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Keywords: anaphylaxis; eliciting dose; food allergy; precautionary allergen labelling; reference dose; thresholds EN anaphylaxis eliciting dose food allergy precautionary allergen labelling reference dose thresholds 1661 1666 6 05/31/22 20220601 NES 220601 The disclosure of "priority" allergens when present as an (intended) ingredient in foods is, in most countries, enshrined in legislation. Are current analytical methods suitable to verify VITAL ® 2.0/3.0 allergen reference doses for EU allergens in foods? Summary report of the Ad hoc Joint FAO/WHO expert consultation on risk assessment of food allergens. part 2: review and establish threshold levels in foods of the priority allergens. "Too high, too low": The complexities of using thresholds in isolation to inform precautionary allergen ("may contain") labels. [Extracted from the article]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

We demonstrated that patients with accidental allergic reactions reported more problems with regard to mobility, self-care, usual activities, pain/discomfort and anxiety/depression compared with patients without accidental allergic reactions. Patients with accidental allergic reactions during the 1-year follow-up ( I n i = 36) had higher total yearly direct and indirect costs compared to patients without accidental allergic reactions ( I n i = 10) (mean €1186 [bootstrap 95% CI: €609-1845] vs €158 [bootstrap 95% CI: €68-266], I p i = .01). Assuming that 2.1% of the Dutch adults has food allergy,1 whereof, 46% experiences accidental allergic reactions yearly,2 a rough estimation of the total yearly costs for all food-allergic Dutch adults with accidental allergic reactions would be 160 million euro and without accidental allergic reactions 25 million euro. (Table S2) When excluding these three patients, the total yearly direct and indirect costs were still significantly higher in patients with accidental allergic reactions compared to patients without accidental allergic reactions (mean €673 [bootstrap 95% CI: €414-967] vs €158 [bootstrap 95% CI: €69-280]), I p i = .03). [Extracted from the article]

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. [ABSTRACT FROM AUTHOR]

Suitability of low-dose, open food challenge data to supplement double-blind, placebo-controlled data in generation of food allergen threshold dose distributions To the Editor, Food allergen threshold dose distributions are used in food allergen risk assessment to determine the level of risk within a food-allergic population to a defined exposure amount of allergenic food protein and to help inform allergen risk management decisions. In conclusion, this study provides support for the use of open food challenge data to supplement DBPCFC data for the generation of food-allergic population threshold dose distributions when there is limited or no data from DBPCFCs available for certain foods. [Extracted from the article]

Introduction Involvement of cofactors, like physical exercise, alcohol consumption and use of several types of medication, are associated with more severe food allergic symptoms. However, there is limited evidence on how often cofactors play a role in food allergic reactions. The study aimed to get more insight into the frequency of exposure to cofactors and how often cofactors are associated with more severe symptoms in food allergic patients. Methods A questionnaire was completed by patients visiting the Allergology outpatient clinic. Patients with food allergy were included. Outcome measures were the frequency of medication use of medication groups that might act as cofactor and the frequency that physical exercise, alcohol consumption and use of analgesics are associated with more severe food allergic symptoms. Results Four hundred ninety-six patients were included in the study. The frequency with which patients used one or more types of medication that might act as cofactors was 7.7%: antacids/acid neutralizing medication (5%), NSAIDs (2%), beta blockers (0.6%), angiotensin-converting enzyme inhibitors (0.6%), and angiotensin receptor blockers (0.2%). Of all patients, 13% reported more severe symptoms to food after involvement of one or more of the cofactors: physical exercise (10%), alcohol consumption (5%), and use of analgesics (0.6%). Sixty-five percent did not know if these cofactors caused more severe symptoms; 22% reported that these cofactors had no effect. Conclusions Only a small percentage of patients (7.7%) used medication that might aggravate food allergic reactions. Physical exercise and alcohol consumption were the most frequently reported cofactors, but occurring still in only 10% or less. [ABSTRACT FROM AUTHOR]