Can my child with IgE‐mediated peanut allergy introduce foods labeled with “may contain traces”?

Abstract

Peanut IgE‐mediated food allergy is one of the most common food allergies in children with a prevalence that has increased in the past decades in Westernized countries. Peanut allergies can trigger severe reactions and usually persist over time. Peanut‐allergic children and their families are often confronted to processed foods with precautionary allergen labeling (PAL) such as “may contain traces of peanuts,” which are frequently used by the food industry. Patients are generally confused as to whether eating such foods entails a risk of allergic reaction, which can ultimately lead to dietary restrictions and decreased quality of life. Thus, guidance toward eviction of foods with PALs such as “may contain traces of peanuts” is a recurring problem that peanut‐allergic patients address during pediatric allergy consultations with varying attitudes among allergists. Many studies have evaluated peanut contamination in foods with PALs, with generally less than 10% of foods containing detectable levels of peanuts, albeit heterogeneous amounts, with in rare occasions levels that could trigger allergic reactions in certain patients. The risk of reacting to foods with traces varies significantly with threshold, with patients with the lowest reaction thresholds at highest risk, and a dramatic reduction of risk as threshold increases. Thus, risk stratification based on individual reaction threshold may help stratify patients’ risk of reacting to foods with PAL. In clinical practice, a single‐dose 30 mg peanut protein oral food challenge may be an option to stratify peanut‐allergic patients’ risk when introducing foods with PAL, as illustrated by three clinical cases.

Characteristics of Allergen Labelling and Precautionary Allergen Labelling in Packaged Food Products Available in Latin America

“…The PAL statement “may contain traces of…” was the most commonly utilized statement, which agrees with other studies [ 15 , 38 ] but 32 other types of PAL were also identified in the present study. It should be noted that PAL generates anxiety and confusion among food-allergic individuals and/or parents/caregivers [ 39 ] as its excessive use could contribute to increasing the socioeconomic disease burden [ 12 ]. Furthermore, both healthcare professionals and food-allergic individuals are facing a dilemma regarding what to do with PAL products [ 11 , 12 , 13 ] as most food products with PAL have undetectable levels of allergens and are not risky for most food-allergic individuals [ 9 , 10 ].…”

“…It should be noted that PAL generates anxiety and confusion among food-allergic individuals and/or parents/caregivers [ 39 ] as its excessive use could contribute to increasing the socioeconomic disease burden [ 12 ]. Furthermore, both healthcare professionals and food-allergic individuals are facing a dilemma regarding what to do with PAL products [ 11 , 12 , 13 ] as most food products with PAL have undetectable levels of allergens and are not risky for most food-allergic individuals [ 9 , 10 ]. Argentina had one of the highest percentage of products with PAL (38.2%) although this country was also the only one that has regulated the use of PAL among the countries surveyed [ 9 , 18 ].…”

“…Alternatively, a scientific approach called voluntary incidental trace allergen labelling (VITAL) was developed by the Australian manufacturing industry in 2007 [ 39 ]. This approach is based on the reference doses (thresholds) for specific allergens [ 12 , 40 ]. An allergen dose that is likely to trigger allergic reactions in 1% or 5% of the food-allergic population is called ED01 or ED05, respectively [ 12 ].…”

“…Although PAL is not intended to replace allergen risk analysis and management, most food products with PAL do not have detectable levels of the allergen(s) of interest and, therefore, do not represent a risk for the vast majority of food-allergic individuals [ 9 , 10 ]. This fact encourages food-allergic individuals to take the risk of consuming foods with PAL and casts doubts among healthcare professionals about the safe use of foods with PAL in allergen-restricted diets [ 11 , 12 , 13 ]. Furthermore, the excessive use of PAL limits the availability of packaged food products for food-allergic individuals and/or parents/caregivers, which could give rise to an additional economic burden [ 9 , 12 , 13 ].…”

“…This fact encourages food-allergic individuals to take the risk of consuming foods with PAL and casts doubts among healthcare professionals about the safe use of foods with PAL in allergen-restricted diets [ 11 , 12 , 13 ]. Furthermore, the excessive use of PAL limits the availability of packaged food products for food-allergic individuals and/or parents/caregivers, which could give rise to an additional economic burden [ 9 , 12 , 13 ]. Developed and emerging countries have evaluated the prevalence and characteristics of food products with PAL [ 14 , 15 , 16 ] but in Latin America, no study has addressed either the characteristics of food allergen labelling or PAL.…”