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How much is too much? Threshold dose distributions for 5 food allergens

How much is too much? Threshold dose distributions for 5 food allergens
How much is too much? Threshold dose distributions for 5 food allergens
BACKGROUND: Precautionary labeling is used to warn consumers of the presence of unintended allergens, but the lack of agreed allergen thresholds can result in confusion and risk taking by patients with food allergy. The lack of data on threshold doses below which subjects are unlikely to react is preventing the development of evidence-based allergen management strategies that are understood by clinician and patient alike.

OBJECTIVE: We sought to define threshold dose distributions for 5 major allergenic foods in the European population.

METHODS: Patients with food allergy were drawn from the EuroPrevall birth cohort, community surveys, and outpatient clinic studies and invited to undergo a food challenge. Low-dose, double-blind, placebo-controlled food challenges were undertaken with commercially available food ingredients (peanut, hazelnut, celery, fish, and shrimp) blinded into common matrices. Dose distributions were modeled by using interval-censoring survival analysis with 3 parametric approaches.

RESULTS: Of the 5 foods used for challenge, 4 produced similar dose distributions, with estimated doses eliciting reactions in 10% of the allergic population (ED10), ranging from 1.6 to 10.1 mg of protein for hazelnut, peanut, and celery with overlapping 95% CIs. ED10 values for fish were somewhat higher (27.3 mg of protein), although the CIs were wide and overlapping between fish and plant foods. Shrimp provided radically different dose distributions, with an ED10 value of 2.5 g of protein.

CONCLUSION: This evidence base will contribute to the development of reference doses and action levels for allergens in foods below which only the most sensitive subjects might react.
food, allergy, threshold, peanut, hazelnut, celeriac, fish, shrimp, europrevall
0091-6749
964-971
Ballmer-Weber, Barbara K.
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Fernandez-Rivas, Montserrat
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Beyer, Kirsten
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Defernez, Marianne
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Sperrin, Matthew
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Mackie, Alan R.
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Salt, Louise J.
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Hourihane, Jonathan O'B.
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Asero, Riccardo
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Belohlavkova, Simona
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Kowalski, Marek
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de Blay, Frédéric
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Papadopoulos, Nikolaos G.
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Clausen, Michael
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Knulst, André C.
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Roberts, Graham
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Popov, Ted
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Sprikkelman, Aline B.
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Dubakiene, Ruta
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Vieths, Stefan
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van Ree, Ronald
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Crevel, René
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Mills, E. N. Clare
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Ballmer-Weber, Barbara K.
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Fernandez-Rivas, Montserrat
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Beyer, Kirsten
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Defernez, Marianne
a5dfd55c-477e-46a0-91a1-b3f23b7310e0
Sperrin, Matthew
e1dd5334-ed19-48c7-b486-024fb03330ba
Mackie, Alan R.
435a29e1-595d-4c22-8f93-ce91ccdc8050
Salt, Louise J.
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Hourihane, Jonathan O'B.
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Asero, Riccardo
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Belohlavkova, Simona
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Kowalski, Marek
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de Blay, Frédéric
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Papadopoulos, Nikolaos G.
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Clausen, Michael
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Knulst, André C.
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Roberts, Graham
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Popov, Ted
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Sprikkelman, Aline B.
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Dubakiene, Ruta
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Vieths, Stefan
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van Ree, Ronald
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Crevel, René
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Mills, E. N. Clare
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Ballmer-Weber, Barbara K., Fernandez-Rivas, Montserrat, Beyer, Kirsten, Defernez, Marianne, Sperrin, Matthew, Mackie, Alan R., Salt, Louise J., Hourihane, Jonathan O'B., Asero, Riccardo, Belohlavkova, Simona, Kowalski, Marek, de Blay, Frédéric, Papadopoulos, Nikolaos G., Clausen, Michael, Knulst, André C., Roberts, Graham, Popov, Ted, Sprikkelman, Aline B., Dubakiene, Ruta, Vieths, Stefan, van Ree, Ronald, Crevel, René and Mills, E. N. Clare (2015) How much is too much? Threshold dose distributions for 5 food allergens. Journal of Allergy and Clinical Immunology, 135 (4), 964-971. (doi:10.1016/j.jaci.2014.10.047). (PMID:25589011)

Record type: Article

Abstract

BACKGROUND: Precautionary labeling is used to warn consumers of the presence of unintended allergens, but the lack of agreed allergen thresholds can result in confusion and risk taking by patients with food allergy. The lack of data on threshold doses below which subjects are unlikely to react is preventing the development of evidence-based allergen management strategies that are understood by clinician and patient alike.

OBJECTIVE: We sought to define threshold dose distributions for 5 major allergenic foods in the European population.

METHODS: Patients with food allergy were drawn from the EuroPrevall birth cohort, community surveys, and outpatient clinic studies and invited to undergo a food challenge. Low-dose, double-blind, placebo-controlled food challenges were undertaken with commercially available food ingredients (peanut, hazelnut, celery, fish, and shrimp) blinded into common matrices. Dose distributions were modeled by using interval-censoring survival analysis with 3 parametric approaches.

RESULTS: Of the 5 foods used for challenge, 4 produced similar dose distributions, with estimated doses eliciting reactions in 10% of the allergic population (ED10), ranging from 1.6 to 10.1 mg of protein for hazelnut, peanut, and celery with overlapping 95% CIs. ED10 values for fish were somewhat higher (27.3 mg of protein), although the CIs were wide and overlapping between fish and plant foods. Shrimp provided radically different dose distributions, with an ED10 value of 2.5 g of protein.

CONCLUSION: This evidence base will contribute to the development of reference doses and action levels for allergens in foods below which only the most sensitive subjects might react.

Text
BALLMER WEBER How much is too much J Allergy Clin Immunol 2015.pdf - Version of Record
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Accepted/In Press date: 15 October 2014
e-pub ahead of print date: 12 January 2015
Published date: April 2015
Keywords: food, allergy, threshold, peanut, hazelnut, celeriac, fish, shrimp, europrevall
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 388686
URI: https://eprints.soton.ac.uk/id/eprint/388686
ISSN: 0091-6749
PURE UUID: 6b4f95d0-5c83-40fc-bbc7-648c53476d45

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Date deposited: 02 Mar 2016 09:41
Last modified: 18 Jul 2019 13:39

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Contributors

Author: Barbara K. Ballmer-Weber
Author: Montserrat Fernandez-Rivas
Author: Kirsten Beyer
Author: Marianne Defernez
Author: Matthew Sperrin
Author: Alan R. Mackie
Author: Louise J. Salt
Author: Jonathan O'B. Hourihane
Author: Riccardo Asero
Author: Simona Belohlavkova
Author: Marek Kowalski
Author: Frédéric de Blay
Author: Nikolaos G. Papadopoulos
Author: Michael Clausen
Author: André C. Knulst
Author: Graham Roberts
Author: Ted Popov
Author: Aline B. Sprikkelman
Author: Ruta Dubakiene
Author: Stefan Vieths
Author: Ronald van Ree
Author: René Crevel
Author: E. N. Clare Mills

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