Food labeling issues in patients with severe food allergies: solving a hamlet-like doubt

Fierro, Vincenzo; Girolamo, Francesco; Marzano, Valeria; Dahdah, Lamia; Mennini, Maurizio

doi:10.1097/aci.0000000000000362

Cited by 20 publications

(14 citation statements)

References 30 publications

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“…Some foods are easily identifiable, others require extra attention. To safeguard the health of food allergic consumers, the health authorities of 66 countries over the five continents require by law that allergenic ingredients must be declared when used in prepackaged foods 13‐15 . Despite scrupulous observance of this prescription, accidental reactions to food may occur in greater proportion with the multiplicity of sensitizations.…”

Section: The Limits Of Food Avoidancementioning

confidence: 99%

The use of biologics in food allergy

Fiocchi

Vickery

Wood

2021

Clin Experimental Allergy

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Background Food allergy continues to pose problems due to its increased frequency and its increasingly high severity. In this context, alongside the traditional avoidance strategies of allergenic foods and desensitization through the cautious progression of exposure to foods in the context of oral immunotherapy (OIT), alternative strategies have made their way in the last decades. We review the possibilities of intervention in food allergy with the use of biological drugs capable of interfering with the synthesis of IgE, with their mechanisms of action, or with complex biological mechanisms that lead to the establishment of a food allergy. Methods Repeated Entrez PubMed searches using the template algorithm “Food allergy” and “biologics” or “Omalizumab” or “Dupilumab” or “milk desensitization” or “oral tolerance induction” or “oral immunotherapy” or “Etokimab” or “Tezepelumab” or “Quilizumab” or “Ligelizumab” or “Tralokinumab” or “Nemolizumab” or “Mepolizumab” or “Reslizumab” or “Benralizumab”. The authors’ clinical experience in paediatric allergy units of University hospitals was also drawn upon. Results The landscape in this context has changed dramatically over the past 10 years. We have acquired knowledge mainly on the effect of different types of anti‐IgE treatments in poliallergic patients with food allergy, and in patients treated with OIT. However, other mediators are being targeted by specific biologic treatments. Among them, the alarmins Il‐33 and TSLP, IL‐4 and IL‐13, eosinophil‐related molecules as IL‐6, IL‐8, IL‐10, IL‐12, and mostly IL‐5, and integrins involved in the pathogenesis of eosinophilic gastrointestinal diseases (EGIDs), as SIGLEC‐8. Conclusions The ever‐better knowledge of the mechanisms of food allergy allowing these developments will improve not only the perspective of patients with the most serious immediate food allergies such as anaphylaxis, but also those of patients with related diseases such as atopic dermatitis, eosinophilic esophagitis, and EGIDs. Biologics are also intended to complement OIT strategies that have developed over the years.

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Section: The Limits Of Food Avoidancementioning

confidence: 99%

The use of biologics in food allergy

Fiocchi

Vickery

Wood

2021

Clin Experimental Allergy

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“…18 On the other hand, a shared clinical threshold allowing the individuation of a legal limit on an allergen-by-allergen basis is not yet presently defined. 20 There are also few official analytical methods and limits of determination that are accepted as analytical reference in specific countries, such in the case of polymerase chain reaction (PCR) methods for allergen detection in Germany and Japan. 21 Overall, this poses a great risk for allergic people, as witnessed by the still observed reactions to food allergens, present even in countries with mandatory labeling.…”

Section: International Requirements For Allergenic Ingredients Labellingmentioning

confidence: 99%

Food labeling issues for severe food allergic patients

Fiocchi

Risso²,

DunnGalvin

et al. 2021

World Allergy Organization Journal

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Food allergy carries high importance and responsibility, affecting an estimated 220 million people worldwide. It is a frequent cause of food-induced anaphylaxis, a life-threatening condition requiring a toll of about one death per 50 million people a year worldwide. In order to help patients to identify allergenic foods and thus avoid anaphylactic reactions, 66 countries over the 5 continents require by law that allergenic ingredients must be declared when used in prepackaged foods. Unfortunately, the mandatory allergen list is not uniform, but varies among different countries. The widespread adoption of Precautionary Allergen Labeling (PAL) results in a proliferation of unregulated PALs with different informative statements. In this situation, the need of a scientific consensus on the definition of food allergy and the identification of a tolerable risk with routinely used detection assays, considering not only the eliciting dose but also the food source, is urgent. The aim of this manuscript is: 1) to draw a picture of the global situation in terms of PALs, and 2) to highlight new approaches that could aid in tackling the problem of regulating the labeling of allergens. These include the Voluntary Incidental Trace Allergen Labelling (VITAL) system, which intersects reference doses and labelling decisions, and a direct quantification of trace amounts of allergens at lower limit of detection (LOD) levels in the food itself through proteomics. We here highlight how, although with some limitations, the steady advances in proteomic approaches possess higher sensitivity than the recommended VITAL reference doses, allowing the identification of allergens at much lower LOD levels than VITAL. Considering that each assay used to detect allergen in food products carries method-specific issues, a more comprehensive and harmonized approach implementing both quantitative and qualitative methods could help overcoming the risk stratification approach and the overuse of PALs, offering promise as the field moves forward towards improving consumers’ quality of life.

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“…Public health interventions, such as public health measures to address food labeling and packaging controls, would also be beneficial. 63 Perceived contamination creates stress when eating in restaurants or food service establishments, because a significant number of food reactions occur when eating food from these settings, even when staff are informed of the food allergy in advance. 64 Results from a survey of restaurants indicated that managers and staff were generally knowledgeable about food allergies and willing to accommodate customers' food allergies, but misconceptions were still reported, such as belief that a person with food allergy can safely consume a small amount of the allergen.…”

Section: Public Health Interventionsmentioning

confidence: 99%