Clinical implications of food allergen thresholds

Graham, François; Eigenmann, Philippe

doi:10.1111/cea.13144

Cited by 15 publications

(15 citation statements)

References 76 publications

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“…For example, 26 000 ppm was only found in one study in one sample 13 . In this same study, the median ppm whole peanut in positive sampled packaged nutrition bars with advisory labels was 28.4 ppm, 13 which represents 0.71 mg peanut protein per 100 g. This level might cause symptoms in patients with very low reaction thresholds representing only a minority of peanut‐allergic patients 12 . Other similar studies found median amounts of peanut protein per serving between 0.07 14 and 0.46 mg 15 .…”

Section: Do Foods With Peanut Precautionary Labeling Actually Containmentioning

confidence: 79%

Can my child with IgE‐mediated peanut allergy introduce foods labeled with “may contain traces”?

Graham

Caubet

Eigenmann

2020

Pediatric Allergy Immunology

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Peanut IgE‐mediated food allergy is one of the most common food allergies in children with a prevalence that has increased in the past decades in Westernized countries. Peanut allergies can trigger severe reactions and usually persist over time. Peanut‐allergic children and their families are often confronted to processed foods with precautionary allergen labeling (PAL) such as “may contain traces of peanuts,” which are frequently used by the food industry. Patients are generally confused as to whether eating such foods entails a risk of allergic reaction, which can ultimately lead to dietary restrictions and decreased quality of life. Thus, guidance toward eviction of foods with PALs such as “may contain traces of peanuts” is a recurring problem that peanut‐allergic patients address during pediatric allergy consultations with varying attitudes among allergists. Many studies have evaluated peanut contamination in foods with PALs, with generally less than 10% of foods containing detectable levels of peanuts, albeit heterogeneous amounts, with in rare occasions levels that could trigger allergic reactions in certain patients. The risk of reacting to foods with traces varies significantly with threshold, with patients with the lowest reaction thresholds at highest risk, and a dramatic reduction of risk as threshold increases. Thus, risk stratification based on individual reaction threshold may help stratify patients’ risk of reacting to foods with PAL. In clinical practice, a single‐dose 30 mg peanut protein oral food challenge may be an option to stratify peanut‐allergic patients’ risk when introducing foods with PAL, as illustrated by three clinical cases.

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Section: Do Foods With Peanut Precautionary Labeling Actually Containmentioning

confidence: 79%

Can my child with IgE‐mediated peanut allergy introduce foods labeled with “may contain traces”?

Graham

Caubet

Eigenmann

2020

Pediatric Allergy Immunology

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“…Our findings could have implications for risk assessment (threshold dose modelling), for patient management (identification of the most sensitive patients, “low threshold reactors”) and diet advice (products with precautionary labelling), OFC indications and procedure (low‐dose challenge protocol, single dose protocol) and for policy makers (food labelling, precautionary allergen labelling) …”

Section: Discussionmentioning

confidence: 99%

Gender, prick test size and rAra h 2 sIgE level may predict the eliciting dose in patients with peanut allergy: Evidence from the Mirabel survey

Elegbede

Papadopoulos

Just

et al. 2019

Clin Experimental Allergy

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Background: Peanut allergy management is based on active avoidance and access to emergency treatment including self-injectable adrenaline. Knowing the dose at which a patient is likely to react is crucial for risk assessment and could significantly improve management by integrating a personalized approach.Objective: To develop a threshold dose distribution curve model from routinely collected data. Methods:The MIRABEL survey is an observational study of 785 patients with peanut allergy/sensitization conducted in France, Belgium and Luxemburg. The current analysis included the 238 participants for whom medical and oral food challenge data were available. Several statistical models (Kaplan-Meier, Cox model, Weibull and Lognormal with predictive factors, basic Weibull and Lognormal) were compared to select the best model and predictive factor combination associated with the threshold doses. Inferences were made with a Bayesian approach.

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“…Outdoor allergens include traffic-related pollutants, fungal and pollen airborne allergens 9,10 . In recent years, food allergies have increased and, as a consequence, they can contribute to the prevalence of childhood asthma 11 . Allergyinduced childhood asthma is a growing public health concern, not only from increasing trends but also from heterogenous repeated exposure to stimuli.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the associations of race, ethnicity, and food allergens in the development of childhood asthma: Re-analysis of publicly available retrospective cross-sectional cohort data

et al. 2018

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Asthma is among the most prevalent chronic diseases affecting children worldwide. Sociodemographic factors, such as race and ethnicity, as well as food allergens and their association with asthma, have been extensively studied in an individual manner. Less is known about how food allergens can influence the effect of sociodemographic factors on childhood asthma prevalence. In this study, we re-analyzed a publicly available retrospective cross-sectional cohort dataset of childhood asthma. Multiple logistic regression of asthma by race and ethnicity, before and after adjustment by the most prevalent allergens, was implemented to the dataset. Hispanic individuals showed a higher odds risk (ORs; 1.30, CI 1.26 -1.35) of asthma than Non-Hispanic individuals (0.24, CI 0.23 -0.25), but after adjustment by most frequent food allergens reactivities (shellfish, peanut, and milk), the asthma odd risks were comparable (Hispanic,.76]; Non-Hispanic, 3.51 [3.47 -3.52]). When considering race, Black individuals (1.90, CI 1.87 -1.94) had higher ORs of asthma than White individuals (0.21, CI 0.20 -0.22), Asian/Pacific Islander individuals (1.00, CI 0.95 -1.05), and Other/Unknown races (1.14, CI 1.11 -1.27). Although the ORs increased by three to four times for all races after adjusting for the most frequent food allergen reactivities, the same pattern of childhood asthma remained when considering races (in this order, Black, Other/Unknown, Asian/Pacific Islander, and White). In the dataset evaluated in this study, food allergens modified the association of race and ethnicity with the development of asthma. Therefore, public health interventions that gear towards the incidence of childhood asthma should contemplate the interplay and differences in nutrition among races and ethnicities.

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Clinical implications of food allergen thresholds

Cited by 15 publications

References 76 publications

Can my child with IgE‐mediated peanut allergy introduce foods labeled with “may contain traces”?

Can my child with IgE‐mediated peanut allergy introduce foods labeled with “may contain traces”?

Gender, prick test size and rAra h 2 sIgE level may predict the eliciting dose in patients with peanut allergy: Evidence from the Mirabel survey

Evaluating the associations of race, ethnicity, and food allergens in the development of childhood asthma: Re-analysis of publicly available retrospective cross-sectional cohort data

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