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Journal articles on the topic 'Allergy Labeling'

Author: Grafiati

Published: 4 June 2021

Last updated: 13 February 2022

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1

Odisho, Nora, Tara F. Carr, and Heather Cassell. "Food Allergy: Labelling and exposure risks." Journal of Food Allergy 2, no. 1 (September 1, 2020): 115–18. http://dx.doi.org/10.2500/jfa.2020.2.200027.

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In the United States, food allergen labeling is regulated by the U.S. Food and Drug Administration with the implementation of the Food Allergen Labeling and Consumer Protection Act in 2006 that requires packaged foods to clearly indicate the presence of any milk, egg, peanut, tree nuts, wheat, soybeans, fish, and crustacean shellfish. Educating patients and their families how to read food labels includes reading the ingredients list as well as the declaration statement that begins with “Contains.” In addition, there is widespread use of precautionary advisory labeling, and patients should be counseled that these precautionary statements are not mandatory and not regulated and, therefore, do not necessarily identify foods with allergen contamination. An allergic reaction to undeclared food allergens as well as complacency with label reading, including precautionary advisory statements, remains a relevant risk for patients with food allergy.

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Shoji, Masahiro, Reiko Adachi, and Hiroshi Akiyama. "Japanese Food Allergen Labeling Regulation: An Update." Journal of AOAC INTERNATIONAL 101, no. 1 (January 1, 2018): 8–13. http://dx.doi.org/10.5740/jaoacint.17-0389.

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Abstract The Japanese food allergen labeling regulation was designed to match real Japanese food allergy circumstances and also to be enforced effectively; thus, (1) regulated food allergens were selected by prevalence and seriousness according to food allergy surveys in Japan; (2) the detection criterion for ELISA monitoring, 10 μg food allergen protein/g (or mL) food, was set up as the threshold value to regulate commercial prepackaged foods; and (3) official food allergen analytical methods, which can determine the threshold value accurately, were developed. These three points are distinctive from other countries. Furthermore, as an on-going project, the regulation has been amended according to food allergy circumstances and requirements of society. This paper presents recent changes regarding the Japanese food allergen labeling regulation. To date, the Japanese food allergen labeling regulation has been enforced for more than 15 years and seems to be working effectively. Now would be an opportune time to review the regulation for its next level of development.

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Koeberl, Martina, Dean Clarke, Katrina J. Allen, Fiona Fleming, Lisa Katzer, N. Alice Lee, Andreas L. Lopata, et al. "European Regulations for Labeling Requirements for Food Allergens and Substances Causing Intolerances: History and Future." Journal of AOAC INTERNATIONAL 101, no. 1 (January 1, 2018): 60–69. http://dx.doi.org/10.5740/jaoacint.17-0386.

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Abstract Food allergies are increasing globally, including numbers of allergens, the sensitization rate, and the prevalence rate. To protect food-allergic individuals in the community, food allergies need to be appropriately managed. This paper describes current Australian food allergen management practices. In Australia, the prevalence of food allergies, the anaphylaxis rate, and the fatal anaphylaxis rate are among the highest in the world. Interagency and stakeholder collaboration is facilitated and enhanced as Australia moves through past, current, and ongoing food allergen challenges. As a result, Australia has been a global leader in regulating the labeling of common allergens in packaged foods and their disclosure in foods not required to bear a label. Moreover, the food industry in Australia and New Zealand has developed a unique food allergen risk management tool, the Voluntary Incidental Trace Allergen Labelling program, which is managed by the Allergen Bureau. This paper summarizes insights and information provided by the major stakeholders involved to protect food-allergic consumers from any allergic reaction. Stakeholders include government; consumer protection, regulation, and enforcement agencies; the food industry; and food allergen testing and food allergen/allergy research bodies in Australia. The ongoing goal of all stakeholders in food allergen management in Australia is to promote best practice food allergen management procedures and provide a wide choice of foods, while enabling allergic consumers to manage their food allergies and reduce the risk of an allergic reaction.

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Kryuchenko, E. V., Yu A. Kuzlyakina, V. S. Zamula, and I. M. Chernukha. "Allergenomics and analysis of causes of unintentional incorpo‑ ration of substances capable of causing IgE‑mediated food allergy into meat products." Theory and practice of meat processing 5, no. 3 (October 26, 2020): 4–11. http://dx.doi.org/10.21323/2414-438x-2020-5-3-4-11.

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The article discusses the definition and mechanism of IgE‑mediated food allergy, provides an overview of the legal regulation of the production and labeling of allergen-containing food products. In order to prevent the inadvertent appearance of allergens in products during their production, an allergenomics procedure is required — a comprehensive assessment of the allergic potential of a food product: allergenicity of product ingredients, risk analysis, and the procedure for managing allergens in the production.

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Torda, Adrienne, and Victor Chan. "Antibiotic Allergies – Is De-labeling Based on Clinical History Feasible?" Open Forum Infectious Diseases 4, suppl_1 (2017): S342. http://dx.doi.org/10.1093/ofid/ofx163.816.

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Abstract Background Up to 25% of patients admitted to hospital have an antibiotic allergy label (AAL), most of which are towards penicillin. However, up to 90% of patients who claim to be allergic to penicillin are actually able to tolerate them1. Whilst skin testing is safe and efficacious in de-labeling patients with a penicillin allergy label, it is usually not widely available. Therefore, we investigated the feasibility of de-labeling based solely upon clinical grounds. Quality of allergy documentation and subsequent antibiotic use was also assessed. Methods This was a cross-sectional study assessing all patients admitted to a tertiary referral teaching hospital over a 5-month period in 2016. All newly admitted patients were prospectively screened for the presence of an antibiotic allergy documented in their electronic medical record. Unless unable to participate, patients were interviewed regarding the detailed nature of their antibiotic allergy. Information regarding allergy documentation, medical condition and antibiotic use was obtained from medical records. Results 3855 patients were screened, 553 (14.35%) had an AAL, and 352 were interviewed. There were 426 allergies, 276 (64.8%) towards a penicillin. Only 52% of patients had a convincing history consistent with antibiotic allergy, and 48% of these were mild cutaneous reactions. It was felt that de-labeling and direct re-challenge would be relatively safe in 70% (298/42) of AALs (if the mild cutaneous allergic group were included). In patients who were prescribed antibiotics during study admission, 25.6% (41/160) of antibiotic prescriptions in our cohort were found to be inappropriate in patients with AALs. Conclusion Direct re-challenge based upon clinical grounds appears to be a feasible clinical option in many patients with AALs and would allow de-labeling of these patients. The major barriers continue to be patient acceptance and risk of severe adverse reactions. Our study also found that major improvements could be made in the specific documentation of allergy and also in selection of guideline-recommended alternate antibiotics. 1. Joint Task Force on Practice Parameters. Drug Allergy: An Updated Practice Parameter. Ann Allergy Asthma Immunol. 2010; 105(4): p. 259–273. Disclosures All authors: No reported disclosures.

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6

Choi, Jinkyung, and Ahyeon Choi. "Perceptions of food labelling about allergens in food products in South Korea." British Food Journal 118, no. 12 (December 5, 2016): 2842–54. http://dx.doi.org/10.1108/bfj-04-2016-0163.

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Purpose Allergy information on food labels is crucial to individuals with food allergies. The purpose of this paper is to investigate what information consumers are concerned with as well as improving the allergen information on the product labels. Design/methodology/approach A questionnaire was developed based on previous studies and was administered to citizens in South Korea. Descriptive analysis and analysis of variance were conducted to find significances of important information when purchasing and improvement needed on the labels in relation to allergy knowledge. Findings The results indicated that respondents were concerned about allergy information and general information regarding the basic value of food and also food safety. In addition, this study found knowledge of food allergies is not related to consideration of allergy information on labels. Originality/value This study measured consumers’ perceptions of the current food allergy labeling when purchasing food products. This study concluded improvements were needed in order to deliver allergy information in a clear manner. Such as font size, shape, and color should be implemented together in order to communicate effectively with allergic consumers.

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McEwen, GN. "CARMINE DYE ALLERGY INGREDIENT LABELING." Annals of Allergy, Asthma & Immunology 83, no. 1 (July 1999): 76. http://dx.doi.org/10.1016/s1081-1206(10)63517-x.

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8

BALDWIN, JAMES L., ALICE H. CHOU, and WILLIAM R. SOLOMON. "CARMINE DYE ALLERGY INGREDIENT LABELING." Annals of Allergy, Asthma & Immunology 83, no. 1 (July 1999): 76. http://dx.doi.org/10.1016/s1081-1206(10)63518-1.

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Arya, Chhavi, and Chetna Jantwal. "A Review on Identified Major Food Allergens: Characteristics and Role in Food Allergy." Indian Journal of Nutrition and Dietetics 54, no. 3 (July 4, 2017): 346. http://dx.doi.org/10.21048/ijnd.2017.54.3.11626.

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Food allergens are the substances present in food that cause food allergy. Human body reactions to food allergens range from mild to severe life threatening anaphylactic shock. At least seventy different foods have been reported to cause allergic reactions and several other foods have been identified which have the potential to provoke allergic reactions. Majority of the identified food allergens are proteins. The Food Allergen Labeling and Consumer Protection Act (FALCPA) identifies eight major food groups i.e. milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, and soybeans as major allergy causing foods. These eight foods are believed to account for 90 per cent of food allergies and are responsible for most serious reactions to foods. Several studies have been done which identify the major allergens in various foods. The present paper attempts to review the major allergens present in various food.

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Shweta, Fnu, Pooja Gurram, Natalia E. Castillo Almeida, Douglas Challener, Edison J. Cano, Miguel Park, Prasanna Narayanan, Lee Skrupky, Gerald Volcheck, and Abinash Virk. "153. Development of a Pathway for Removal of Inappropriate Penicillin Allergy Labels in Hospitalized Patients." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S86—S87. http://dx.doi.org/10.1093/ofid/ofaa439.198.

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Abstract Background More than 90% of reported penicillin allergies are found inaccurate when formally assessed. These allergy labels lead to decreased utilization of first-line beta-lactam antibiotics, and adverse clinical outcomes. The objective of this study was to develop a multi-disciplinary approach to decrease inaccurate labeling among hospitalized patients with documented penicillin allergy. Methods A team of clinicians, pharmacists, and nurses utilized the DMAIC quality strategy to improve accuracy of penicillin allergy labeling. Allergic reactions were stratified to develop a penicillin allergy de-labeling algorithm (Figure 1). Admission to the intensive care unit (ICU) for anaphylaxis was defined as a balancing measure. We reviewed baseline data from patients with a documented penicillin allergy admitted to a single inpatient floor at Mayo Clinic, Rochester between June and October 2019. A cause and effect diagram was used to conduct a root cause analysis. The intervention was then applied to patients who reported penicillin allergy admitted to the same floor from November 2019 to January 2020. Study data were collected and basic descriptive statistics generated. Figure 1: Penicillin allergy delabeling algorithm Results 96 patients were included in the control group with mean age of 71 years (range 65–84 years) and 55% females. Breakdown of documented allergic reactions are represented in Figure 2. 58 (60%) received an antibiotic for a median duration of 1.5 days (IQR: 0 – 6). Of these, 7(12%) received penicillin-class antibiotics, and 41 (70.6%) received non-beta-lactam antibiotics. 2 (2%) of these patients were de-labeled without any penicillin skin tests. Detailed metrics of each PDSA cycle are shown in Table 1. During PDSA cycle 2, inaccurate penicillin documentation was removed in 9/19 (47.4%) of hospitalized patients. There were no ICU admissions for anaphylaxis. Figure 2: Graphic representation of proportion of type of documented allergic reactions to penicillin Table 1: Metrics and outcomes at baseline and during successive PDSA cycles Conclusion Various factors contribute to penicillin allergy mislabeling. Our comprehensive algorithm addresses nuances of penicillin allergic reactions and increased accurate penicillin allergy labeling in 47.4% of the cases. Beta-lactam use also increased to 37% through our pilot project while maintaining patient safety. A multi-disciplinary and patient-centered approach aligned with institutional workflows is necessary to improve patient outcomes. Disclosures All Authors: No reported disclosures

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YEUNG, JUPITER M., RHONA S. APPLEBAUM, and REGINA HILDWINE. "Criteria to Determine Food Allergen Priority." Journal of Food Protection 63, no. 7 (July 1, 2000): 982–86. http://dx.doi.org/10.4315/0362-028x-63.7.982.

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The emergent health issue of food allergens presents an important challenge to the food industry. More than 170 foods have been reported in the scientific literature as causing allergic reactions. Clearly, it would be impossible to deal with the presence of trace amounts of all these in the context of food labeling. If the decision to classify major allergens is based solely on the knowledge and experience of allergists and food scientists in the field, without scientifically defined criteria, it is likely to lead to a proliferation of lists. Such practices may lead to an unnecessary elimination of foods containing important nutrients. This paper defines food allergy, food intolerance, and food anaphylaxis and identifies criteria for classifying food allergens associated with frequent allergic reactions. A practical list of food allergens that may result in potentially life-threatening allergic reactions is provided. A mechanism-based (i.e., immunoglobulin E mediated), acute life-threatening anaphylaxis that is standardized and measurable and reflects the severity of health risk is proposed as the principal inclusion criterion for food allergen labeling. Where available, prevalence in the population and threshold levels of allergens should be used as an additional guide to identify possible future labeling needs.

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12

Spotz, Kristen. "Allergens: An Enhanced Focus." Journal of AOAC INTERNATIONAL 101, no. 1 (January 1, 2018): 56–59. http://dx.doi.org/10.5740/jaoacint.17-0435.

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Abstract Food Allergy Awareness Week was created with the purpose of placing a spotlight on the seriousness of food allergies. Recognized in the United States in mid-May every year, Food Allergy Awareness Week serves as a reminder of the over 15 million Americans who suffer from food allergies. The importance of allergies and allergen labeling can be seen when looking at U.S. Food and Drug Administration recall data: of the 764 recalls in 2016, 305 (representing more than 40%) were due to undeclared allergens. However, recalls for undeclared allergens are a complex issue with numerous factors. The implementation of prevention-based systems with the necessary management components and further error-proofing the systems, along with allergen awareness embedded throughout a company’s food safety culture, can likely help reduce the number of recalls for undeclared allergens. As a resource to manufacturers, the Grocery Manufacturers Association and the Food Allergy Research and Resource Program have developed several resources to assist with developing robust allergen management programs. By reducing the number of recalls for undeclared allergens, the food industry will likely increase and maintain consumer confidence and trust of the food-allergic community. This enhanced consumer confidence and trust could eventually open the door for further collaboration with the food-allergic community and, potentially, advance allergen-related policies.

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Song, You-Chan, Zachary J. Nelson, Michael A. Wankum, and Krista D. Gens. "Effectiveness and Feasibility of Pharmacist-Driven Penicillin Allergy De-Labeling Pilot Program without Skin Testing or Oral Challenges." Pharmacy 9, no. 3 (July 20, 2021): 127. http://dx.doi.org/10.3390/pharmacy9030127.

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Documented penicillin allergies have been associated with an increased risk of adverse outcomes. The goal of this project was to assess the effectiveness and feasibility of a pharmacist-led penicillin allergy “de-labeling” process that does not involve labor-intensive skin testing or direct oral challenges. Adult patients with penicillin allergies were identified and interviewed by an infectious diseases pharmacy resident during a 3-month pilot period. Using an evidence-based standardized checklist, the pharmacist determined if an allergy qualified for de-labeling. In total, 66 patients were interviewed during the pilot period. The average time spent was 5.2 min per patient interviewed. Twelve patients (18%) met the criteria for de-labeling and consented to the removal of the allergy. Four patients (6%) met the criteria but declined removal of the allergy. In brief, 58.3% of patients (7/12) who were de-labeled and 50% of patients (2/4) who declined de-labeling but had their allergy updated to reflect intolerance were subsequently prescribed beta-lactam antibiotics and all (9/9, 100%) were able to tolerate these agents. A pharmacist-led penicillin allergy de-labeling process utilizing a standardized checklist is an effective and feasible method for removing penicillin allergies in patients without a true allergy.

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Miceli, Amanda, Shan Sun, Tonya Scardina, Ajay Bhasin, Larry Kociolek, and Sameer Patel. "1131. Prevalence and Characteristics of Non-β-Lactam Allergy Labeling at a Children’s Hospital." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S402. http://dx.doi.org/10.1093/ofid/ofz360.995.

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Abstract Background Limited data are available on non-β-lactam (NBL) antibiotic allergy labeling in children. Understanding the incidence and patterns of NBL labeling is important as NBL hypersensitivity testing lacks standardization and false labeling may constrain therapeutic options and compromise antimicrobial stewardship. Methods We conducted a retrospective review of patients at our tertiary care pediatric facility and associated clinics who had first reported allergy to NBL antibiotics from January 1, 2015 to December 31, 2015. Demographic data, NBL subclass, severity, description of reaction, and ICD-9/10 diagnostic codes were recorded. In addition, subsequent antibiotic during the following 3 years (2016–2018) was determined. NBL allergy descriptions, when reported, were categorized based on severity and type of reaction. Results Of 35,796 patients with first clinical encounters in 2015, 223 patients (0.6%) had at least one NBL allergy reported, 1370 (3.8%) had a β-lactam allergy reported, and 101 (0.3%) patients had both an NBL and β-lactam allergy. There were 16 patients with two NBL allergies. The median age of patients with NBL allergy was 9.0 years. NBL classes and allergic reaction types are listed in the tables. Chronic conditions of patients with NBL allergy included gastrointestinal disease (n = 51), neurological disease (n = 37), malignancy (n = 36), bone marrow or solid-organ transplant (n = 4), and cystic fibrosis (n = 5). In the subsequent 3 years, 28 patients with NBL allergies received 129 systemic courses of antibiotics as inpatients, including 8 patients who received ≥10 courses. Conclusion Although not as common as β-lactam allergies, NBL allergies were noted in a substantial number of new patients. When described, the majority of patients did not have severe reactions, and were most likely nonallergic adverse reactions. As many of the patients have chronic conditions and require subsequent antibiotics, adjudication of true allergy status may be beneficial. Disclosures All authors: No reported disclosures.

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Stone, Cosby A., Jason Trubiano, David T. Coleman, Christine R. F. Rukasin, and Elizabeth J. Phillips. "The challenge of de‐labeling penicillin allergy." Allergy 75, no. 2 (May 26, 2019): 273–88. http://dx.doi.org/10.1111/all.13848.

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Foreman, Caroline, Thanh-Thao Adriana Le, Joshua M. Inglis, and William Bernard Smith. "Penicillin allergy labeling on medical alert jewelry." Annals of Allergy, Asthma & Immunology 124, no. 6 (June 2020): 627–29. http://dx.doi.org/10.1016/j.anai.2020.03.002.

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Song, Youchan, Zachary Nelson, and Krista Gens. "171. Effectiveness and Feasibility of Pharmacist-Driven Penicillin Allergy De-Labeling Pilot Program." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S93. http://dx.doi.org/10.1093/ofid/ofaa439.215.

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Abstract Background Prevalence of true hypersensitivity to penicillins is low (0.5–2%). Documented penicillin allergies have been associated with an increased risk of adverse outcomes, including methicillin resistant Staphylococcus aureus infections, Clostridioides difficile infections, and surgical site infections. “De-labeling” of inappropriately documented allergies can decrease the use of unnecessary broad-spectrum antibiotics and prevent negative outcomes, but labor-intensive skin testing and oral challenges can be a barrier to program implementation. The goal of this project is to assess the effectiveness and feasibility of a pharmacist-led penicillin allergy de-labeling process that does not involve skin testing or oral challenges. Methods Adult patients with penicillin allergies were identified using a report within the electronic health record during a 3-month pilot period. Patients identified were interviewed by an infectious diseases pharmacy resident, and an allergy history was assessed utilizing a standardized checklist. The patients’ answers determined the ability to de-label via pharmacist utilization of an evidence-based and standardized checklist developed for this project. All documentation included a detailed patient allergy history along with a beta-lactam cross-reactivity chart to help guide future antibiotic choices. Results 66 patients were interviewed during the pilot. 12 patients (18%) met criteria for de-labeling and consented to the removal of the allergy. 4 patients (6%) met criteria for de-labeling but declined the removal of the allergy. Average time spent during patient interview was 5.2 minutes per patient. 58.3% of patients (7/12) who were de-labeled were subsequently prescribed a beta-lactam, and 100% (7/7) were able to tolerate the agents. 1 out of 4 patients (25%) who declined de-labeling but had their allergy updated to reflect intolerance was prescribed beta-lactams and was able to tolerate the agents (1/1, 100%). Conclusion A pharmacist-led penicillin allergy de-labeling process utilizing a standardized checklist is an effective method for removing penicillin allergies in patients who do not have a true allergy to penicillins. This pharmacist-led process is a feasible method for sites unable to perform oral challenges or skin testing. Disclosures All Authors: No reported disclosures

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Patel, Radha, Nicole Saccone, Kent Stock, Sara Utley, and Dawn Bouknight. "998. Challenging Penicillin Allergies: Pharmacist led program in a community hospital." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S351. http://dx.doi.org/10.1093/ofid/ofz360.862.

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Abstract Background Penicillin (PCN) allergy has been approximated to be reported in 10% of the United States population. Studies utilizing PCN skin testing have demonstrated that less than 1% of the population have a true PCN allergy. With increasing data on the negative consequences associated with a PCN allergy diagnosis, correctly identifying these patients is imperative. PCN skin testing has resulted in high rates of penicillin de-labeling; however, there are limited data evaluating the impact of a pharmacist-led PCN allergy evaluation with removal through utilization of oral challenges. The aim of this study was to utilize pharmacists to correctly identify those who are not penicillin-allergic to help decrease unnecessary use of broad-spectrum antibiotics and to optimize therapy. Methods This is a single-center, prospective review looking at a 10-month period of a pharmacist-led de-labeling project of patients with a PCN allergy. The electronic medical record system and decision support software were used to identify eligible patients. Adults ≥18 years of age with a PCN allergy were included. During the evaluation, pharmacists utilized a series of standardized questions which was reviewed with the infectious disease physician to classify the patient’s allergy. Based on classification a protocol was followed that either led to the patient retaining their allergy, or removal. The primary objective is to evaluate the rate of removal of penicillin allergies. Secondary objectives reviewed removal rate of patients on active antibiotics, and evaluate how many were switched to β-lactam. Results A total of 492 patients with PCN allergies were interviewed by a pharmacist. Pharmacist de-labeled 99/492 (20%) PCN allergies. Of those patients, 23% were removed through oral challenge and 76% through patient history. There were 175 patients on active antibiotics and 52/175 (30%) had their allergies removed. Finally, 36/52 (69%) were switched to a β-lactam. Conclusion A pharmacist-led penicillin allergy de-labeling project is beneficial in reducing PCN allergies when skin testing is unavailable in community hospitals. As seen about 1 in 5 patients were able to remove their allergy through allergy evaluation or oral challenge. Furthermore, pharmacist evaluation of the allergy not only helped remove the allergy but also resulted in the most appropriate antibiotic. Disclosures All authors: No reported disclosures.

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Coleman, David, Cosby Stone, Wei-Qi Wei, and Elizabeth Phillips. "Readiness for Penicillin Allergy de-labeling: Perception of Allergy Label (PenPAL) Survey." Journal of Allergy and Clinical Immunology 145, no. 2 (February 2020): AB343. http://dx.doi.org/10.1016/j.jaci.2019.12.084.

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Ramsey, Allison, Anne M. Holly, and Mary L. Staicu. "Use of Telemedicine for Penicillin Allergy De-Labeling." Journal of Allergy and Clinical Immunology 141, no. 2 (February 2018): AB33. http://dx.doi.org/10.1016/j.jaci.2017.12.106.

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Gerace, Kali, Li Wang, and Elizabeth J. Phillips. "The Negative Impact of Persistent Penicillin Allergy Labeling." Journal of Allergy and Clinical Immunology 137, no. 2 (February 2016): AB397. http://dx.doi.org/10.1016/j.jaci.2015.12.1231.

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Bourke, Jack, Rebecca Pavlos, Ian James, and Elizabeth Phillips. "Improving the Effectiveness of Penicillin Allergy De-labeling." Journal of Allergy and Clinical Immunology: In Practice 3, no. 3 (May 2015): 365–74. http://dx.doi.org/10.1016/j.jaip.2014.11.002.

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Leone, Marc, Claire Zunino, Vanessa Pauly, Calypso Mathieu, François Antonini, Veronica Orlean, Nadim Cassir, et al. "Beta-lactam allergy labeling in intensive care units." Medicine 100, no. 27 (July 9, 2021): e26494. http://dx.doi.org/10.1097/md.0000000000026494.

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Stankovic, Ivan. "Food allergens: Hypersensitivity to food and food constituents." Veterinarski glasnik 62, no. 5-6 (2008): 341–49. http://dx.doi.org/10.2298/vetgl0806341s.

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Adverse reactions to food which occur only in susceptible individuals may result from true physical hypersensitivity to components of foods or from psychological factors. Non-allergic food hypersensitivity may be due to a metabolic defect in the affected individual, while in food allergy immune mechanism is involved. Food allergy can be further subdivided into IgE-mediated food allergy and non-IgE-mediated food allergy, depending on the underlying allergic mechanism. Most cases of confirmed food allergy involve the production of IgE antibodies and a network of interactions between various cell types and chemical mediators. This type of allergic reaction is known as an IgE-mediated allergy (or a type I hypersensitivity reaction), and it produces immediate symptoms. The most severe form of IgE-mediated allergy is systematic answer known as anaphylaxis that can be fatal in the absence of adequate medical help. Other less severe allergy manifestations are symptoms like swelling, itching, redness and heat in the mouth, gut, skin or respiratory tract. Hypersensitivity to food requires special dietary treatment, but total exclusion of some foods from the diet can be very difficult, because of the wide distribution of some foodstuffs in the diet or their presence as impurities in other foods. It is very important that producers have good systems of control, traceability and labeling of possible presence of food allergens in order to help people with food allergies to conduct their restrictive diets that are in most cases their lifelong treatment.

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Monaci, Linda, Elisabetta De Angelis, Rocco Guagnano, Aristide P. Ganci, Ignazio Garaguso, Alessandro Fiocchi, and Rosa Pilolli. "Validation of a MS Based Proteomics Method for Milk and Egg Quantification in Cookies at the Lowest VITAL Levels: An Alternative to the Use of Precautionary Labeling." Foods 9, no. 10 (October 19, 2020): 1489. http://dx.doi.org/10.3390/foods9101489.

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The prevalence of food allergy has increased over the last decades and consequently the food labeling policies have improved over the time in different countries to regulate allergen presence in foods. In particular, Reg 1169 in EU mandates the labelling of 14 allergens whenever intentionally added to foods, but the inadvertent contamination by allergens still remains an uncovered topic. In order to warn consumers on the risk of cross-contamination occurring in certain categories of foods, a precautionary allergen labelling system has been put in place by food industries on a voluntary basis. In order to reduce the overuse of precautionary allergen labelling (PAL), reference doses and action limits have been proposed by the Voluntary Incidental Trace Allergen Labelling VITAL project representing a guide in this jeopardizing scenario. Development of sensitive and reliable mass spectrometry methods are therefore of paramount importance in this regard to check the contamination levels in foods. In this paper we describe the development of a time-managed multiple reaction monitoring (MRM) method based on a triple quadrupole platform for milk and egg quantification in processed food. The method was in house validated and allowed to achieve levels of proteins lower than 0.2 mg of total milk and egg proteins, respectively, in cookies, challenging the doses recommended by VITAL. The method was finally applied to cookies labeled as milk and egg-free. This method could represent, in perspective, a promising tool to be implemented along the food chain to detect even tiny amounts of allergens contaminating food commodities.

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Dinakar, Chitra. "Updated epinephrine autoinjector labeling." Journal of Allergy and Clinical Immunology: In Practice 4, no. 5 (September 2016): 1020–21. http://dx.doi.org/10.1016/j.jaip.2016.06.008.

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Nehra, Monika, Mariagrazia Lettieri, Neeraj Dilbaghi, Sandeep Kumar, and Giovanna Marrazza. "Nano-Biosensing Platforms for Detection of Cow’s Milk Allergens: An Overview." Sensors 20, no. 1 (December 19, 2019): 32. http://dx.doi.org/10.3390/s20010032.

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Among prevalent food allergies, cow milk allergy (CMA) is most common and may persist throughout the life. The allergic individuals are exposed to a constant threat due to milk proteins’ presence in uncounted food products like yogurt, cheese, and bakery items. The problem can be more severe due to cross-reactivity of the milk allergens in the food products due to homologous milk proteins of diverse species. This problem can be overcome by proper and reliable food labeling in order to ensure the life quality of allergic persons. Therefore, highly sensitive and accurate analytical techniques should be developed to detect the food allergens. Here, significant research advances in biosensors (specifically immunosensors and aptasensors) are reviewed for detection of the milk allergens. Different allergic proteins of cow milk are described here along with the analytical standard methods for their detection. Additionally, the commercial status of biosensors is also discussed in comparison to conventional techniques like enzyme-linked immunosorbent assay (ELISA). The development of novel biosensing mechanisms/kits for milk allergens detection is imperative from the perspective of enforcement of labeling regulations and directives keeping in view the sensitive individuals.

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Myles, Ian A., and Douglas Beakes. "An Allergy to Goldfish? Highlighting Labeling Laws for Food Additives." World Allergy Organization Journal 2, no. 12 (2009): 314–16. http://dx.doi.org/10.1097/wox.0b013e3181c5be33.

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Stein, Amy, Christine MacBrayne, Cheryl Yang, Tara Sarin, Allison Hicks, Justin Searns, Lalit Bajaj, Maureen Egan Bauer, and Kirstin Carel. "Clinical Pathway to Increase Rates of Penicillin Allergy De-labeling." Journal of Allergy and Clinical Immunology 145, no. 2 (February 2020): AB76. http://dx.doi.org/10.1016/j.jaci.2019.12.664.

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Trubiano, Jason A., Susan E. Beekmann, Phillip M. Polgren, Leon J. Worth, M. L. Grayson, and Elizabeth J. Phillips. "Antibiotic Allergy De-Labeling: Teaching an Old Dog New Tricks." Journal of Allergy and Clinical Immunology 137, no. 2 (February 2016): AB398. http://dx.doi.org/10.1016/j.jaci.2015.12.1233.

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Mullur, Jyotsna, and Tanya M. Laidlaw. "Aspirin allergy labeling after desensitization: education, communication, and patient safety." Journal of Allergy and Clinical Immunology: In Practice 8, no. 10 (November 2020): 3629–30. http://dx.doi.org/10.1016/j.jaip.2020.06.018.

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Primhak, Sarah, Natasha Pool, Gayl Humphrey, Lesley Voss, Rachel H. Webb, Elizabeth M. Wilson, Stephen Ritchie, Eamon Duffy, and Emma Best. "1138. Script for Pediatrics: Creating a Smartphone Application to Improve Antimicrobial Prescribing." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S405. http://dx.doi.org/10.1093/ofid/ofz360.1002.

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Abstract Background When considering antimicrobial stewardship (AMS) interventions, pediatrics is an important and often overlooked group. By 5 years of age, 97% of New Zealand (NZ) children have received antibiotics (median 8 antibiotic courses/child). Prescribing is complex due to age and weight-based adjustments, unpalatable oral preparations and inappropriate allergy labeling. Our tertiary Children’s Hospital has >250 web-based nationally utilized guidelines, 15% including antimicrobials. A point prevalence audit showed only 63% guideline adherence for inpatient antimicrobial prescriptions. We designed an accessible app to bring antibiotic prescribing and antibiotic allergy decision-making to prescribers at point of care. Methods Using local hospital and community guidelines, the national formulary and in consultation with subspecialist teams, 31 algorithms were developed. Each algorithm asked questions including diagnosis, age, antibiotic allergy history and known colonization with-resistant organisms. Results The smartphone app (Script) uses the algorithms to advise on appropriate antimicrobial, dose, route and duration of treatment. Advice regarding IV-oral switch parameters and oral antibiotic choice is provided. If allergy is suspected symptom-based decision-making enables the user to choose an alternative agent or encourages allergy de-labeling. Further AMS occurs in some algorithms when advice is given not to prescribe antimicrobials. Conclusion Script for Pediatrics launched in NZ in March 2019 with >1000 users in the first 6 weeks. The most frequently accessed guidelines are otitis media, pneumonia and meningitis. Smartphone applications with local relevance and the ability to update in real-time may prove important tools, by providing easily accessible and intuitive advice to help support antimicrobial stewardship activities. This intervention has been rapidly adopted by pediatric hospital prescribers. The impact on prescribing in concordance with guidelines, timely intravenous to oral antibiotic switch and allergy de-labeling will be assessed. Disclosures All authors: No reported disclosures.

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Boo, Chelsea C., Christine H. Parker, and Lauren S. Jackson. "A Targeted LC-MS/MS Method for the Simultaneous Detection and Quantitation of Egg, Milk, and Peanut Allergens in Sugar Cookies." Journal of AOAC INTERNATIONAL 101, no. 1 (January 1, 2018): 108–17. http://dx.doi.org/10.5740/jaoacint.17-0400.

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Abstract Food allergy is a growing public health concern, with many individuals reporting allergies to multiple food sources. Compliance with food labeling regulations and prevention of inadvertent cross-contact in manufacturing requires the use of reliable methods for the detection and quantitation of allergens in processed foods. In this work, a novel liquid chromatography-tandem mass spectrometry multiple-reaction monitoring method for multiallergen detection and quantitation of egg, milk, and peanut was developed and evaluated in an allergen-incurred baked sugar cookie matrix. A systematic evaluation of method parameters, including sample extraction, concentration, and digestion, were optimized for candidate allergen peptide markers. The optimized method enabled the reliable detection and quantitation of egg, milk, and peanut allergens in sugar cookies, with allergen concentrations as low as 5 ppm allergen-incurred ingredient.

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SHETH, S., S. WASERMAN, R. KAGAN, R. ALIZADEHFAR, M. PRIMEAU, S. ELLIOT, Y. STPIERRE, E. TURNBULL, R. WICKETT, and L. JOSEPH. "Improving Food Labeling for the Allergic Consumer." Journal of Allergy and Clinical Immunology 121, no. 2 (February 2008): S183. http://dx.doi.org/10.1016/j.jaci.2007.12.676.

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Choi, Ki-Bo, Hye-Joo Kim, and Eun-Soon Lyu. "Status of Food Allergy and Perception on Food Allergen Labeling System among Middle and High School Students with Food Allergy in Busan." Korean Journal of Food and Cookery Science 36, no. 01 (February 28, 2020): 93–100. http://dx.doi.org/10.9724/kfcs.2020.36.1.93.

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Lee, Ah-Hyun, Kyu-Earn Kim, Kyung-Eun Lee, Seong-Hui Kim, Tae-Whan Wang, Kyung Won Kim, and Tong-Kyung Kwak. "Prevalence of food allergy and perceptions on food allergen labeling in school foodservice among Korean students." Allergy Asthma & Respiratory Disease 1, no. 3 (2013): 227. http://dx.doi.org/10.4168/aard.2013.1.3.227.

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Hornak, Joseph Patrik, and David Reynoso. "44. Antibiotic Class-Based Distribution and Analysis of Reported Beta-Lactam Allergies amongst Hospitalized Patients." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S45. http://dx.doi.org/10.1093/ofid/ofaa439.089.

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Abstract Background Reported β-lactam allergy (BLA) is very common, yet less than 10% of these patients exhibit true hypersensitivity. When faced with reported BLAs, physicians often choose alternative antibiotics which can be associated with C. difficile infection, drug-resistance development, poorer outcomes, & increased costs. Effective identification of these patients is necessary for subsequent, appropriate BLA “de-labeling.” Here, we conducted a single-center analysis of alternative antibiotic utilization amongst patients reporting BLA and compare the frequency of drug-resistant infections and C. difficile infection in allergic & non-allergic patients. Methods This is a retrospective review of adult patients hospitalized at The University of Texas Medical Branch from 1/1/2015 to 12/31/2019. Pooled electronic medical records were filtered by antibiotic orders and reported allergies to penicillins or cephalosporins. Patients with drug-resistant and/or C. difficile infection (CDI) were identified by ICD-10 codes. Microsoft Excel & MedCalc were used for statistical calculations. Results Data were available for 118,326 patients and 9.3% (11,982) reported a BLA, with the highest rates seen in those receiving aztreonam (85.9%, 530/617) & clindamycin (33.7%, 3949/11718). Amongst patients reporting BLA, high ratios-of-consumption (relative to all patients receiving antibiotics) were seen with aztreonam (7.0), clindamycin (2.7), cephalosporin/β-lactamase inhibitors (2.4), & daptomycin (2.1). Compared to the non-BLA population, BLA patients more frequently experienced MRSA infection (3.0% vs 1.5%, OR 1.99, 95% CI 1.79–2.23, p< 0.0001), β-lactam resistance (1.2% vs 0.6%, OR 2.07, 95% CI 1.72–2.49, p< 0.0001), and CDI (1.2% vs 0.7%, OR 1.85, 95% CI 1.54–2.23, p< 0.0001). Conclusion Our measured BLA rate matches approximate expectations near 10%. Moreover, these patients experienced significantly higher frequencies of drug-resistant bacterial infections and CDI. Targeted inpatient penicillin allergy testing stands to be particularly effective in those patients receiving disproportionately utilized alternative agents (e.g. aztreonam, clindamycin, daptomycin). β-lactam allergy “de-labeling” in these patients is likely a valuable antimicrobial stewardship target. Disclosures All Authors: No reported disclosures

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Altschul, Aimee S., Debbie L. Scherrer, Anne Muñoz-Furlong, and Scott H. Sicherer. "Manufacturing and labeling issues for commercial products: Relevance to food allergy." Journal of Allergy and Clinical Immunology 108, no. 3 (September 2001): 468. http://dx.doi.org/10.1067/mai.2001.117794.

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Castells, Mariana C. "Drug allergy labeling and delabeling in the coronavirus disease 2019 era." Annals of Allergy, Asthma & Immunology 124, no. 6 (June 2020): 523–25. http://dx.doi.org/10.1016/j.anai.2020.04.012.

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-Amigo, Carmen Diaz, and Bert Popping. "Labeling Regulations, Detection Methods, and Assay Validation." Journal of AOAC INTERNATIONAL 95, no. 2 (March 1, 2012): 337–48. http://dx.doi.org/10.5740/jaoacint.sge_diaz-amigo.

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Abstract Gluten is a commonly used cereal derivative found in bakery products, among other items. In some susceptible individuals, however, it triggers immune responses of different kinds; there is, to a lesser extent, the wheat allergy that is immunoglobulin E (IgE)-mediated and leads to histamine release and typical allergic symptoms. In this case, other water-soluble proteins, like albumins, are also involved. On the other hand, there is, more frequently, celiac disease (CD), where the gluten causes immune reactions in the intestines of certain individuals, leading to degeneration of villi, which typically leads to malabsorption of nutrients and, consequently, malnutrition. The only currently effective health strategy for affected consumers is avoidance of gluten-containing products, based on clear labeling rules. However, despite unanimously accepted Codex definitions by all member jurisdictions, the national implementation of equivalent laws shows significant differences. In the context of CD and in support of the gluten-free statement, regulatory enforcement, as well as manufacturers' quality controls are mostly based on analytical results. However, numerous methods are available, some of which have been validated better than others, and many provide different results on identical samples. Reasons include detection of different gluten components and variability in extraction efficiency due to different buffer compositions, especially from processed foods. Last but not least, the lack of reference materials is hindering the process of generating comparable data across different ELISA kits, as well as other methods. How can such data still be used to support a gluten-free claim? New methodologies, in particular mass spectrometric analysis of gluten derived peptides, are being introduced in numerous laboratories. This methodology is not only capable of detecting gluten derived peptides but can also differentiate between and quantitate wheat, barley, rye, and oat. This paper presents analytical limitations, as well as promising new approaches in support of industry and enforcement activities to ensure compliance with the gluten-free claim under the current regulatory framework.

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Chersi, Alberto, Maria Luisa Trinca, and Matilde Camera. "14C-labeling of synthetic peptides." Journal of Immunological Methods 110, no. 2 (June 1988): 271–73. http://dx.doi.org/10.1016/0022-1759(88)90114-7.

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Chen, Xiaoxu, Yuekun Wu, Yaozhong Hu, Yan Zhang, and Shuo Wang. "Lactobacillus rhamnosus GG Reduces β-conglycinin-Allergy-Induced Apoptotic Cells by Regulating Bacteroides and Bile Secretion Pathway in Intestinal Contents of BALB/c Mice." Nutrients 13, no. 1 (December 27, 2020): 55. http://dx.doi.org/10.3390/nu13010055.

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Allergy can cause intestinal damage, including through cell apoptosis. In this study, intestinal cell apoptosis was first observed in the β-conglycinin (β-CG) allergy model, and the effect of Lactobacillus rhamnosus GG (LGG) on reducing apoptosis of cells in the intestine and its underlying mechanisms were further investigated. Allergic mice received oral LGG daily, and intestinal tissue apoptotic cells, gut microbiota, and metabolites were evaluated six and nine days after intervention. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) analysis revealed that LGG intervention could reduce the incidence of cell apoptosis more effectively than natural recovery (NR). The results of 16S rRNA analysis indicated that LGG intervention led to an increase in the relative abundance of Bacteroides. Metabolite analysis of intestinal contents indicated that histamine, N-acetylhistamine, N(α)-γ-glutamylhistamine, phenylalanine, tryptophan, arachidonic acid malate, and xanthine were significantly decreased, and deoxycholic acid, lithocholic acid were significantly increased after the LGG intervention on β-CG allergy; the decreases in histamine and N(α)-γ-glutamylhistamine were significant compared with those of NR. In conclusion, LGG reduces apoptosis of cells induced by β-CG allergy, which may be related to regulation of Bacteroides and the bile secretion pathway.

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Taylor, Steve L., and Sue L. Hefle. "Food allergen labeling in the USA and Europe." Current Opinion in Allergy and Clinical Immunology 6, no. 3 (June 2006): 186–90. http://dx.doi.org/10.1097/01.all.0000225158.75521.ad.

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Allgöwer, Stefanie M., Chris A. Hartmann, Clarissa Lipinski, Vera Mahler, Stefanie Randow, Elke Völker, and Thomas Holzhauser. "LAMP-LFD Based on Isothermal Amplification of Multicopy Gene ORF160b: Applicability for Highly Sensitive Low-Tech Screening of Allergenic Soybean (Glycine max) in Food." Foods 9, no. 12 (November 26, 2020): 1741. http://dx.doi.org/10.3390/foods9121741.

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Soybean (Glycine max) allergy can be life threatening. A lack of causative immunotherapy of soybean allergy makes soybean avoidance indispensable. Detection methods are essential to verify allergen labeling and unintentional allergen cross contact during food manufacture. Here, we aimed at evaluating our previously described primers for loop-mediated isothermal amplification (LAMP) of multicopy gene ORF160b, combined with a lateral flow dipstick (LFD)-like detection, for their performance of soybean detection in complex food matrices. The results were compared with those obtained using quantitative real-time Polymerase Chain Reaction (qPCR) as the current standard of DNA-based allergen detection, and antibody-based commercial lateral flow device (LFD) as the current reference of protein-based rapid allergen detection. LAMP-LFD allowed unequivocal and reproducible detection of 10 mg/kg soybean incurred in three representative matrices (boiled sausage, chocolate, instant tomato soup), while clear visibility of positive test lines of two commercial LFD tests was between 10 and 102 mg/kg and depending on the matrix. Sensitivity of soybean detection in incurred food matrices, commercial retail samples, as well as various processed soybean products was comparable between LAMP-LFD and qPCR. The DNA-based LAMP-LFD proved to be a simple and low-technology soybean detection tool, showing sensitivity and specificity that is comparable or superior to the investigated commercial protein-based LFD.

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Zurzolo, Giovanni A., Jennifer J. Koplin, Michael L. Mathai, Steve L. Taylor, Dean Tey, and Katrina J. Allen. "Foods with precautionary allergen labeling in Australia rarely contain detectable allergen." Journal of Allergy and Clinical Immunology: In Practice 1, no. 4 (July 2013): 401–3. http://dx.doi.org/10.1016/j.jaip.2013.03.002.

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MARUI, Eiji. "The Roles of Food Labeling and Risk Communication in Food Allergy Control." Food Hygiene and Safety Science (Shokuhin Eiseigaku Zasshi) 51, no. 6 (2010): 393–95. http://dx.doi.org/10.3358/shokueishi.51.393.

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Choi, Yongmi, Seyoung Ju, and Hyeja Chang. "Food allergy knowledge, perception of food allergy labeling, and level of dietary practice: A comparison between children with and without food allergy experience." Nutrition Research and Practice 9, no. 1 (2015): 92. http://dx.doi.org/10.4162/nrp.2015.9.1.92.

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Lee, Eun-Joo, and Ho Kyung Ryu. "A Study on Food Allergy Occurrence and Parental Perceptions of Food Allergen Labeling System in School Food Service." Korean Journal of Community Living Science 27, no. 3 (August 31, 2016): 521–31. http://dx.doi.org/10.7856/kjcls.2016.27.3.521.

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AHN, S., T. FURLONG, C. WEISS, and S. SICHERER. "Consumer Attitudes and Response to New Food Allergen Labeling." Journal of Allergy and Clinical Immunology 121, no. 2 (February 2008): S182. http://dx.doi.org/10.1016/j.jaci.2007.12.674.

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Simons, E., C. Weiss, T. Furlong, and S. H. Sicherer. "Impact of ingredient labeling practices for food-allergic consumers." Journal of Allergy and Clinical Immunology 115, no. 2 (February 2005): S243. http://dx.doi.org/10.1016/j.jaci.2004.12.979.

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