Accidental food allergy reactions: Products and undeclared ingredients

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Background: Cofactors, such as physical exercise and alcohol intake, might be associated with the severity or occurrence of food allergic reactions.Objective: To gain insight into the frequency of presence of potential cofactors in accidental food allergic reactions in adults and to what extent these factors influence the severity and occurrence of allergic reactions.Methods: A prospective cohort study was conducted, with a 1-year follow-up in adult patients with a physician-diagnosed food allergy. Patients were required to fill in a questionnaire after every accidental allergic reactions to food over a 1-year period. The primary outcome measure was the frequency that potential cofactors were present in these allergic reactions.Results: A total of 157 patients were included, of which 46% reported a total of 153 reactions during a 1-year follow-up period. In 74% of the reactions, ≥1 potential cofactor was reported to be present: tiredness (38%), alcohol intake (16%), stress (14%), symptoms of pollinosis (16%), symptoms of asthma (9%), sickness/flu (3%), physical exercise (3%) and use of analgesics (2%). More than one potential cofactor was reported in almost half of all reactions (47%). There was no significant difference in the presence of these factors between mild, moderate and severe reactions (P = 0.522). In the total study population, 9% of the patients used medication that might act as cofactor (antacids, angiotensin receptor blockers [ARBs], beta blockers and angiotensin-converting enzyme inhibitors [ACEIs]) on a daily basis, which however did not influence the occurrence of reactions. Furthermore, 38% daily used allergy-suppressing medication.Conclusions: Although factors suggested to be cofactors were frequently present during accidental food allergic reactions, we found no evidence for an association between the potential cofactors examined and reaction severity, in a population where most reactions were of mild to moderate severity. K E Y W O R D Saccidental reaction, alcohol, cofactor, exercise, food allergy

Section: Study Design and Settingmentioning

confidence: 99%

Potential cofactors in accidental food allergic reactions are frequently present but may not influence severity and occurrence

Versluis

Os‐Medendorp

Blom

et al. 2018

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“…[1][2][3][4][5] Avoidance of the trigger food(s) is central to management by patients but accidental ingestion is common, causing frequent and sometimes life-threatening reactions. [6][7][8][9][10] Admission rates for anaphylaxis have increased approximately threefold between 2005 and 2012 in several countries. [11][12][13] Management of both food allergy (by patients and health practitioners) and allergens (by industry) is currently hindered by gaps in the evidence and in the implementation of our current knowledge compounded by a lack of consensus.…”

Section: Backg Rou N Dmentioning

confidence: 99%

Evidence‐based approaches to the application of precautionary allergen labelling: Report from two iFAAM workshops

Galvin

Roberts

Schnadt³

et al. 2019

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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.

“…A systematic review and meta‐analysis has reported the pooled lifetime prevalence of self‐reported FA as 17.3% (95% CI: 17.0‐17.6) . Avoidance of the trigger food(s) is central to effective self‐management but unintentional consumption is common causing frequent reactions, some of which may be life‐threatening . Admission rates for anaphylaxis have increased approximately threefold between 2005 and 2012 .…”

Section: Introductionmentioning

confidence: 99%

Understanding how consumers with food allergies make decisions based on precautionary labelling

Galvin

Roberts

Regent³

et al. 2019

Background Understanding consumer perceptions is crucial if effective food safety policy and risk communication are to be developed and implemented. We sought to understand how those living with food allergy assess risk with precautionary allergen labelling (PAL) and their preference in how risks are communicated within a quantitative risk assessment (QRA) framework. Methods The Integrated Approaches to Food Allergen and Allergy Risk Management (iFAAM) labelling online survey was developed for adults and parents of children with food allergy and distributed across Germany, Ireland, Netherlands, Spain and UK via patient support groups. Results There were 1560 complete responses. ‘This product is not suitable for’ was selected as first choice for PAL by 46% overall and ‘May contain’ was selected as the first choice by 44%. Seventy‐three percent reported that it would improve their trust in a product if a QRA process had been used to make a decision about whether to include ‘may contain’. Overall, 66% reported that a ‘statement + symbol’ on the label indicating a QRA, would help them to understand the risk assessment process that had been used by the food manufacturer. Conclusions Consumers want to know what process has actually taken place for the placing of a PAL and/or risk assessment statement on a particular food product. Our findings provide a basis for the development of more informative communication around food allergen risk and safety and support evidence‐based policy‐making in the context of the legislative requirements of the European Union's Food Information for Consumers Regulation.