D2.271 - The non-mandatory food allergens that we should not sweep under the rug: data from the Allergy-Vigilance Network

The list of mandatory food allergens provided by the European Regulation includes 14 allergens but other foods are often involved in food-induced anaphylaxis (FIA). Our aim was to determine the main food allergens triggering FIA and their features, besides those already included in the mandatory food labelling.

We analysed FIA cases triggered by food allergens involved in 1% or more of all food anaphylaxis cases that do not belong to the mandatory food labelling (FA-1%), and reported by the Allergy-Vigilance Network from 2002 to 2023.

Of the 2999 FIA cases declared from 2002 to 2023, 413 (13.8%) FIA were triggered by one FA-1%: goat's/sheep's milk (GSM) (n=84; 2.8%), buckwheat (n=71; 2.4%), pea and/or lentil (n=55; 1.8%), alpha-gal (n=50; 1.7%), pine nut (n=49; 1.6%), kiwi (n=44; 1.5%), beehive products and apple (n=30; 1.0%, each). Buckwheat, alpha-gal, beehive products and apple-induced anaphylaxis were more likely to occur in adults (median age, year [IQR]: 30 [2-77], 50 [10-81], 35 [10-64] and 25 [4-61], respectively) than the other FA-1%. GSM, buckwheat, alpha-gal, pine nut and kiwi were frequently involved in severe anaphylaxis (grade 3/grade 4 according to Ring classification modified by Behrendt in 45.9%/4.7%, 46.5%/1.4%, 54.0%/8%, 49.0%/0, and 51.0%/0, respectively). Among FA-1%, GSM and buckwheat were the two most frequent food allergens associated with a high rate of anaphylaxis recurrence (34.5% and 21.0%, respectively) and a hidden consumption (15.5% and 16.9%, respectively).

Eight food allergens, involved in 1% or more of food induced anaphylaxis, need to be highlighted because of their frequency and potential severity. GSM, buckwheat, pine nut, pea and lentil, taken together, are responsible for nearly 1 in 10 cases of food anaphylaxis; and therefore should be added to the list of priority food allergens in Europe.