RESUMO
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.
Assuntos
Anafilaxia , Hipersensibilidade Alimentar , Alérgenos , Arachis , Hipersensibilidade Alimentar/diagnóstico , Rotulagem de Alimentos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de RiscoAssuntos
Dessensibilização Imunológica/métodos , Hipersensibilidade a Amendoim/terapia , Academias e Institutos , Administração Oral , Comitês Consultivos , Regulamentação Governamental , Humanos , Hipersensibilidade a Amendoim/imunologia , Formulação de Políticas , Estados Unidos , United States Food and Drug AdministrationRESUMO
IgE-mediated food allergies are common and currently there is no cure. Traditionally, management has relied upon patient education, food avoidance and the provision of an emergency medication plan. Despite this, food allergy can significantly impact on quality of life. Therefore, in recent years, evolving research has explored alternative management strategies. A more active approach to management is being adopted, which includes early introduction of potentially allergenic foods, anticipatory testing, active monitoring, desensitisation to food allergens and active risk management. This review will discuss these areas in turn.