TOPLINE:

Several allergenic plant foods not required to carry allergen labeling in Europe — particularly certain seeds and legumes — often triggered severe allergic reactions, including anaphylaxis.

METHODOLOGY:

• Researchers used real-world data to assess how often and how severely people reacted to allergenic foods not requiring mandatory labeling in Europe.
• They reviewed reactions to allergenic foods not requiring mandatory labeling in 533 people; of these, 57.2% were adults, and 51% were female individuals.
• A total of 11 food items across four groups were examined: five legumes, four seeds, buckwheat, and beehive products.
• The severity of the reaction was assessed using the numerical Food Allergy Severity Score (nFASS), and anaphylaxis was verified using standard criteria; these reactions were compared with reactions to allergens with mandatory labeling.

TAKEAWAY:

• A total of 589 reactions to nonmandatory labeled allergenic foods were recorded, accounting for 4.4% of all food-induced reactions. Sunflower seeds and lentils were the top allergy triggers, and 68.5%-86.7% of reactions across the four food groups were anaphylaxis.
• Reactions to pumpkin seeds were more severe than those to sunflower seeds (median nFASS, 4.77 vs 4.10) or poppy seeds (median nFASS, 4.77 vs 3.44; P < .05 for both). Reactions to pine nuts were more severe than those to poppy seeds (P < .01).
• Reactions induced by peas and fenugreek were more severe than those induced by lentils (P < .05 for both). Mandatory labeled legumes and cereals induced more severe reactions than nonmandatory labeled groups (P < .05 for both).
• The severity of seed reactions did not differ by labeling, and the severity of legume reactions did not differ once peanut was excluded. Reports on fenugreek and pumpkin seed reactions increased over time.

IN PRACTICE:

“These findings highlight the need for further evaluation and suggest placing such foods on a Europe-wide watch list to enable structured monitoring of prevalence, severity, and potency, as proposed by the recent FAO-WHO [Food and Agriculture Organization-World Health Organization] expert consultation. This would pave the way for evidence-based inclusion in mandatory allergen labeling,” the authors of the study wrote.

SOURCE:

The study was jointly led by Sabine Dölle-Bierke, PhD, of Universitätsmedizin Berlin in Berlin and Alejandro Gonzalo-Fernandez of Grupo de Investigación en Alergia, IdISSC, Madrid, Spain. It was published online on March 23 in Allergy.

LIMITATIONS:

Severity was graded using past reports and may have introduced recall and information bias. Data came only from voluntary allergy centers, likely missing milder cases or those outside clinic. The included studies used different methods and were not population-based, limiting comparability.

DISCLOSURES:

The Anaphylaxis Registry received support from the Network for Online Registration of Anaphylaxis NORA e.V. Two integrated projects received funding from the European Commission. Some authors reported receiving research funding from public and nonprofit sources and from institutional grants. Several authors reported receiving honoraria, speaker/lectures fees, or consultancy fees and serving in advisory board roles from pharmaceutical, diagnostic, and biotechnology companies. One author reported shareholdings in a healthcare company. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.