‘Significant variability’ exists in some early allergen introduction foods
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There is “significant variability” in allergen composition, concentration and dose per serving among commercially available early allergen introduction foods, an expert told Healio Primary Care.
The research was part of an online supplement to The Journal of Allergy and Clinical Immunology, published Feb. 1. The data are were also presented during the virtual American Academy of Allergy, Asthma and Immunology Annual Meeting.
“The rapid commercialization of [early allergen introduction foods (EIF)] has provided consumers and allergic families with a choice of EIF as aids for allergy prevention, which has several consequences,” Martin Chapman, BSc, PhD, president and CEO of INDOOR Biotechnologies, told Healio Primary Care. “The foods may be perceived as drugs or over-the-counter treatments and to have similar efficacy. Consumers may also consider them to be equally effective for different allergens.”
Chapman and Stephanie Filep, BS, director of laboratory services at INDOOR Biotechnologies, analyzed 86 extracts from 32 EIFs and four control foods. They used a “validated” fluorescent multiplex array to look for Ana o 3, Api g 1, Arah 1, Arah 3, Arah 6, Bos d 5, Bos d 11, Cor a 9, Cyp c 1, Gal d 1, Gal d 2, Gly m 5, Jug r 1, Ses I 1, Sin a 1, shrimp tropomyosin and Tri a 19 allergens.
“The individual allergens were selected because more than 50% of allergic patients react to these allergens by producing allergic (IgE) antibodies,” Chapman explained.
Chapman and Filep found that combined peanut allergen levels up to 24,061 g/g were measured in peanut puffs (doses of 56 mg-168 mg for each 7 g serving). Peanut allergens were “undetectable” in mixed food blend puffs. “Major” allergen levels above 10,000 g/g were identified in several milk, egg and peanut powders, with cumulative allergen doses of 147 mg-2,811 mg. Mixed food blend crackers, fruit sauces, puffs and powders had lower allergen levels — fewer than 10 g/g — and some had undetectable allergens. The researchers also reported that the allergen concentration in these EIFs varied over a three or greater log range and “provided lower cumulative doses of allergen” of fewer than 20 mg.
Chapman said the results were “not too surprising, given the challenges of formulating food products.” He encouraged health care providers to take the findings into consideration when choosing EIF products for themselves or their patients.
“Establishing guidelines for EIF would aid health care providers in determining the best treatment plan for their patients,” he added.
Perspective
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In this abstract, Filep and Chapman tested for some of the known major allergen components for peanuts, tree nuts, milk, egg, wheat, soy and shrimp and suggested there is major allergen variability in some EIF. This abstract is interesting because there is a lack of readily available information about allergen concentration in foods being commercially marketed as EIF. Therefore, their study raises an important issue of allergen variability in some EIF.
In the 2000s, physicians were encouraged to delay the introduction of highly allergenic foods. We now know that early introduction is better to try to prevent food allergies, especially in high-risk infants, based on the Learning Early About Peanut (LEAP) study in 2015. However, recent findings suggest that only 30% of pediatricians follow guidelines for early introduction of peanut. As physicians, we should make sure we discuss early introduction of foods with our patients and their parents, incorporate it as an important agenda item during visits and integrate these discussions into our clinical workflow. We should also caution patients and parents about the large allergen variability that may exist in some commercially available EIF and counsel them to use more “natural” or “less processed” versions of major allergen food sources.
I agree with Filep and Chapman’s conclusion, which states there should be guidelines and standardization of formulas for early introduction food products so that health care providers and consumers can make informed decisions. It is important that we know the specific concentrations of the allergen components, since previous studies have shown not all allergen components are created equal in their impact on patients.
For more information: Food Allergy Research and Education (FARE). How to safely introduce peanut foods to children. https://www.babysfirst.org/introducing-peanut-foods-babies.
Reference: Gupta RS, et al. JAMA Network Open. 2020;doi:10.1001/jamanetworkopen.2020.10511.
Associate physician, Brigham and Womens Hospital
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