Improving allergen labeling on foods: are we getting there?

Published: February 8, 2021

There is increasing interest in global approaches to improve food labelling for those with food allergies and coeliac disease, particularly with respect to Precautionary Allergen (“may contain”) labels. Recent approaches use “eliciting doses” based on patient thresholds – the amount of an allergen which would cause an allergic reaction in, for example, 1% or 5% of patients with a given food allergy. However, data are lacking as to how reproducible these amounts are, and the risk of anaphylaxis in those who react to very low levels of allergen exposure.

In an analysis recently published in The Journal of Allergy and Clinical Immunology (JACI), Patel and colleagues collected data from oral peanut challenges from 19 published studies (identified in a systematic review), representing 3151 patients. The authors undertook an individual participant data (IPD) meta-analysis in 534 who underwent at least 2 peanut challenges, allowing them to look at individual-level changes in reaction threshold, from one occasion to another. The study was supported by the UK Medical Research Council with additional support from the National Institute for Health Research.

The authors found that if 1000 people with peanut allergy were exposed to ≤5mg peanut protein (about 1/70 of a peanut), around 50 would react with any symptoms, but only between 1 and 5 would have anaphylaxis. Up to 5 individuals might not react on that occasion, but react to the same amount on a second occasion – but only with mild symptoms: none would be expected to have anaphylaxis. For an even lower level of exposure at ≤1mg peanut protein, 10 people per 1000 would react, of whom up to 2 could have anaphylaxis; however, this very low level of peanut exposure is more difficult to measure using current analytical techniques available to the food industry.

While there is inherent variability in the amount of allergen consumers react to, these data provide evidence that this is very unlikely to impact on patient safety in terms of current attempts to improve allergen labelling on foods.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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