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Summary Background There is an emerging consensus that, as with other risks in society, zero risk for food-allergic people is not a realistic or attainable option. Food allergy challenge data and new risk assessment methods offer the opportunity to develop quantitative limits for unintended allergenic ingredients which can be used in risk-based approaches. However, a prerequisite to their application is defining a tolerable level of risk. This requires a value judgement and is ultimately a 'societal' decision that has to involve all relevant stakeholders. Objective The aim of the workshop was to bring together key representatives from the stakeholders (regulators, food industry, clinical researchers and patients), and for the first time ever discuss the definition of a tolerable level of risk with regard to allergic reactions to food. Results The discussions revealed a consensus that zero risk was not a realistic option and that it is essential to address the current lack of agreed action levels for cross-contamination with allergens if food allergen management practice is to be improved. The discussions also indicated that it was difficult to define and quantify a tolerable level of risk, although both the clinical and the industry groups tried to do so. A consensus emerged that doing nothing was not a viable option, and there was a strong desire to take action to improve the current situation. Conclusions and Clinical Relevance Two concrete actions were suggested: (1) Action levels should be derived from the data currently available. Different scenarios should be examined and further developed in an iterative process. On the basis of this work, a tolerable level of risk should be proposed. (2) 'One-dose' clinical trial with a low challenge dose should be performed in multiple centres to provide additional information about the general applicability of dose-distribution models and help validate the threshold levels derived. [ABSTRACT FROM AUTHOR]

Food allergy represents an increasingly important health problem, with prevalence in Western Europe continuing to rise. While some reactions are mild, others can include life-threatening anaphylactic shock. It is estimated that food allergies affect 1-2% of the adult population and < or =8% of children. Relatively few foods are to blame for a large majority of allergic reactions to food in the UK, with most reactions being to milk, eggs, peanuts (Arachis hypogea), nuts, fish, shellfish, soyabean, sesame (Sesamum indicum L.) and wheat. There is currently no cure for food allergy and the few available treatments are focused on relieving the specific symptoms. Consumers with food allergies and food intolerances rely on food labelling to enable them to make informed choices about the foods they eat. Whilst there have recently been important advances in the labelling of food allergens, these advances relate only to requirements for the labelling of the deliberate use of specified food allergens in foods sold pre-packed. In other areas the development of guidance for food manufacturers and retailers on how to assess the risks of possible allergen cross-contamination during food production and manufacture, and then to determine appropriate advisory labelling, is well advanced. Work to address the issue of how to provide appropriate allergen information for foods sold loose, or in catering establishments, is also in progress. [ABSTRACT FROM AUTHOR]

Highlights issues for the safety assessement of novel foods during a discussion meeting sponsored by the Advisory Committee on Novel Foods and Processes and Committee on Toxicity of Chemicals in Great Britain. Effects of novel foods on the gastrointestinal system in humans; Assessment of the potential allergenicity of novel foods; Need for post-market surveillance of newly approved novel foods.

Food allergy is a relatively recent newcomer to the ranks of food safety issues, only being effectively recognised as such in the last 25-30 years. This recognition, allied with the near impossibility of avoiding the unintended presence of small, yet potentially dangerous residues of allergenic constituents, brought with it the need to assess and manage the resulting risk. This paper provides an overview of the development and current knowledge and thinking on risk assessment and its application to risk management of food allergens. It also discusses the associated challenges, in particular those around communicating meaningfully that risk to allergic consumers, including the use of precautionary labelling. The paper also provides an introductory context to the more detailed analyses of these issues in the following papers, based on the deliberations of a recent stakeholder workshop. The paper concludes that consistent risk management approaches using agreed quantitative action levels based on scientifically robust principles will provide optimal protection to allergic consumers. Growing amounts of data from oral food challenges along with the parallel development of risk assessment methodologies, such as probabilistic modelling, offer a realistic possibility of agreement among stakeholders on such levels in the near future., (Copyright © 2014 ILSI Europe. Published by Elsevier Ltd.. All rights reserved.)

Risk assessment describes the impact of a particular hazard as a function of dose and exposure. It forms the foundation of risk management and contributes to the overall decision-making process, but is not its endpoint. This paper outlines a risk analysis framework to underpin decision-making in the area of allergen cross-contact. Specifically, it identifies challenges relevant to each component of the risk analysis: risk assessment (data gaps and output interpretation); risk management (clear and realistic objectives); and risk communication (clear articulation of risk and benefit). Translation of the outputs from risk assessment models into risk management measures must be informed by a clear understanding of the model outputs and their limitations. This will lead to feasible and achievable risk management objectives, grounded in a level of risk accepted by the different stakeholders, thereby avoiding potential unintended detrimental consequences. Clear, consistent and trustworthy communications actively involving all stakeholders underpin these objectives. The conclusions, integrating the perspectives of different stakeholders, offer a vision where clear, science-based benchmarks form the basis of allergen management and labelling, cutting through the current confusion and uncertainty. Finally, the paper recognises that the proposed framework must be adaptable to new and emerging evidence., (Copyright © 2014 ILSI Europe. Published by Elsevier Ltd.. All rights reserved.)

Food allergy is a significant health issue in the UK, affecting between 1 and 2% of adults and 5 and 8% of children. The UK Food Standards Agency seeks to ensure the safety of food allergic consumers by providing them with information and guidance on food choices. Since 1995, with the aim of addressing important policy issues and improving the quality of the support and guidance available for food allergic consumers, the Agency (and before that the Ministry of Agriculture, Fisheries and Food), has had a programme of research dedicated to investigating the causes and mechanisms of food allergy and delivering benefits for UK consumers. In this paper, we outline some of the major scientific challenges that the programme has sought to address. We reflect on how the findings have been used as a basis for the development of sound, evidence-based policy and advice for UK consumers, and the current direction of research being supported by the programme., (Crown Copyright © 2010. Published by Elsevier Ireland Ltd. All rights reserved.)

We have reached a point where it is difficult to improve food allergy risk management without an agreement on levels of acceptable risk. This paper presents and discusses the perspectives of the different stakeholders (allergic consumers, health professionals, public authorities and the food industry) on acceptable risk in food allergy. Understanding where these perspectives diverge and even conflict may help develop an approach to define what is acceptable. Uncertainty about food allergy, its consequences and how to manage them is the common denominator of the stakeholders' views. In patients, uncertainty is caused by the unpredictability of reactions and the concern about whether avoidance strategies will be effective enough. Variability of symptoms and the lack of markers do not allow stratification of patients according to their reactivity, and force health professionals to give the same advice to all patients despite the fact that the risk to each is not identical. Regulators and the food industry struggle with the fact that the lack of management thresholds forces them to make case-by-case decisions in an area of uncertainty with penalties for under- or over-prediction. As zero risk is not a realistic possibility, consensus on acceptable risk will be needed., (Copyright 2010 Elsevier Inc. All rights reserved.)