Peanut Can Be Used as a Reference Allergen for Hazard Characterization in Food Allergen Risk Management: A Rapid Evidence Assessment and Meta-Analysis

Paul J. Turner*, Nandinee Patel, Barbara K. Ballmer-Weber, Joe L. Baumert, W. Marty Blom, Simon Brooke-Taylor, Helen Brough, Dianne E. Campbell, Hongbing Chen, R. Sharon Chinthrajah, René W.R. Crevel, Anthony E.J. Dubois, Motohiro Ebisawa, Arnon Elizur, Jennifer D. Gerdts, M. Hazel Gowland, Geert F. Houben, Jonathan O.B. Hourihane, André C. Knulst, Sébastien La VieilleMaría Cristina López, E. N.Clare Mills, Gustavo A. Polenta, Natasha Purington, Maria Said, Hugh A. Sampson, Sabine Schnadt, Eva Södergren, Stephen L. Taylor, Benjamin C. Remington

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Regional and national legislation mandates the disclosure of “priority” allergens when present as an ingredient in foods, but this does not extend to the unintended presence of allergens due to shared production facilities. This has resulted in a proliferation of precautionary allergen (“may contain”) labels (PAL) that are frequently ignored by food-allergic consumers. Attempts have been made to improve allergen risk management to better inform the use of PAL, but a lack of consensus has led to variety of regulatory approaches and nonuniformity in the use of PAL by food businesses. One potential solution would be to establish internationally agreed “reference doses,” below which no PAL would be needed. However, if reference doses are to be used to inform the need for PAL, then it is essential to characterize the hazard associated with these low-level exposures. For peanut, there are now published data relating to over 3000 double-blind, placebo-controlled challenges in allergic individuals, but a similar level of evidence is lacking for other priority allergens. We present the results of a rapid evidence assessment and meta-analysis for the risk of anaphylaxis to a low-level allergen exposure for priority allergens. On the basis of this analysis, we propose that peanut can and should be considered an exemplar allergen for the hazard characterization at a low-level allergen exposure.

Original languageEnglish
Pages (from-to)59-70
Number of pages12
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume10
Issue number1
DOIs
StatePublished - Jan 2022

Funding

FundersFunder number
Johnson and Johnson
Alladapt Therapeutics
Dutch Governmental TNO Research Cooperation Funds
Aimmune Therapeutics
Deutscher Allergie
Swedish Food Agency
Imperial College London
Irish Food Allergy Network
Upfield R&D BV
Biotechnology and Biological Sciences Research Council
Clemens von Pirquet Foundation
Zoetis LLC
Stanford Maternal and Child Health Research Institute
Irish Association of Allergy and Immunology
Syngenta PLC
National Institute for Health Research
End Allergies Together
UK Medical Research Council, UK Food Standards Agency
Reacta Biotech Ltd
Imperial College Healthcare NHS Trust
Food Standards Agency
National Institutes of Health
Chief Executive Officer for Allergy & Anaphylaxis Australia
National Institute of Allergy and Infectious Diseases
Novartis
National Health and Medical Research Council
DAAB
Foundation for Alcohol Research and Education
University of Nebraska
Innovate UK
European Academy of Allergy and Clinical Immunology
Anaesthetic Research Society
NCRC Ireland
Imperial BRC
Astellas Pharma US
DBV Technologies
N-Fold Therapeutics
Sanofi
Manchester Biomedical Research Centre
Temple St Hospital Foundation
Genentech
European Food Safety Authority
Reacta Biotech
Allergenis
UK Research and Innovation
Medical Research CouncilMR/K010468/1

    Keywords

    • Anaphylaxis
    • Eliciting dose
    • Food allergy
    • Precautionary allergen labeling
    • Reference dose
    • Threshold

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