Praktische adviezen bij pollengerelateerde voedselallergie

Pollen-related food allergies, such as birch pollen-related food allergy, are common in patients with atopic dermatitis. Diagnostics consist of a careful history, combined with assessing sensitization to tree pollen and, if possible, crossreacting foods. However, several potential pitfalls exist. While cross-reactivity between pollen and food is associated with mild oral allergy symptoms, it is imperative to provide patients with some practical advice

Praktische adviezen bij pollengerelateerde voedselallergie

Pollen-related food allergies, such as birch pollen-related food allergy, are common in patients with atopic dermatitis. Diagnostics consist of a careful history, combined with assessing sensitization to tree pollen and, if possible, crossreacting foods. However, several potential pitfalls exist. While cross-reactivity between pollen and food is associated with mild oral allergy symptoms, it is imperative to provide patients with some practical advice

A systematic review of the effect of thermal processing on the allergenicity of tree nuts

Background: Allergenicity of foods can be influenced by processing. Tree nuts are an important source of nutrition and increasingly consumed; however, processing methods are quite variable and data are currently lacking on the effects of processing on allergenicity. Objective: To perform a systematic literature review on the effects of food processing on the allergenicity of tree nuts. Methods: A systematic literature search of PubMed and Embase databases was performed, with screening of references, related articles and citations. Studies were included if they assessed the allergenicity or immunogenicity of processed nuts. Results: The search resulted in 32 articles suitable for analysis. Clinical studies indicate that roasting reduces the allergenicity of hazelnut in individuals with a birch pollen allergy and reactivity to raw hazelnut. Thermal processing may reduce the allergenicity of the PR-10 protein in hazelnut and almond in vitro. The majority of the in vitro studies investigating the allergenicity of nonspecific lipid transfer proteins (nsLTPs) and seed storage proteins in hazelnut, almond, cashew nut, Brazil nut, walnut, pecan nut and pistachio nut show heat stability towards different thermal processing methods. Conclusion: Thermal processing may reduce allergenicity of PR-10 proteins in hazelnut and almond, in contrast to nsLTPs and seed storage proteins. This has important implications for source materials used for IgE testing and food challenges and diet advice

Frequentie en oorzaak van onverwachte allergische reacties op voedsel [Frequency and cause of unexpected allergic reactions to food]

Unexpected reactions occur in patients with food allergy, but frequency data are scare. This prospective study investigates the frequency, severity and causes of unexpected allergic reactions to food in adults with a doctor's diagnosed food allergy. Participants complete an online questionnaire after every unexpected reaction and send in the culprit product including the food label. The product is analyzed for suspected allergens. Preliminary results show that the mean number of reactions was 1 per person per year. Most reactions occurred after consuming pre-packaged food and composite meals outdoors.© 2014 De Nederlandse Vereniging voor Dermatologie en Venereologie

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. Information regarding the 14 EU-regulated allergens was evaluated by the frequency of emphasizing allergens in the ingredient list, use of precautionary allergen labelling (PAL), icons and an allergen information section. Effectiveness of communication was assessed evaluating readability and findability of information on allergens using principles of Gestalt and Cognitive Load theories. Results As requested by EU regulation 1169/2011, emphasizing allergens in the ingredient list was almost 100%, all other presentations of information on allergens on labels was highly diverse. A separate allergen information section was present on most private label products. This section could, but not necessarily did, repeat allergens from the ingredient list and/or give a PAL. Brands often provided a PAL at the end of the ingredient list. Part of the products displayed an icon at different locations of the label. Label background, a lack of cohesion and variation in location of topics hamper the identification of relevant information on allergens by (allergic) consumers. Recommendations include a standardized order for mandatory and voluntary topics on the label and a separate allergen information section. Conclusion and clinical relevance Overall, consumers encounter a wide and inconsistent range in ways of presentation of allergen information on labels. Standardization according to basic design principles can improve usability and support safe food purchases for allergic consumers

Components in soy allergy diagnostics: Gly m 2S albumin has the best diagnostic value in adults

BackgroundThus far, four soy allergens have been characterized. Their diagnostic value was assessed only using a case-control design with controls not suspected of soy allergy or in a soy-allergic population without controls. Our objective was to analyze the diagnostic value of specific immunoglobulin E (sIgE) to Gly m 2S albumin, Gly m 4, 5, and 6, and their possible relation with severity or culprit soy product. MethodsAdult patients suspected of soy allergy were included (n=46). Allergy was confirmed by challenge (n=19) or history (n=16) and excluded by challenge in 11 patients. Soy components were analyzed by ImmunoCAP. Diagnostic value was assessed in the challenged patient group by an area under receiver operating characteristic (ROC) curve (AUC). ResultsSpecific immunoglobulin E to Gly m 2S albumin had the highest AUC (0.79), comparable to skin prick test (SPT) and sIgE to soy extract (0.76 and 0.77, respectively). All patients were sensitized to either soy extract or Gly m 4 (sIgE0.35kU/l). sIgE to soy extract, Gly m 5, and Gly m 6 was significantly higher in patients with mild symptoms (P=0.04, 0.02 and 0.02, respectively). Patients only reacting to soy milk had higher sIgE levels to Gly m 4 (median 9.8 vs 1.1 kU/l, P=0.01). ConclusionSpecific immunoglobulin E to Gly m 2S albumin had the best accuracy in diagnosing soy allergy. Gly m 5 and 6 were related to mild symptoms. Higher levels of Gly m 4 were related to allergy to soy milk

Precautionary allergen labeling: current communication problems and potential for future improvements.

Background While there are EU laws for priority allergenic ingredients information on food product packaging, there is no legislation about Precautionary Allergen Labelling (PAL) for unintended allergen presence (UAP). As a result, PAL is used in different ways by different manufacturers and retailers, which hampers consumers' interpretation of the information in the PAL. Aim Previous research has focused on the forms of PAL that are used and on the way they are interpreted and used by consumers. This study adds the perspective of producers, retailers and branch organizations. Methods Thirteen interviews with QA-and QC-professionals were conducted to find out more about the reasoning behind their PAL-use and to find out how PAL could be optimized. Results Results show that harmonization is needed, on different levels: in the way information on UAP is shared between parties involved in the food chain; in the way PAL is presented and phrased; and in the rules and regulations on PAL. Conclusion More research is needed on possible ways to share (updates on) information on UAP with consumers