• W Marty Blom, Anouska D Michelsen-Huisman, Harmieke van Os-Medendorp, Gert van Duijn, Mary-Lène de Zeeuw-Brouwer, Astrid Versluis, Jacqueline J M Castenmiller, Hubert P J M Noteborn, Astrid G Kruizinga, André C Knulst, and Geert F Houben.
• Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands; Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. Electronic address: marty.blom@tno.nl.
• J. Allergy Clin. Immunol. 2018 Sep 1; 142 (3): 865-875.

BackgroundAccidental allergic reactions to food are frequent and can be severe and even fatal.ObjectiveWe sought to analyze the culprit food products and levels of unexpected allergens in accidental reactions.MethodsA prospective cohort study was conducted in adults (n = 157) with a physician-confirmed diagnosis of food allergy. During a 1-year follow-up, 73 patients reported accidental allergic reactions and the culprit food products. Food samples received (n = 51) were analyzed for a wide range of suspected noningredient allergens, and risk was quantified.ResultsA very diverse range of food products was responsible for the unexpected allergic reactions. Thirty-seven percent (19/51) of products analyzed had 1 to 4 culprit allergens identified that were not supposed to be present according to the ingredient declaration. Concentrations varied from 1 to 5000 mg of protein of the allergenic food per kilogram of food product and were greatest for peanut, milk, and sesame. Milk proteins posed the highest estimated risk for objective allergic reactions. The intake of culprit allergens by patients varied considerably. For those cases in which culprit allergens were detected, the intake of at least 1 allergen exceeded the reference dose or a culprit allergen with a yet unknown reference dose was present. Both patient neglect of precautionary allergen labeling statements and omission of using a precautionary allergen labeling statement by food manufacturers seem to contribute to accidental reactions.ConclusionA wide range of food products are causing accidental reactions in patients with food allergy. Eight different allergens not declared on the ingredient lists were detected in the culprit food products, all of which were representative of allergens regulated in the European Union.Copyright © 2018 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

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