How does dose impact on the severity of food-induced allergic reactions, and can this improve risk assessment for allergenic foods?

Funding informationThis work was conducted by an expert group of the European branch of the International Life Sciences Institute, ILSI Europe. This publication was coordinated by the Food Allergy Task Force. Industry members of this task force are listed on the ILSI Europe website at http://ilsi.eu/task-forces/food-safety/food-allergy/. Experts are not paid for the time spent on this work; however, the nonindustry members within the expert group were offered support for travel and accommodation costs from the Food Allergy Task Force to attend meetings to discuss the manuscript and a small compensatory sum (honorarium) with the option to decline. The expert group carried out the work, that is collecting/analysing data/information and writing the scientific paper separate to other activities of the task force. The research reported is the result of a scientific evaluation in line with ILSI Europe's framework to provide a precompetitive setting for public‐private partnership. ILSI Europe facilitated scientific meetings and coordinated the overall project management and administrative tasks relating to the completion of this work. For further information about ILSI Europe, please email [email protected] or call +3227710014. The opinions expressed herein and the conclusions of this publication are those of the authors and do not necessarily represent the views of ILSI Europe nor those of its member companies or any regulatory authority

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How does dose impact on the severity of food-induced allergic reactions, and can this improve risk assessment for allergenic foods?

Quantitative risk assessment (QRA) for food allergens has made considerable progress in recent years, yet acceptability of its outcomes remains stymied because of the limited extent to which it has been possible to incorporate severity as a variable. Reaction severity, particularly following accidental exposure, depends on multiple factors, related to the allergen, the host and any treatments, which might be administered. Some of these factors are plausibly still unknown. Quantitative risk assessment shows that limiting exposure through control of dose reduces the rates of reactions in allergic populations, but its impact on the relative frequency of severe reactions at different doses is unclear. Food challenge studies suggest that the relationship between dose of allergenic food and reaction severity is complex even under relatively controlled conditions. Because of these complexities, epidemiological studies provide very limited insight into this aspect of the dose‐response relationship. Emerging data from single‐dose challenges suggest that graded food challenges may overestimate the rate of severe reactions. It may be necessary to generate new data (such as those from single‐dose challenges) to reliably identify the effect of dose on severity for use in QRA. Success will reduce uncertainty in the susceptible population and improve consumer choice