Risk Management for Food Allergy

Food Science and Technology International Series

List of Contributors

Foreword

Introduction

History of ‘Allergy’ Labeling

Where are we now – The Book

The Authors

Section 1: Food Allergy: Causes, Prevalence, and Impacts

Chapter one. Living with Food Allergy: Cause for Concern

Abstract

Introduction

Qualitative Studies on the Impact of Food Allergy on HRQL

Children and Teens: The Evolution of Uncertainty

The Parental Perspective: Living with Uncertainty

The Parental Perspective: Quantitative

The Child, Adolescent, and Adult Perspective: Quantitative

Discussion

Improving Risk Management and HRQL: A Better Way?

References

Chapter two. Which Foods Cause Food Allergy and How Is Food Allergy Treated?

Abstract

Introduction

Foods Involved in Allergic Reactions

Symptoms and Severity of Food Allergy

Management

References

Chapter three. The Epidemiology of Food Allergy

Abstract

Prevalence

Time Trends of Food Allergy Prevalence and Health Care Utilization

Risk Factors for Food Allergy

The Natural History of Food Allergies

The Consequences of Food Allergy

Conclusions

References

Section 2: Allergen Thresholds and Risk Assessment

Chapter four. How to Determine Thresholds Clinically

Abstract

Introduction and Definitions

Meal, Source Material, and the Matrix Issue

Factors Affecting the Outcome of Challenges

Inclusion and Exclusion Criteria for Patients to Undergo Titrated Challenges

Safety Aspects of Titrated DBPCFC

Pre- and Post-Challenge Assessments of Patients

Which Symptom Defines the Individual Threshold Dose?

Challenge Protocols and Dosing

An Open Food Challenge Always Has to Follow a Negative DBPCFC

References

Chapter five. Thresholds or ‘How Much Is Too Much?’

Abstract

Introduction

What is Meant by Thresholds in the Context of Food Allergy and Allergens?

Thresholds Before EuroPrevall: What Data Were Available and How Useful Were They for Risk Assessment?

How Have Threshold Data Been Generated? Protocols and Their Evolution

Factors Affecting the Outcome of Challenge Studies and the Type of Data Generated

Tools for the Analysis of Threshold Data

Conclusions

References

Chapter six. From Hazard to Risk – Assessing the Risk

Abstract

Introduction

Why and When is it Necessary to Estimate the Risk from Allergenic Food?

Safety Assessment in Food Allergy Using One Data Point (NOAEL or LOAEL) and an Estimated Food Consumption

Safety Assessment in Food Allergy Based on All Available Challenge Data and an Estimated Intake Food Consumption (Benchmark Dose/Margin of Exposure Approach)

Exposure Assessment

Risk Assessment in Food Allergy Based on the Distribution of Input Data (Challenge, Contamination, Consumption) (Probabilistic Approach)

Examples of Risk Assessments Using All Three Approaches

Summary of Risk Assessment Examples

Uncertainty Factors

Severity Considerations in Risk Assessment

VITAL Program

Concluding Remarks

References

Section 3: Risk Management of Gluten

Chapter seven. Celiac Disease and Risk Management of Gluten

Abstract

Abbreviations

Introduction

Definition of Celiac Disease

Gluten Sensitivity

Wheat (Food) Allergy

Diagnosis of Celiac Disease

A Public Health Problem

Time, Place, and Person

Clinical Presentation

Associated Diseases

A Multifactorial Etiology

Etiopathogenetic Considerations

Case Identification

Living with Celiac Disease

Risk Assessment in Celiac Disease

Adherence Problems

How to Keep Celiac Customers Happy and Safe?

Support Strategies

Perspectives for the Future

Case Stories

References

Section 4: Practical Food Allergen Risk Management

Chapter eight. Food Allergen Risk Management in the Factory – From Ingredients to Products

Abstract

Introduction

Allergen Risk Management: Principles and Systems

Employee Training and Awareness

Ingredients/Raw Materials – Suppliers, Storage, and Handling

Production – Material Flow, Factory and Equipment Design, Product Scheduling, and Rework

Production – Cleaning and Cleaning Validation

Labeling

References

Chapter nine. Managing Food Allergens: Case Histories and How They Were Handled

Abstract

Introduction

Case Study 1 – Supply Chain

Case Study 2 – Supply Chain, Manufacturing – ‘All Nuts are Equal’

Case Study 3 – Labeling

Case Study 4 – Manufacturing (Large Company)

Case Study 5 – Manufacturing (Rework)

Case Study 6 – Manufacturing and Design – ‘Nut Snow’

Case Study 7 – Manufacturing (Small Company)

Case Study 8 – Allergen Awareness – ‘No Protein = No Food Allergen: True or False?’

Case Study 9 – Product Development, Training, Allergen Awareness: – ‘Food Allergens: Never Heard of Them!’

Case Study 10 – Training, Allergen Awareness, and Supplier Verification

Case Study 11 – Auditor’s Allergen Awareness and Understanding

Case Study 12 – An Ethical Dilemma

Conclusion

References

Chapter ten. Catering – How to Keep Allergic Consumers Happy and Safe

Abstract

Introduction

Why Do Consumers Currently Not Have the Information They Need to Make Safe Choices When Eating Out?

What Is the Current Legal Position and Are Any Changes Expected?

Best Practice Guidance Published by the UK Food Standards Agency in 2008 on the Provision of Allergen Information for Non-Pre-Packed Foods

The Responsibilities of the Food Allergic Consumer

Future Developments and Recommendations

References

Chapter eleven. Food Allergen Risk Management in the United States and Canada

Abstract

Introduction

US National Food Allergen Risk Management

US State and Local Allergen Risk Management

Canadian National Allergen Risk Management

Conclusions

Chapter twelve. The Importance of Food Allergy Training for Environmental Health Service Professionals

Abstract

Introduction

The Effectiveness of an Avoidance Diet

Legislative Basis for the Risk Management of Food Allergens

The Role of the EHO in the Risk Management of Food Allergens

Deficits in Training Resources for Catering Staff

Deficits in Food Allergy Awareness Among Catering Staff

A Food Allergy Training Program for the Island of Ireland

References

Chapter thirteen. Detecting and Measuring Allergens in Food

Abstract

Introduction

Immunochemical Methods for the Detection of Food Allergens

Mass Spectrometry

Polymerase Chain Reaction (PCR)

Conclusions

References

Chapter fourteen. Effect of Processing on the Allergenicity of Foods

Abstract

Introduction

Effects of Processing Major Allergenic Foods of Plant Origin

Whole Food Effects of Food Processing

Conclusions

References

Chapter fifteen. Communication with Food Allergic Consumers: A Win-Win Experience

Abstract

Introduction

Start with the Basic Fact That Education and Sensitivity Training Related to Food Allergic Consumers Must Be Holistic and Inclusive

Putting the Program into Practice and Selling the Benefits Beyond Your Company

Conclusion and Summary

References

Chapter sixteen. May Contain – To Use or Not?

Abstract

Introduction

History and Origins of Precautionary Labeling

Legal and Regulatory Status of Precautionary Allergen Labeling

How to Determine the Tolerable Level of Risk

VITAL and a Threshold-Based Approach to Risk Assessment

The Future of Precautionary Statements

References

Chapter seventeen. Regulatory Controls for Food Allergens

Abstract

Introduction

How Best to Protect the Public at Risk from Adverse Reactions to the Major Food Allergens?

Why Do We Need Specific Allergen Labeling Rules?

Codex

European Legislation Regarding Food Allergen Risk Communication

‘Gluten-Free’ and Other ‘Free from’ Claims

Regulatory Lists Around the World

What is not Covered by Legislation?

Conclusions

References

Chapter eighteen. Keeping Updated

Abstract

Introduction

The Allergen Bureau (Australia)

The American Academy of Allergy, Asthma, and Immunology

Canadian Food Inspection Agency

Catering for Allergy (UK)

The European Academy of Allergy and Clinical Immunology

The European Food Safety Authority

Food Allergy Information (EU)

The Food Allergy Research and Resource Program (US)

Food Allergy Support (UK)

Food and Drug Administration (US)

The Food Standards Agency (UK)

The InformAll Database (UK)

Food Science and Technology International Series

Index