Integrated assessment of simultaneous threshold exceedance of heat, air pollution and airborne allergenic pollen across Europe.

Background: Climate change is expected to elevate exposure to several environmental health risk factors, including extreme environmental temperatures, air pollution and airborne allergenic pollen. Given their interconnected effects on respiratory and cardiovascular diseases, it is crucial to evaluate these exposures simultaneously. Yet, comprehensive efforts to do so remain limited.

Sesame eliciting and safe doses in a large sesame allergic population.

Background: Sesame is a significant food allergen causing severe and even fatal reactions. Given its increasing prevalence in western diet, sesame is listed as an allergenic food requiring labeling in the United States and EU. However, data on the population reaction doses to sesame are limited.

The 50th percentile of the general population single eating occasion intake of food is optimal for the calculation of action levels for precautionary allergen labelling.

Lack of guidance regarding selection of food intake values for allergen risk assessment can lead to different outcomes for similar levels of allergens in food products. Several food consumption survey databases (United States, North-West Europe, and Netherlands) were analyzed to identify optimal food intake percentiles using a sensitivity analysis. Deterministic risk assessment scenarios using the 50th percentile up to the maximum intake per food group were compared with probabilistic risk assessment outcomes.

Reproducibility of food challenge to cow's milk: Systematic review with individual participant data meta-analysis.

Background: Cow's milk (CM) is an increasingly common cause of severe allergic reactions, but there is uncertainty with respect to severity of reactions at low-level CM exposure, as well as the reproducibility of reaction thresholds.

Objective: We undertook an individual participant data (IPD) meta-analysis of studies reporting double-blind, placebo-controlled food challenges in CM to determine the rate of anaphylaxis to low-level exposures and the reproducibility of reaction thresholds.

Methods: We performed a systematic review and IPD meta-analysis of studies reporting relevant data.

Poor understanding of allergen labelling by allergic and non-allergic consumers.

Background: Understanding consumers' interpretation of allergy information is crucial for effective food safety policies. We evaluated consumer understanding of allergy information on foods in controlled, experimental studies.

Method: Using 18 packaged foods, we evaluated consumer understanding of information about allergens in two experiments: First, a comparison of foods with no stated allergen versus allergen as a stated ingredient versus a precautionary allergen label (PAL); second, a comparison of three common variants of PAL.

Using data from food challenges to inform management of consumers with food allergy: A systematic review with individual participant data meta-analysis.

Background: Eliciting doses (EDs) (eg, ED or ED values, which are the amounts of allergen expected to cause objective symptoms in 1% and 5% of the population with an allergy, respectively) are increasingly being used to inform allergen labeling and clinical management. These values are generated from food challenge, but the frequency of anaphylaxis in response to these low levels of allergen exposure and their reproducibility are unknown.

Objective: Our aim was to determine (1) the rate of anaphylaxis in response to low-level peanut exposure and (2) the reproducibility of reaction thresholds (and anaphylaxis) at food challenge.

A systematic comparison of food intake data of the United States and the Netherlands for food allergen risk assessment.

National population-based food consumption surveys are used in food allergen risk assessment. It would be beneficial if food intake data is interchangeable between countries to bridge potential gaps present in national survey data, which is only possible when risk assessment outcomes for comparable food product groups between countries are fairly similar. Additionally, merged food intake data would enable risk assessments that cover scenarios for various countries, if based on the most critical situation.

Allergen labelling: Current practice and improvement from a communication perspective.

Background: Allergen information on product labels is crucial in food allergy management, though inadequacy in current labelling practices is one of the major causes for accidental reactions upon consuming prepacked food products.

Objective: This study analyses current status of communicating allergen information on food labels and provides practical recommendations for improving the label format based on communication theory.

Methods: Product labels (N 288) of seven food categories from private label products and brands were obtained at three retailers in the Netherlands.

Full range of population Eliciting Dose values for 14 priority allergenic foods and recommendations for use in risk characterization.

Previously, we published selected Eliciting Dose (ED) values (i.e. ED01 and ED05 values) for 14 allergenic foods, predicted to elicit objective allergic symptoms in 1% and 5%, respectively, of the allergic population (Remington et al.

Allergen risk assessment: Food intake levels of the general population represent those of food allergic patients.

Unintentional intake of allergens through food products poses a daily risk for allergic patients. Models estimating the risk of reactions mostly use intake data from general population surveys. Our study evaluates the comparability of food intake levels in the general population to those in the food allergic population.

Risk of shared equipment in restaurants for consumers with peanut allergy: a simulation for preparing Asian foods: A simulation for preparing Asian foods.

Background: Allergic reactions to meals consumed outside the home are common and can be severe and sometimes fatal.

Objective: To quantify the risk reduction potentially achieved by increasing an individual's threshold sensitivity to peanut (such as by means of immunotherapy) in scenarios of peanut exposure through shared kitchen materials in a restaurant setting.

Methods: Three versions of popular peanut-containing sauces were selected to represent common ingredients used in Asian cooking.

Updated population minimal eliciting dose distributions for use in risk assessment of 14 priority food allergens.

Food allergy and allergen management are important global public health issues. In 2011, the first iteration of our allergen threshold database (ATDB) was established based on individual NOAELs and LOAELs from oral food challenge in roughly 1750 allergic individuals. Population minimal eliciting dose (EDp) distributions based on this dataset were published for 11 allergenic foods in 2014.

Deriving individual threshold doses from clinical food challenge data for population risk assessment of food allergens.

Background: Food allergies are a significant public health issue, and the only effective management option currently available is strict avoidance of all foods containing the allergen. In view of the practical impossibility of limiting risks to zero, quantitative allergen risk assessment and management strategies are needed.

Objective: We sought to develop appropriate methods for informing population-based risk assessments and risk management programs to benefit all stakeholders but particularly patients with food allergy.

Evidence-based approaches to the application of precautionary allergen labelling: Report from two iFAAM workshops.

Food allergy is a major public health concern with avoidance of the trigger food(s) being central to management by the patient. Food information legislation mandates the declaration of allergenic ingredients; however, the labelling of the unintentional presence of allergens is less defined. Precautionary allergen labelling (PAL) was introduced by the food industry to help manage and communicate the risk of reaction from the unintended presence of allergens in foods.

Defining the targets for the assessment of IgE-mediated allergenicity of new or modified food proteins.

Many food innovations rely on the introduction and use of new or modified proteins. New or modified food proteins may lead to major health risks due to their inherent potential to cause food allergy. Currently, the pre-market allergenicity assessment for new or modified food proteins and protein sources relies on methods for identifying allergenic hazards based on characteristics of known allergens.

Sensitivity analysis to derive a food consumption point estimate for deterministic food allergy risk assessment.

One of the input parameters in food allergy risk assessment is the amount of a given food consumed at an eating occasion. There is no consensus on how to use food consumption data when assessing the risk from unintended allergen presence in food products. A sensitivity analysis was performed to establish the optimal food consumption estimate for a deterministic food allergy risk assessment.

Potential cofactors in accidental food allergic reactions are frequently present but may not influence severity and occurrence.

Background: Cofactors, such as physical exercise and alcohol intake, might be associated with the severity or occurrence of food allergic reactions.

Objective: To gain insight into the frequency of presence of potential cofactors in accidental food allergic reactions in adults and to what extent these factors influence the severity and occurrence of allergic reactions.

Methods: A prospective cohort study was conducted, with a 1-year follow-up in adult patients with a physician-diagnosed food allergy.

Accidental food allergy reactions: Products and undeclared ingredients.

Background: Accidental allergic reactions to food are frequent and can be severe and even fatal.

Objective: We sought to analyze the culprit food products and levels of unexpected allergens in accidental reactions.

Methods: A prospective cohort study was conducted in adults (n = 157) with a physician-confirmed diagnosis of food allergy.