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Update on threshold doses of food allergens: implications for patients and the food industry.

Abstract

PURPOSE OF REVIEW

The purpose of this review is to bring the reader up to date on the importance of assessing a food's lowest observed adverse-effect level (LOAEL) with two aims. Firstly, to help industry choose tests with a level of sensitivity capable of detecting food allergens hidden in industrial products. Secondly, to specify protective measures for highly allergic individuals in order to prevent recurrent severe anaphylaxis. The review also seeks to highlight the present issues and unsolved questions.

RECENT FINDINGS

Thanks to standardized oral-provocation tests (double-blind placebo-controlled food challenges), LOAELs have been identified for many IgE-dependent food allergies. Most studies concern the pediatric population. Data is available for milk, egg, peanut, wheat flour, and sesame. The LOAELs are commonly in the range of 1-2 mg of natural foods, representing a few hundred micrograms of protein. These minimal reactive doses characterize about 1% of people allergic to milk, egg, or peanut. The level at which no observed adverse effect is seen might be a few tens of micrograms of protein for peanut. At the present time, allergy to oil seems to be restricted to unrefined cold-pressed oils.

SUMMARY

Concerning IgE-dependent food allergies, the threshold dose inducing symptoms is now known to vary a great deal according to the individual. A reactive dose of less than 65 mg characterizes 16 and 18% of patients allergic to egg or peanut. Less than 30 mg of milk proteins characterizes 5% of those allergic to milk. For milk, egg, and peanut, 1% of patients have a very low threshold, about 1 mg. Such data emphasize the necessity of using detection tests with a sensitivity better than 10 parts per million. The modifications of allergenicity undergone by protein ingredients that are now commonly introduced into industrially made products are not yet sufficiently known. A better knowledge of the reactive doses of these proteins is needed.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital, 29 avenue de Lattre de Tassigny, 54035 Nancy, France. s.barrat@chu-nancy.fr

    Source

    MeSH

    Allergens
    Dose-Response Relationship, Immunologic
    Egg Hypersensitivity
    Food Hypersensitivity
    Food Industry
    Food Supply
    Humans
    Immunoglobulin E
    Immunologic Tests
    Milk Hypersensitivity
    Peanut Hypersensitivity
    Sensitivity and Specificity

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    15126945

    Citation

    Moneret-Vautrin, Denise Anne, and Gisèle Kanny. "Update On Threshold Doses of Food Allergens: Implications for Patients and the Food Industry." Current Opinion in Allergy and Clinical Immunology, vol. 4, no. 3, 2004, pp. 215-9.
    Moneret-Vautrin DA, Kanny G. Update on threshold doses of food allergens: implications for patients and the food industry. Curr Opin Allergy Clin Immunol. 2004;4(3):215-9.
    Moneret-Vautrin, D. A., & Kanny, G. (2004). Update on threshold doses of food allergens: implications for patients and the food industry. Current Opinion in Allergy and Clinical Immunology, 4(3), pp. 215-9.
    Moneret-Vautrin DA, Kanny G. Update On Threshold Doses of Food Allergens: Implications for Patients and the Food Industry. Curr Opin Allergy Clin Immunol. 2004;4(3):215-9. PubMed PMID: 15126945.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Update on threshold doses of food allergens: implications for patients and the food industry. AU - Moneret-Vautrin,Denise Anne, AU - Kanny,Gisèle, PY - 2004/5/6/pubmed PY - 2004/12/16/medline PY - 2004/5/6/entrez SP - 215 EP - 9 JF - Current opinion in allergy and clinical immunology JO - Curr Opin Allergy Clin Immunol VL - 4 IS - 3 N2 - PURPOSE OF REVIEW: The purpose of this review is to bring the reader up to date on the importance of assessing a food's lowest observed adverse-effect level (LOAEL) with two aims. Firstly, to help industry choose tests with a level of sensitivity capable of detecting food allergens hidden in industrial products. Secondly, to specify protective measures for highly allergic individuals in order to prevent recurrent severe anaphylaxis. The review also seeks to highlight the present issues and unsolved questions. RECENT FINDINGS: Thanks to standardized oral-provocation tests (double-blind placebo-controlled food challenges), LOAELs have been identified for many IgE-dependent food allergies. Most studies concern the pediatric population. Data is available for milk, egg, peanut, wheat flour, and sesame. The LOAELs are commonly in the range of 1-2 mg of natural foods, representing a few hundred micrograms of protein. These minimal reactive doses characterize about 1% of people allergic to milk, egg, or peanut. The level at which no observed adverse effect is seen might be a few tens of micrograms of protein for peanut. At the present time, allergy to oil seems to be restricted to unrefined cold-pressed oils. SUMMARY: Concerning IgE-dependent food allergies, the threshold dose inducing symptoms is now known to vary a great deal according to the individual. A reactive dose of less than 65 mg characterizes 16 and 18% of patients allergic to egg or peanut. Less than 30 mg of milk proteins characterizes 5% of those allergic to milk. For milk, egg, and peanut, 1% of patients have a very low threshold, about 1 mg. Such data emphasize the necessity of using detection tests with a sensitivity better than 10 parts per million. The modifications of allergenicity undergone by protein ingredients that are now commonly introduced into industrially made products are not yet sufficiently known. A better knowledge of the reactive doses of these proteins is needed. SN - 1528-4050 UR - https://www.unboundmedicine.com/medline/citation/15126945/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=15126945 DB - PRIME DP - Unbound Medicine ER -