One of the biggest bugbears of life as a food allergic person is Precautionary Allergen Labelling (PAL) or May Contain labelling. This is intended to warn you if there is a risk that the food concerned might be contaminated with any of the 14 major allergens. But because it is both voluntary and unregulated it totally fails to provide reliable information. As a result allergic consumers either restrict their diets unecessarily ‘to be safe’ or put themselves at risk by ignoring it as they do not trust it.
What the allergic world needs therefore is reliable and enforceable regulation in this area. But to achieve this the regulators need to know exactly how much of an allergen is needed to trigger a reaction – what is termed a threshold level. However, because each allergic person’s reactions are individual, it is not possible to establish a threshold which will be accurate for every single allergic person. The aim therefore has to be to establish a level of allergen below which the majority of the allergic population will not react.
Establishing thresholds
But there is no universal level as the protein levels and allergenicity of each allergen is different, so individual thresholds have to be established for each food. But even that is not as simple as it looks as research over the last 20 years has shown that allergic people can react differently to the same allergen depending on their state of health, whether they have just exercised, whether they have consumed alcohol, whether they are sleep deprived, etc.
It is these variables that the TRACE study, which first reported in 2019, has been trying to establish for peanut in the hopes that in due course their findings may also be applicable to other allergens.
Their 2019 report which you can read in full here showed that both exercise and sleep deprivation significantly and independently reduced the ‘threshold of reactivity’ (the amount needed to trigger a reaction) by approximately half in people with peanut allergy. This fairly dramatically increases their risk of a reaction.
Further work, recently published in the Journal of Allergy and Clinical Immunology, has shown that sleep deprivation not only lowers the level at which a reaction may occur but that it can significantly increase the severity of that reaction. Exercise does not appear to be important in terms of the severity of that reaction.
However, this recent work also found that the severity of a reaction increased with repeated challenges. In other words, your reactions are likely to get more serious each time a reaction is triggered.
The way forward
These findings may seem abstruse but they all help to build a picture which will allow the regulators to establish a level of allergen below which the vast majority of the allergic population will not react. Once they have that, that level can be set in a regulation and managing that allergen becomes a great deal easier.
As with gluten, manufacturers will have a figure to which to work and for which they can test. And they can label their products as containing more or less than that level. Policing contamination also becomes much easier as enforcement authorities have a level to which they can require manufacturers to adhere and if it is not met they can prosecute. And life becomes very much easier for the allergic person who can now trust that if a label says that the food is free of the relevant allergen, it means that it contains less than the threshold level which has been deemed safe for them to consume.
Roll on that day.
Bird flu – could an escalating number of phone masts be relevant?
Roll on that day indeed, although I wonder whether it’s really ultimately possible to do this, at least without confusing the public too much. I think sometimes we assume that a threshold for one of the 14 allergens is already established, but of course (discounting sulphites) it isn’t: gluten is merely one of the proteins within one of the 14 allergens (or allergen groups in this case), and not the legislated allergen itself. With so many individual proteins within each top-14 allergen, I do not envy the task of the researchers, nor of anyone involved in food industry, allergen control or anyone else …
And this is just the top 14 allergens, or maybe initially just nuts as the Trace study was all about nuts. I took part in the early stages of that research which was fascinating actually the only time I got to see a specialist allergist and asthma expert. Ultimately, I was too allergic to go forward with the study as I had a wheat allergy too and the peanuts were delivered in some kind of wheaty thing.
And what worries me also is that we look a label for allergens or PALS and rightly or wrongly most of us think something is safe if the precautionary labelling is absent. Is this true? or does it mean the manufacturer doesn’t know, doesn’t care or just isn’t doing the a**e covering that so many of them do. We are indeed a long way off but maybe one day we’ll see moves fotrward. We got there with gluten and 20ppm, so why not allergens too?
Taht is exactly why it is so important that we finally get this issue of thresholds sorted Ruth. The Australians had come up with a workable model 10, or maybe even 15 years ago – why can’t we!