There has been growing interest from patients, healthcare professionals and the public about food allergy with fatalities hitting the headlines. Questions about the threshold of reactivity and food allergen labelling remain often unanswered and guidance is required to inform the recommendations given to food allergic patients and their families. This task force will review recently published studies about food allergen thresholds, specifically: how thresholds are determined, factors which can impact on food allergen threshold and biomarkers to predict threshold; and will elaborate a position paper on the basis of this evidence to support the clinical care provided to food allergic patients, namely allergen doses that should be given to diagnose and treat food allergies, recommendations about which foods need to be avoided and which foods can be safely eaten by food allergic patients and food allergen labelling.

Food allergy is a public health issue, with major implications for industry and healthcare systems. Confusion and inappropriate allergen declaration have been linked to fatalities which are widely reported in the media. This is partly because while there is mandatory disclosure of “Annex 2” allergens when used as ingredients, this does not apply to allergens which may be present due to cross-contact. This results in wide and inconsistent use of “may contain” precautionary allergen labelling (PAL), causing confusion and anxiety in patients who look to their healthcare professionals for advice and reassurance. While the Food Allergen Thresholds TF had a productive year in 2020, activities for 2021 were suspended due to lack of budget from EAACI to undertake the final stage of the taskforce, namely a major, pan-European iterative stakeholder consultation with patient representative organisations to (i) define what patients understand by “acceptable risk” in terms of the trade-off between PAL and appropriate dietary restrictions (ii) better understand what patients want from PAL, and in a meaningful and trustworthy way. Our objectives for 2022 are: (i)the pan-European iterative stakeholder consultation described above; (ii)update and finalise a position paper describing how the current evidence base can be used to deliver personalised patient care: improve diagnosis, optimise immunotherapy and better inform dietary management. This work is timely: the United Nations’ FAO and World Health Organisation are finalising new international CODEX guidelines to (i)validate/update the list of allergens required for disclosure (ii)agree threshold levels for priority allergens, and (iii)evaluate evidence for PAL. A number of TF members are active in this work, facilitating the global impact of the TF.

IG Food Allergy

Chair: Paul Turner
Secretary: Alexandra Santos