Fiocchi Alessandro, Monaci Linda, De Angelis Elisabetta, Calandrelli Veronica, Dahdah Lamia, Valluzzi Rocco, Urbani Sara, Mazzuca Carmen, Arasi Stefania, Cafarotti Arianna, Riccardi Carla, Artesani Maria Cristina, Putignani Lorenza, Pecora Valentina, Marzano Valeria, Fierro Vincenzo
Allergy Dpt, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Institute of Sciences of Food Production, CNR-ISPA, Bari, Italy.
Clin Transl Allergy. 2023 Sep;13(9):e12301. doi: 10.1002/clt2.12301.
The frequency and severity of reactions in food-allergic consumers exposed to unintentional food allergen contamination during production is unknown. To warn allergic consumers, it has been suggested for pre-packaged foods to be precautionary labelled when the food allergen contamination may exceed the amount to which 1%-5% of the population could react (ED01-ED05). ED01 for hazelnut and milk have been estimated at 0.1 and 0.2 mg, respectively, by the Voluntary Incidental Trace Allergen Labelling (VITAL) initiative. The respective reference doses recommended by the FAO/WHO Codex consultation are 3 and 2 mg. We evaluated the reactivity to potential traces of milk and hazelnut allergens in allergen-free pre-packaged products by children affected by severe allergies to milk and hazelnuts.
Oral Food Challenges with commercially available hazelnut-free wafer biscuits and milk-free chocolate pralines were administered to patients with severe food allergies to hazelnut and cow's milk, respectively. Contamination levels of milk or hazelnut allergens were measured using chromatographic separation interfaced with triple quadrupole mass spectrometry.
No hazelnut allergic patient showed allergic reactions to exposure to biscuits, nor any milk allergic patient displayed allergic reactions to the dark chocolate praline. While no hazelnut trace was detected in biscuits, the praline was found to be contaminated by milk at concentrations ranging between 8 and 35 mg total protein/kg food. In our dose model, these amounts exceeded 1.5-10 times the VITAL ED01 and reached the threshold suggested by the FAO/WHO Codex consultation.
Upon the consumption of food products available on the market, many patients with severe food allergies tolerate significantly higher doses of allergen than reference doses indicated in the VITAL system used for precautionary allergen labelling. These doses support the safety of the FAO/WHO recommended reference doses.
食品过敏消费者在生产过程中接触到无意的食品过敏原污染时，反应的频率和严重程度尚不清楚。为了警示过敏消费者，有人建议当食品过敏原污染可能超过1%-5%的人群会产生反应的量（ED01-ED05）时，预包装食品应进行预防性标签标注。通过自愿性偶然微量过敏原标签（VITAL）倡议，已分别估算出榛子和牛奶的ED01为0.1毫克和0.2毫克。粮农组织/世卫组织食品法典委员会磋商推荐的各自参考剂量为3毫克和2毫克。我们评估了对牛奶和榛子严重过敏的儿童对无过敏原预包装产品中潜在微量牛奶和榛子过敏原的反应性。
分别对患有严重榛子和牛奶食品过敏的患者给予市售无榛子威化饼干和无牛奶巧克力果仁糖进行口服食物激发试验。使用与三重四极杆质谱联用的色谱分离法测量牛奶或榛子过敏原的污染水平。
没有榛子过敏患者对接触饼干表现出过敏反应，也没有牛奶过敏患者对黑巧克力果仁糖表现出过敏反应。虽然在饼干中未检测到榛子痕迹，但发现果仁糖被牛奶污染，总蛋白浓度为8至35毫克/千克食品。在我们的剂量模型中，这些量超过了VITAL ED01的1.5至10倍，并达到了粮农组织/世卫组织食品法典委员会磋商建议的阈值。
食用市售食品时，许多严重食物过敏患者耐受的过敏原剂量明显高于用于预防性过敏原标签标注的VITAL系统中指示的参考剂量。这些剂量支持了粮农组织/世卫组织推荐的参考剂量的安全性。
