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Review
. 2018 Jul;73(7):1383-1392.
doi: 10.1111/all.13405. Epub 2018 Feb 9.

How does dose impact on the severity of food-induced allergic reactions, and can this improve risk assessment for allergenic foods?: Report from an ILSI Europe Food Allergy Task Force Expert Group and Workshop

A E J Dubois  1 , P J Turner  2 , J Hourihane  3 , B Ballmer-Weber  4 , K Beyer  5 , C-H Chan  6 , M H Gowland  7 , S O'Hagan  8 , L Regent  9 , B Remington  10 , S Schnadt  11 , T Stroheker  12 , R W R Crevel  13
Affiliations
Review

How does dose impact on the severity of food-induced allergic reactions, and can this improve risk assessment for allergenic foods?: Report from an ILSI Europe Food Allergy Task Force Expert Group and Workshop

A E J Dubois et al. Allergy. 2018 Jul.

Abstract

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.

Keywords: allergenic foods; eliciting dose; precautionary allergen labelling; risk assessment; severity.

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Figures

Figure 1
Figure 1
Hierarchy of risks faced by people susceptible to food allergy
Figure 2
Figure 2
The “Swiss cheese” model. Adapted from reference28
Figure 3
Figure 3
Different patterns of clinical reactivity are seen at food challenge. Many individuals will experience initially subjective symptoms, with objective symptoms appearing with further doses (A). Anaphylaxis will only develop if the food challenge continues. Others will experience anaphylaxis as their first objective symptom: either at a dose of allergen exposure with no preceding subjective symptoms (B), or with prior subjective symptoms (C). Note that anaphylaxis can occur at all levels of exposure (both at low levels of allergen exposure, represented by the solid bars, and higher doses indicated by dotted lines). Reproduced (with permission) from reference40
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References

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