The severity of allergic reactions in a real-world environment is
independent of the eliciting amounts of foods.
Abstract
Introduction Patients with food allergies necessite having personalized
information on their risk of reaction in “real-life” situations. This
multicentric study aimed to investigate the link during accidental
reactions between the nature and amount of food allergens consumed in
“real life situation” and the severity of the symptoms. Methods
Patients were prospectively recruited from the 1 st of
December 2020 to the 31 st of December 2021 at the
emergency departments in the Geneva University Hospitals and local
pediatric urgent care, trough the allergology outpatient consultation,
at school and daycare facilities and trough their primary care
physicians. Medical history of patients presenting reactions suggestive
with immediate food allergy and suspected food samples were collected.
Allergy diagnostic tests were retrospectively and prospectively
collected. The samples were analyzed for their allergen content. Results
We recruited 147 subjects with an accidental immediate-type allergic
reaction to a food. We were able to collect 115 reaction-eliciting food
samples allowing to quantify the allergen amount occasioning the
reaction, as well as correlating this amount to the severity of the
reaction. Children represented a large part of the reactors, and most
reactions were to common food allergens such as tree nuts, cow’s milk as
well as peanuts and hen’s egg. Reactions were mostly to pre-packaged
foods and seven were to products with Precautionary allergy labeling, or
without labelling to the corresponding allergen. Reactions were of
various degrees of severity, and independent to the amount of allergen
ingested. Discussion The severity of reactions did not show a direct
correlation with allergen quantity, emphasizing individual sensitivity.
Some reactions occurred with allergen amounts significantly below the
legal limit for mandatory labelling of 1 g/kg in Switzerland. The study
also highlighted considerable variability in allergen concentrations in
foods labeled with possible “contaminations” or “traces.” These
findings raise questions about the accuracy of allergen labeling and
regulations.