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Background: Precautionary Allergen ("may contain") Labelling (PAL) is used by industry to communicate potential risk to food-allergic individuals posed by unintended allergen presence (UAP). In 2014, the World Allergy Organization (WAO) highlighted that PAL use was increasing, but often applied inconsistently and without regulation - which reduces its usefulness to consumers with food allergy and those purchasing food for them. WAO proposed the need for a regulated, international framework to underpin application of PAL. In 2019, the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) of the United Nations convened an expert consultation to address the issue of PAL, the outputs of which are now being considered by the Codex Committee on Food Labelling (CCFL)., Objectives: To summarise the latest data to inform the application of PAL in a more systematic way, for implementation into global food standards., Methods: A non-systematic review of issues surrounding precautionary labelling and food allergens in pre-packaged products., Results: Approximately, 100 countries around the world have legislation on the declaration of allergenic ingredients. Just a few have legislation on UAP. Given the risks that UAP entails, non-regulated PAL creates inconvenience in real life due to its unequal, difficult interpretation by patients. The attempts made so far to rationalize PAL present lights and shadows., Conclusions: At a time when CCFL is considering the results of the FAO/WHO Expert Consultation 2020-2023, we summarise the prospects to develop an effective and homogeneous legislation at a global level, and the areas of uncertainty that might hinder international agreement on a regulated framework for PAL of food allergens., Competing Interests: Paul J Turner: Grants from UK Medical Research Council, UK Food Standards Agency, JM Charitable Foundation, NIHR/Imperial Biomedical Research Centre and End Allergies Together, outside the submitted work; personal fees from UK Food Standards Agency, DBV Technologies, Aimmune Therapeutics, Allergenis and ILSI Europe outside the submitted work. Antonio Bognanni: No conflicts to disclose. Stefania Arasi: Advisory board member, consultant, and/or speaker for Novartis, DBV, Ferrero, and Ulrich outside the submitted work. Ignacio J Ansotegui: Advisory board member, consultant, and/or speaker for Bayer, Bial, Cipla, Eurodrug, Faes Farma, Gebro, Glenmark, Menarini, MSD, Roxall and Sanofi outside the submitted work. Sabine Schnadt: Speaker honoraria and advisory panel consultancy outside the submitted work for Aimmune and DBV. Sébastien La Vieille: Employment: Health Canada (Government of Canada) - no conflict of interest. Jonathan O’B Hourihane: Research funding from Johnson& Johnson, DBV Technologies; Travel support Stallergenes; Speaker fees Nutricia; Consultancy Camallergy, Stallergenes; Board membership Clemens von Pirquet Foundation and Irish Food Allergy Network. Torsten Zuberbier: Institutional funding for research and/or honoria for lectures and/or consulting from Amgen, AstraZeneca, AbbVie, ALK, Almirall, Astellas, Bayer Health Care, Bencard, Berlin Chemie, FAES, HAL, Henkel, Kryolan, Leti, L'Oreal, Meda, Menarini, Merck, MSD, Novartis, Pfizer, Sanofi, Stallergenes, Takeda, Teva and UCB, Uriach; in addition, he is a member of ARIA, DGAKI, ECARF, GA2LEN and WAO. Philippe Eigenmann: Speaker and advisory board honoraria: DBV technologies, Novartis, ThermoFisher Scientific, Nestlé Health Sciences, Synlab, GSK,; Stocks and Stock options: DBV technologies. Motohiro Ebisawa: No conflicts to disclose. Mario Morais-Almeida: No conflicts to disclose. Julie Barnett: Funded research from Food Standards Agency, UK. Member of Food Standards Agency Advisory Committee for Social Science. Bryan Martin: No conflicts to disclose. Linda Monaci: Speaker honoraria and funded research project by Ferrero outside the submitted work. Graham Roberts: No conflicts to disclose. Gary Wong: Advisory panel consultancy outside the submitted work for Haleon, Nestle, Novartis, OM Pharma, Ferrero. Ruchi Gupta: Research support from the National Institutes of Health (NIH) (R21 ID # AI135705, R01 ID # AI130348, U01 ID # AI138907), Food Allergy Research & Education (FARE), Melchiorre Family Foundation, Sunshine Charitable Foundation, Novartis, and Genentech. Medical consultant/advisor for Genentech, Novartis, Food Allergy Research & Education (FARE), OWYN, Kaléo, Aquestive Therapeutics, and Byrn Pharma. Ownership interest in Yobee Care, Inc. Sophia Tsabouri: No conflicts to disclose. Clare Mills: No conflicts to disclose. Simon Brooke-Taylor: Consults to and receives payment from the Allergen Bureau of Australia & New Zealand. Consults on food regulation and compliance with Australian and New Zealand food standards to the food industry. Joan Bartra: Speaker honoraria outside the submitted work for Thermo Fisher Scientific, Novartis, Menarini. Michael Levin: Speaker honoraria and advisory panel consultancy outside the submitted work for Viatris, Novartis, Organon, Sanofi, Pfizer. Marion Groetch: No commercial interests to disclose. Royalties from UpToDate and Academy of Nutrition and Dietetics and consulting fees from Food Allergy Research Education; serves on the Medical Advisory Board of IFPIES, as a Senior Advisor to FARE, as a Health Sciences Advisor for APFED. Luciana Tanno: Speaker honoraria of Sanofi, DBV Technologies, Research grant from ANS (Agence Numerique de Santé), AllerGos. Elham Hossny: No conflicts to disclose. Barbara Ballmer Weber: Speaker honoraria and advisory panel consultancy outside the submitted work for Thermo Fisher Scientific, Novartis, ALK, Allergopharma, Menarini, Sanofi, MSD, Aiummune. Vincenzo Fierro: Speaker honoraria for Stallergenes, Sanofi, GSK. Benjamin C Remington: No conflicts to disclose. Jennifer Gerdts: Food Allergy Canada receives unrestricted funding support for educational programming from Pfizer, DBV, Sanofi, American Peanut Council and consultant fees from Novartis. M Hazel Gowland: Speaker honoraria: Food industry, technical and regulatory conferences, academic lecture fees Advisory panel consultancy: UK Food Standards Agency, Safefood, industry food technical and public health organisations. Funded research: FSA, UKRI, Safefood funded studies, UK Fatal Anaphylaxis Registry. Derek Chu: No conflicts to disclose. Marjan Van Ravenhorst: Employee, Allergenen Consultancy BV. Jennifer Koplin: No conflicts to disclose. Alessandro Fiocchi: Speaker honoraria and advisory panel consultancy outside the submitted work for Nutricia, Abbott, Danone, Stallergenes, DBV, Novartis. Funded research (Institution) from Sanofi, Novartis, Ferrero, DBV, GSK, Astrazeneca, Hipp GmBDH, Humana SpA., (© 2024 The Authors.)

Given an apparent increase in food allergies worldwide, the focus on prevention strategies has intensified. Following the Learning Early About Peanut study, there is now a widespread acceptance that peanut should be introduced promptly into the diet of high-risk infants. However, most food allergies are caused by triggers other than peanut and additional prevention strategies are being evaluated. The appreciation of the role of an impaired skin barrier in the process of food sensitization and subsequent allergy has led to a spectrum of dermatologically orientated studies. Other prevention strategies address the role of the microbiome, dietary components, and other modifiable risk factors. With regard to early introduction of foods other than peanut, studies are heterogeneous in design and governmental and professional society response to the early introduction trials has varied, ranging from new guidelines confining advice specifically to peanut, to ones recommending prompt introduction of a broad spectrum of allergenic foods. Much remains to be determined with regard to the acceptability and uptake of the new guidelines and their impact on infant feeding behavior and food allergy outcomes. This review discusses the panoply of prevention approaches, their promise, and limitations., (Copyright © 2019 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Food allergy has been associated with lower weight and height in cross-sectional studies in children; however, this has not been investigated in longitudinal studies to explore growth over time, and previous studies have not accounted for coexisting eczema., Objective: The objective of this study was to examine the association of IgE-mediated food allergy and eczema with anthropometric measures at 1 and 4 years of age., Methods: In the HealthNuts population-based cohort, infants recruited at age 1 year underwent a skin prick test to egg, peanut, and sesame; those sensitized had oral food challenges. Food challenges repeated at 4 years determined food allergy persistence or resolution. Eczema was defined as parent report of eczema diagnosis. Parent-reported weight and height and child health record data were used to calculate age- and sex-adjusted percentiles from World Health Organization charts. Multivariable linear regression models were fitted to examine the effect of food allergy and eczema on weight and height controlling for potential confounders., Results: Children with both food allergy and eczema at age 1 had lower percentiles for mean weight (51.3 vs 58.3 percentile, P = .001) and height (48.4 vs 53.4, P = .028) at age 1 compared with those with neither condition. There was no difference for children with only food allergy or eczema at age 1. By age 4, children with persistent food allergy and persistent eczema, but not those with resolved food allergy, were still shorter and lighter., Conclusions: Children with both food allergy and eczema were shorter and lighter throughout early childhood, with more pronounced differences in those with persistent food allergy., (Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)