Full range of population Eliciting Dose values for 14 priority allergenic foods and recommendations for use in risk characterization

Houben, Geert F.; Baumert, Joseph L.; Blom, W. Marty; Kruizinga, Astrid G.; Meima, Marie Y.; Remington, Benjamin C.; Wheeler, Marcia A.; Westerhout, Joost; Taylor, Steve L.

doi:10.1016/j.fct.2020.111831

Cited by 95 publications

(111 citation statements)

References 26 publications

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“…To minimize selection bias, we utilized a recruitment strategy that did not involve the subjective selection of participants by healthcare professionals, nor did we exclude participants with a history of anaphylaxis. Furthermore, the distribution of eliciting doses at challenge in this study (as depicted in Figure 1) is not dissimilar to published data for cow's milk, 22 which strongly supports our assessment that our participants are very likely to represent the population with CMPA in Europe. We were unable to determine the proportion of subjects with tolerance to baked milk, as this had not been assessed in the majority of subjects.…”

Section: Discussionsupporting

confidence: 88%

“…Threshold dose distribution for the 118 participants who also underwent formal food challenge to cow's milk, compared to published dose‐distribution data by Houben et al 22 Error bars represent 95% confidence intervals…”

Section: Resultsmentioning

confidence: 99%

“…One such scheme is the Voluntary Incidental Trace Allergen Labelling (VITAL) in Australia. The VITAL Scientific Expert Panel recently updated reference doses for major food allergens, using updated OFC datasets and a new Stacked Model Averaging algorithm incorporating five different statistical models (Weibull, Log Logistic, Log Normal, Log Double Exponential, General Pareto) 2,22 . For cow's milk protein, an ED 05 of 2.4 mg (95%CI 1.3 to 5.0) was proposed, although the action level was based on an ED 01 of 0.2 mg (95%CI 0.1 to 0.5).…”

Section: Discussionmentioning

confidence: 99%

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Single‐dose oral challenges to validate eliciting doses in children with cow’s milk allergy

Turner

d’Art

Duca

et al. 2021

Pediatric Allergy Immunology

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Background There is increasing interest in the use of eliciting doses (EDs) to inform allergen risk management. The ED can be estimated from the distribution of threshold doses for allergic subjects undergoing food challenges within a specified population. Estimated ED05 values for cow's milk (the dose expected to cause objective allergic symptoms in 5% of the milk‐allergic population) range from 0.5 mg to 13.9 mg cow's milk protein. We undertook a single‐dose challenge study to validate a predicted ED05 for cow's milk of 0.5 mg protein. Methods Participants were recruited from 4 clinical centres. Predetermined criteria were used to identify patients reacting to 0.5 mg cow's milk protein (approximately 0.015 mL of fresh cow's milk). Children over 1 year underwent formal challenge to cow's milk to confirm clinical reactivity. Results 172 children (median age 6.0 (IQR 0.7‐11) years, 57% male) were included in this analysis. Twelve (7.0%, 95% CI 3.7%‐11.9%) children experienced objective symptoms that met the predetermined criteria. One participant had mild anaphylaxis that responded to a single dose of adrenaline, the remainder experienced only mild symptoms with no treatment required. We did not identify any baseline predictors of sensitization that were associated with objective reactivity to the single‐dose challenge using 0.5 mg cow's milk protein. Conclusions These data support an estimated ED05 for cow's milk of 0.5 mg protein. Values for ED05 above 0.5 mg for cow's milk protein proposed for allergen risk management need to be reviewed.

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Section: Discussionsupporting

confidence: 88%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Single‐dose oral challenges to validate eliciting doses in children with cow’s milk allergy

Turner

d’Art

Duca

et al. 2021

Pediatric Allergy Immunology

Self Cite

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“…Baseline demographics of participants who underwent single-dose challenge to cow's milk General Pareto) 2,22. For cow's milk protein, an ED 05 of 2.4 mg (95%CI 1.3 to 5.0) was proposed, although the action level was based on an ED 01 of 0.2 mg (95%CI 0.1 to 0.5).…”

mentioning

confidence: 99%

Single dose oral challenges to validate eliciting doses in children with cow's milk allergy

Turner

d’Art

Duca

et al. 2020

Preprint

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“…Compared to the VITAL 3.0 updated thresholds, set to offer a protection of 99% of the allergic population (0.2 mg for peanuts and 0.1 mg for hazelnuts) 18 , it is unlikely that products with smaller exposure values would trigger an objective allergic reaction (0.02 mg < VITAL doses). Regarding the highest intake values (1.12 mg for peanuts and 86.7 mg for hazelnuts), according to Houben et al 2020, an objective reaction would be experienced by up to 4% and 24% of peanut and hazelnut-allergic individuals, respectively 23 . Thus, allergic reactions can be expected to occur for both allergens, especially hazelnuts, because of its high concentrations.…”

Section: Discussionmentioning

confidence: 99%

Peanut and hazelnut occurrence as allergens in foodstuffs with precautionary allergen labeling in Canada

et al. 2021

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Precautionary allergen labeling (PAL) is widely used by food industries. Occurrence studies revealed that few analyzed products contained the allergen(s) present in the statement, but little is known in Canada. To improve manufacturing practices and better manage allergen cross-contamination, occurrence data is needed to determine the exposure of allergic individuals eating those products. Samples were analyzed for peanuts (n = 871) and hazelnuts (n = 863) using ELISA methods. Within samples analyzed for peanuts, 72% had a PAL (n = 628), 1% had peanuts as a minor ingredient (n = 9) and 27% were claimed “peanut-free” (n = 234). Most hazelnut samples had a PAL for tree nuts/hazelnuts (94%; n = 807) with 6% claimed “nut-free” (n = 56). Peanuts and hazelnuts were found in 4% (0.6–28.1 ppm) and 9% (0.4–2167 ppm) of all samples, respectively. Chocolates were mostly impacted; they should be treated apart from other foods and used in risk assessments scenarios to improve manufacturing practices, reducing unnecessary PAL use.

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Full range of population Eliciting Dose values for 14 priority allergenic foods and recommendations for use in risk characterization

Cited by 95 publications

References 26 publications

Single‐dose oral challenges to validate eliciting doses in children with cow’s milk allergy

Single‐dose oral challenges to validate eliciting doses in children with cow’s milk allergy

Single dose oral challenges to validate eliciting doses in children with cow's milk allergy

Peanut and hazelnut occurrence as allergens in foodstuffs with precautionary allergen labeling in Canada

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