantial margin with fewer and less severe side effects than other modalities. This review discusses the mechanisms of SLIT, early studies of its use in food allergy and larger randomized controlled trials for treatment of peanut allergy. Future directions using the mechanisms involved in SLIT include oral mucosal immunotherapy for peanut allergy.
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Affiliation(s)
- Stephen A Schworer
- Department of Medicine, Division of Rheumatology, Allergy & Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Edwin H Kim
- Department of Medicine, Division of Rheumatology, Allergy & Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
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Bégin P, Chan ES, Kim H, Wagner M, Cellier MS, Favron-Godbout C, Abrams EM, Ben-Shoshan M, Cameron SB, Carr S, Fischer D, Haynes A, Kapur S, Primeau MN, Upton J, Vander Leek TK, Goetghebeur MM. CSACI guidelines for the ethical, evidence-based and patient-oriented clinical practice of oral immunotherapy in IgE-mediated food allergy. Allergy Asthma Clin Immunol 2020; 16:20. [PMID: 32206067 PMCID: PMC7079444 DOI: 10.1186/s13223-020-0413-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/14/2020] [Indexed: 12/17/2022] Open
Abstract
Background Oral immunotherapy (OIT) is an emerging approach to the treatment of patients with IgE-mediated food allergy and is in the process of transitioning to clinical practice. Objective To develop patient-oriented clinical practice guidelines on oral immunotherapy based on evidence and ethical imperatives for the provision of safe and efficient food allergy management. Materials and methods Recommendations were developed using a reflective patient-centered multicriteria approach including 22 criteria organized in five dimensions (clinical, populational, economic, organizational and sociopolitical). Data was obtained from: (1) a review of scientific and ethic literature; (2) consultations of allergists, other healthcare professionals (pediatricians, family physicians, nurses, registered dieticians, psychologists, peer supporters), patients and caregivers; and patient associations through structured consultative panels, interviews and on-line questionnaire; and (3) organizational and economic data from the milieu of care. All data was synthesized by criteria in a multicriteria deliberative guide that served as a platform for structured discussion and development of recommendations for each dimension, based on evidence, ethical imperatives and other considerations. Results The deliberative grid included 162 articles from the literature and media reviews and data from consultations involving 85 individuals. Thirty-eight (38) recommendations were made for the practice of oral immunotherapy for the treatment of IgE mediated food allergy, based on evidence and a diversity of ethical imperatives. All recommendations were aimed at fostering a context conducive to achieving objectives identified by patients and caregivers with food allergy. Notably, specific recommendations were developed to promote a culture of shared responsibility between patients and healthcare system, equity in access, patient empowerment, shared decision making and personalization of OIT protocols to reflect patients' needs. It also provides recommendations to optimize organization of care to generate capacity to meet demand according to patient choice, e.g. OIT or avoidance. These recommendations were made acknowledging the necessity of ensuring sustainability of the clinical offer in light of various economic considerations. Conclusions This innovative CPG methodology was guided by patients' perspectives, clinical evidence as well as ethical and other rationales. This allowed for the creation of a broad set of recommendations that chart optimal clinical practice and define the conditions required to bring about changes to food allergy care that will be sustainable, equitable and conducive to the well-being of all patients in need.
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Affiliation(s)
- P Bégin
- 1Division of Clinical Immunology, Rheumatology and Allergy, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC Canada.,2Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC Canada.,3Research Center of the Sainte-Justine University Hospital Center, Montreal, QC Canada
| | - E S Chan
- 4Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC Canada
| | - H Kim
- 5Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada.,6Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON Canada
| | - M Wagner
- 7Unit Methods, Ethics and Participation, INESSS, National Institute for Excellence in Health and Social Services, Montreal, QC Canada
| | - M S Cellier
- 3Research Center of the Sainte-Justine University Hospital Center, Montreal, QC Canada
| | - C Favron-Godbout
- 8Department of Bioethics, School of Public Health of the University of Montreal, Montreal, Canada
| | - E M Abrams
- 9Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, MB Canada
| | - M Ben-Shoshan
- 10Division of Allergy Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC Canada
| | - S B Cameron
- 4Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC Canada.,Community Allergy Clinic, Victoria, BC Canada
| | - S Carr
- 12Department of Pediatrics, University of Alberta, Edmonton, AB Canada
| | - D Fischer
- 5Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada
| | - A Haynes
- 13Discipline of Pediatrics, Memorial University of Newfoundland, St. John's, NL Canada
| | - S Kapur
- 14Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - M N Primeau
- 15Division of Allergy and Clinical Immunology, Department of Medicine, CISSS Laval, Laval, QC Canada
| | - J Upton
- 16Division of Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - T K Vander Leek
- 12Department of Pediatrics, University of Alberta, Edmonton, AB Canada
| | - M M Goetghebeur
- 7Unit Methods, Ethics and Participation, INESSS, National Institute for Excellence in Health and Social Services, Montreal, QC Canada
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Differences in management of peanut allergy between allergists and pediatricians. Ann Allergy Asthma Immunol 2020; 124:512-513. [PMID: 32006704 DOI: 10.1016/j.anai.2020.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/06/2020] [Accepted: 01/23/2020] [Indexed: 11/24/2022]
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Tackett AP, Roberts CM, Farrow M, McQuaid EL. Food insecurity and caregiver perceptions of food allergen risk by food purchase location in children with food allergies. Transl Behav Med 2020; 9:404-412. [PMID: 31094448 DOI: 10.1093/tbm/ibz059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Meeting nutritional needs of children with food allergy (FA) may be challenging without affordable, quality foods. Food purchase location may impact availability of FA-safe foods; however, no research examining food purchase location in families of children with FA exists. This study compared caregiver report of food insecurity (FIS; food insecure vs. food secure), FA risk, and history of food-induced anaphylaxis (FIA) in families of children with FA, who primarily purchase food items at grocery/supermarkets (n = 140) or convenience marts/bodegas (CB; n = 32). Caregivers (N = 172; 49% mothers, 49% fathers, 2% grandparent/other relative) of children with FA (57% male; Mage = 7.5 years; 66% White [22% Latinx and 44% non-Latinx] and 23% Black) completed an online survey. Variables included demographics, history of FIA, and caregiver perceptions of FIS and FA risk. Caregivers who purchased food items from CB versus supermarkets reported higher perceived risk of accidental ingestion (χ2 = 20.49, p < .001, 94% vs. 50%), severe reaction (χ2 = 15.05, p < .001, 97% vs. 61%), death (χ2 = 27.48, p < .001, 91% vs. 49%), FIS (χ2 = 21.69, p < .001, 94% vs. 49%), and FIA (χ2 = 11.96, p = .001, 94% vs. 32%). Effect sizes were small-moderate (Cramer's V = .26-.40). Families who purchased food at CB reported greater food allergen concerns and FIS than families who purchased food at supermarkets. Differences in FA-related perceived risks may reflect the health disparity and adversity these families face to meet basic nutritional needs, such as FA-related constraints. Point-of-care efforts are needed to provide early screening for families who may be at risk for experiencing FIS.
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Affiliation(s)
- Alayna P Tackett
- Oklahoma Tobacco Research Center, Oklahoma City, OK, USA.,Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Caroline M Roberts
- Psychology Department, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Michael Farrow
- Bradley/Hasbro Children's Hospital Research Center, Rhode Island Hospital, Providence, RI, USA
| | - Elizabeth L McQuaid
- Bradley/Hasbro Children's Hospital Research Center, Rhode Island Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
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Islam MO, Palit P, Shawon J, Hasan MK, Mahmud A, Mahfuz M, Ahmed T, Mondal D. Exploring novel therapeutic strategies against vivax malaria through an integrated computational investigation to inhibit the merozoite surface protein−1 of Plasmodium vivax. INFORMATICS IN MEDICINE UNLOCKED 2020. [DOI: 10.1016/j.imu.2020.100471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kwon J, Lee YM, Wen H. Knowledge, attitudes, and behaviors about dining out with food allergies: A cross-sectional survey of restaurant customers in the United States. Food Control 2020. [DOI: 10.1016/j.foodcont.2019.106776] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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38
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Robison RG. Emerging Food Allergy Treatments. Pediatr Ann 2019; 48:e468-e472. [PMID: 31830285 DOI: 10.3928/19382359-20191114-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Immunoglobulin E (IgE)-mediated food allergy affects up to 8% of the pediatric population and occurs when a person develops antibodies to specific food proteins resulting in immediate reaction upon ingestion of the food in question. Current treatment revolves around strict allergen avoidance and prompt treatment of systemic, anaphylactic reactions with injectable epinephrine. However, despite strict avoidance, unexpected reactions are a significant problem. Therefore, therapeutic options for treatment of food allergy are in high demand. This article focuses on emerging therapies including oral immunotherapy, sublingual immunotherapy, epicutaneous immunotherapy, and possible adjunct therapies for the treatment and desensitization of IgE-mediated food allergy. [Pediatr Ann. 2019;48(12):e468-e472.].
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Costa C, Coimbra A, Vítor A, Aguiar R, Ferreira AL, Todo-Bom A. Food allergy-From food avoidance to active treatment. Scand J Immunol 2019; 91:e12824. [PMID: 31486118 DOI: 10.1111/sji.12824] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/14/2019] [Accepted: 08/29/2019] [Indexed: 12/31/2022]
Abstract
The prevalence of food allergy (FA) has increased too rapidly, possibly due to environmental factors. The guidelines recommend strict allergen avoidance, but FA is still the main cause of anaphylaxis in all age groups. Immunotherapy is the only treatment able to change the course of allergic disease, and oral immunotherapy (OIT) is the more effective route in FA. However, it carries the risk of adverse reactions, including anaphylaxis. To improve OIT safety, adjuvant therapy with the immunoglobulin E (IgE) monoclonal antibody omalizumab has been extensively used. Results suggest particular benefit in patients with high risk of fatal anaphylaxis. An alternative approach is to use omalizumab instead of OIT to prevent severe allergic reactions upon accidental exposure. This paper reviews current evidence regarding IgE-mediated FA, focusing on natural tolerance and food sensitization acquisition, and on avoidance measures and their limitations.
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Affiliation(s)
- Célia Costa
- Immunoallergology Department, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte (CHLN), EPE, Lisbon, Portugal
| | - Alice Coimbra
- Immunoallergology Department, Hospital de S. João EPE, Centro Hospitalar de São João (CHSJ), Porto, Portugal
| | - Artur Vítor
- Pediatrics Department, Hospital de S. João EPE, Centro Hospitalar de São João (CHSJ), Porto, Portugal
| | - Rita Aguiar
- Immunoallergology Department, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte (CHLN), EPE, Lisbon, Portugal
| | - Ana Luísa Ferreira
- Immunoallergology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNGE), Vila Nova de Gaia, Portugal
| | - Ana Todo-Bom
- Immunoallergology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Fierstein JL, Chadha AS, Valaika SS, Gupta RS. Understanding food allergy education needs in early childhood schools. Ann Allergy Asthma Immunol 2019; 124:91-93. [PMID: 31698094 DOI: 10.1016/j.anai.2019.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/21/2019] [Accepted: 10/26/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Jamie L Fierstein
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Avneet S Chadha
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Sarah S Valaika
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ruchi S Gupta
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.
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Accidental versus new food allergy reactions in a pediatric emergency department. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1662-1664. [DOI: 10.1016/j.jaip.2018.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/29/2018] [Accepted: 11/16/2018] [Indexed: 01/27/2023]
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Fuciños C, Estévez N, Míguez M, Fajardo P, Chapela MJ, Gondar D, Rúa ML. Effectiveness of proteolytic enzymes to remove gluten residues and feasibility of incorporating them into cleaning products for industrial purposes. Food Res Int 2019; 120:167-177. [PMID: 31000227 DOI: 10.1016/j.foodres.2019.02.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
The development of protocols for efficient gluten elimination is one of the most critical aspects of any allergen management strategy in the industry. The suitability of different proteolytic enzymes to be included in a cleaning formulation that allows the effective elimination of gluten residues was studied. Alcalase (ALC), neutrase (NEUT) and flavourzyme (FLAV) were selected from in silico analysis. The presence of 1% (v/v) of linear alkylbenzene sulphonate (LAS), a common anionic detergent, improved the gluten solubility, which may favour its elimination. Chromatographic analysis showed that the three enzymes studied were able to hydrolyse gluten in the presence of LAS. The highest percentage of short peptides (< 5 kDa) was achieved with ALC, what increases the probability of reducing the gluten antigenicity. Besides, in the presence of ALC and detergent LAS have detected the lowest levels of gluten with ELISA kits. So, effective amounts of ALC and LAS were added to a cleaning formulation, where its proteolytic activity was maintained above 90% after 37 days at 4 °C and 25 °C (under dark). Preliminary validation of the effectiveness enzymatic cleaning formulation to hydrolyse gluten was performed in a ready-to-eat/frozen food company, in which previous episodes of cross-contamination with gluten have been detected. The gluten content decreased to values below 0.125 μg/100 cm2 when the cleaning formulation was tested on different surfaces with different cleaning protocols, demonstrating the high suitability of the enzymatic cleaning formulation developed.
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Affiliation(s)
- Clara Fuciños
- Analytical and Food Chemistry Department, Faculty of Sciences, University of Vigo, As Lagoas, 32004 Ourense, Spain.
| | - Natalia Estévez
- Analytical and Food Chemistry Department, Faculty of Sciences, University of Vigo, As Lagoas, 32004 Ourense, Spain
| | - Martín Míguez
- Analytical and Food Chemistry Department, Faculty of Sciences, University of Vigo, As Lagoas, 32004 Ourense, Spain
| | - Paula Fajardo
- Health, Nutrition and Pharma Unit, R&D Area, ANFACO-CECOPESCA, Colegio Universitario 16, Vigo, 36310 Pontevedra, Spain
| | - María José Chapela
- Health, Nutrition and Pharma Unit, R&D Area, ANFACO-CECOPESCA, Colegio Universitario 16, Vigo, 36310 Pontevedra, Spain
| | - Dora Gondar
- KEMEGAL, Pol. Ind. Pousadoiro, Parcela 11, Vilagarcía de Arousa 36600, Spain
| | - M Luisa Rúa
- Analytical and Food Chemistry Department, Faculty of Sciences, University of Vigo, As Lagoas, 32004 Ourense, Spain
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Impact of the regulation (EU) 1169/2011: Allergen-related recalls in the rapid alert system for food and feed (RASFF) portal. Food Control 2019. [DOI: 10.1016/j.foodcont.2018.11.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Soon JM. Food allergen knowledge, attitude and practices among UK consumers: A structural modelling approach. Food Res Int 2019; 120:375-381. [PMID: 31000251 DOI: 10.1016/j.foodres.2019.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 12/25/2022]
Abstract
Food allergies are becoming more prevalent and affect up to 1-2% of adults and 5-8% of children in the UK. This study investigated the food allergen knowledge, attitude towards food allergens and food allergy management practices among food allergic and intolerant consumers and/or their family members and carers. Questionnaires were distributed at three major Free From events in the UK in 2017 and 2018. Structural Equation Modelling (SEM) was used as a confirmatory technique to determine the model's validity. Cereals containing gluten, milk and eggs were the most common triggers reported by the consumers. Other trigger foods such as chocolate, garlic, maize, onions, red and white meat, spices, and fruits such as apples and cherries were also reported. Consumers demonstrated very good understanding on the severity of allergic reactions, prevention method and hidden egg ingredients. Overall, consumers were relatively good in the knowledge section. The participants were motivated in their personal allergen avoidance towards food allergens especially in checking food labels, preference for more free from product choices and handwashing. Consumers did not rely on dietary apps or social media to find out about allergen-free food products. Both knowledge and attitude did not translate into food allergy management practices. Significant correlation between knowledge and attitude was identified suggesting that as knowledge decreases, so will their attitude scores. This study suggests that targeted and systematic food allergy management topics and peer support could be used to improve consumers' knowledge and attitude to positively impact food allergen handling practices.
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Affiliation(s)
- Jan Mei Soon
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK.
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Sensitivity analysis to derive a food consumption point estimate for deterministic food allergy risk assessment. Food Chem Toxicol 2019; 125:413-421. [DOI: 10.1016/j.fct.2019.01.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 11/18/2022]
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Houben G, Blom M, Alvito P, Assunção R, Crevel R, Fæste CK, Le TM, Madsen CB, Remington B, Stroheker T, Vassilopoulou E, Verhoeckx K, Žiarovská J, Constable A. Defining the targets for the assessment of IgE-mediated allergenicity of new or modified food proteins. Food Chem Toxicol 2019; 127:61-69. [PMID: 30826409 DOI: 10.1016/j.fct.2019.02.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 12/20/2022]
Abstract
Many food innovations rely on the introduction and use of new or modified proteins. New or modified food proteins may lead to major health risks due to their inherent potential to cause food allergy. Currently, the pre-market allergenicity assessment for new or modified food proteins and protein sources relies on methods for identifying allergenic hazards based on characteristics of known allergens. However, there is no general consensus on the allergenicity parameters to use and the criteria that should apply for the evaluation and decisions to be made. In this paper, we propose that the strategy for allergenicity risk assessment of new or modified food proteins and the methodologies applied should be governed by the risk management questions to be answered, reflected in the information needed by risk managers to enable their informed decision making. We generated an inventory of health outcome-related assessment parameters and criteria potentially important for risk management decision-making and we discuss the implications of selecting different optional criteria (e.g. cut-off values) for what could be accepted as safe with regards to the health outcomes in the (at risk) population. The impact of these various options on both method development and risk management practices was investigated.
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Affiliation(s)
| | | | - Paula Alvito
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Ricardo Assunção
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | | | | | - Thuy-My Le
- University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | - Jana Žiarovská
- Slovak University of Agriculture, Nitra, Slovak Republic
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The role of incurred materials in method development and validation to account for food processing effects in food allergen analysis. Anal Bioanal Chem 2019; 411:4465-4480. [PMID: 30758527 DOI: 10.1007/s00216-019-01642-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 12/12/2022]
Abstract
The issue of undeclared allergens represents a matter of great concern, being the subject of many alert notifications by the Rapid Alert System for Food and Feed portal of the European Commission, often leading to food recalls. The availability of reliable analytical approaches able to detect and quantify hidden allergens in processed foods is increasingly requested by the food industry, food safety authorities and regulatory bodies to protect sensitive consumers' health. The present review discusses the fundamental role of incurred materials for method development and analytical performance assessment in a metrology perspective on testing for undeclared allergens in processed foodstuffs. Due to the nature of the analytes and their susceptibility to various processing effects, reliability and comparability of results have posed a great challenge. In this context, the use of incurred samples as reference materials permits simulation of the effects of food processing on target analyte structure affecting analyte extractability and detectability. Graphical abstract ᅟ.
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Dantzer JA, Wood RA. Next-Generation Approaches for the Treatment of Food Allergy. Curr Allergy Asthma Rep 2019; 19:5. [PMID: 30689123 DOI: 10.1007/s11882-019-0839-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW IgE-mediated food allergies are an increasing health concern, and current management includes food avoidance and use of emergency medications. Effective treatment of food allergy is highly desirable. Next generation approaches for the treatment of food allergy aim to improve both safety and efficacy, potentially including long-term tolerance. RECENT FINDINGS Oral immunotherapy (OIT) and epicutaneous immunotherapy (EPIT) will likely be integrated into clinical practice as part of food allergy management in the near future. Newer approaches, such as sublingual immunotherapy (SLIT), modified proteins, lysosomal-associated membrane protein DNA (LAMP DNA) vaccines, and the use of immunomodulatory agents, are early in development and depending on results, could also become important treatment options. This is a review of novel approaches to the treatment of food allergy that are currently under investigation, including the use of SLIT, modified proteins, probiotics, Chinese herbal supplements, biologic therapies, and DNA vaccines, as well as a summary of the current status of OIT and EPIT.
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Affiliation(s)
- Jennifer A Dantzer
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, John Hopkins University School of Medicine, 600 N. Wolfe St., CMSC 1102, Baltimore, MD, 21287, USA
| | - Robert A Wood
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, John Hopkins University School of Medicine, 600 N. Wolfe St., CMSC 1102, Baltimore, MD, 21287, USA.
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Michelsen-Huisman AD, van Os-Medendorp H, Blom WM, Versluis A, Castenmiller JJM, Noteborn HPJM, Kruizinga AG, Houben GF, Knulst AC. Accidental allergic reactions in food allergy: Causes related to products and patient's management. Allergy 2018; 73:2377-2381. [PMID: 30004595 PMCID: PMC6585738 DOI: 10.1111/all.13560] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | - Harmieke van Os-Medendorp
- Department of Dermatology and Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - W. Marty Blom
- Department of Dermatology and Allergology; University Medical Center Utrecht; Utrecht The Netherlands
- The Netherlands Organisation for Applied Scientific Research (TNO); Zeist The Netherlands
| | - Astrid Versluis
- Department of Dermatology and Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | | | | | - Astrid G. Kruizinga
- The Netherlands Organisation for Applied Scientific Research (TNO); Zeist The Netherlands
| | - Geert F. Houben
- Department of Dermatology and Allergology; University Medical Center Utrecht; Utrecht The Netherlands
- The Netherlands Organisation for Applied Scientific Research (TNO); Zeist The Netherlands
| | - André C. Knulst
- Department of Dermatology and Allergology; University Medical Center Utrecht; Utrecht The Netherlands
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Barnett J, Begen FM, Gowland MH, Lucas JS. Comparing the eating out experiences of consumers seeking to avoid different food allergens. BMC Public Health 2018; 18:1263. [PMID: 30442121 PMCID: PMC6238278 DOI: 10.1186/s12889-018-6117-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/12/2018] [Indexed: 01/13/2023] Open
Abstract
Background Eating outside the home is challenging for consumers with food allergy (FA) and intolerance (FI) and lack of allergen information provision in eating out venues can lead to unnecessary restrictions. Following European legislation (2014) designed to improve allergen information provision, little is known about differences in information provision experienced by consumers seeking to avoid particular allergens, or how this impacts on their eating out experiences. This study compared the information provision that consumers with FA/FI to different allergens experience when eating out. Methods Using mixed methods, participants were recruited from across the UK and took part in self-report surveys or in-depth interviews. Surveys were completed by 232 participants avoiding either gluten (n = 66), nuts (peanuts/tree nuts) (n = 94), or milk (n = 74), and responses were subject to quantitative analyses. Interviews were carried out with 49 participants avoiding either gluten (n = 13), nuts (n = 14), milk (n = 13) or a combination of these allergens (n = 9), and analysed using the framework approach. Results Although general improvements in information provision following the legislation were reported, variations in provision between allergen groups led participants seeking to avoid milk to conclude that their dietary needs were less well-understood and seen as less important. These perceptions were reflected in a reluctance to involve eating out venue staff in deliberations about the potential for milk-free meal options. Conclusions The provision of visual indicators of the presence of milk and of staff trained in allergen-awareness would improve the eating out experiences of consumers seeking to avoid milk. Medical professions can play a key role in encouraging these patients to pursue their right to make enquiries about allergens in order to avoid accidental milk ingestion when eating out. Electronic supplementary material The online version of this article (10.1186/s12889-018-6117-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julie Barnett
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Fiona M Begen
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | | | - Jane S Lucas
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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