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Proposal of 0.5 mg ...
Proposal of 0.5 mg of protein/100 g of processed food as threshold for voluntary declaration of food allergen traces in processed food-A first step in an initiative to better inform patients and avoid fatal allergic reactions: A GA(2)LEN position paper
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- Zuberbier, T. (author)
- Charite Univ Med Berlin, Dept Dermatol & Allergy, Berlin, Germany.;Humboldt Univ, Berlin, Germany.;Berlin Inst Hlth, Comprehens Allergy Ctr, Berlin, Germany
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- Dorr, T. (author)
- Charite Univ Med Berlin, Dept Dermatol & Allergy, Berlin, Germany.;Humboldt Univ, Berlin, Germany.;Berlin Inst Hlth, Comprehens Allergy Ctr, Berlin, Germany
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- Aberer, W. (author)
- Med Univ Graz, Dept Dermatol, Graz, Austria
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show more...
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- Alvaro, M. (author)
- Hosp St Joan de Deu, Serv Allergol Immunol Clin, Barcelona, Spain
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- Angier, E. (author)
- Univ Southampton, Fac Med, Primary Care Populat Sci & Med Educ, Southampton, Hants, England
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- Arasi, S. (author)
- Bambino Gesu Hosp IRCCS, Pediat Allergol Unit, Rome, Italy
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- Arshad, H. (author)
- Univ Hosp Southampton NHS Fdn Trust, NIHR Southampton Biomed Res Ctr, Southampton, Hants, England.;Univ Southampton, Fac Med, Clin & Expt Sci, Southampton, Hants, England.;St Marys Hosp, David Hide Asthma & Allergy Res Ctr, Newport, Wight, England
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- Ballmer-Weber, B. (author)
- Univ Hosp Zurich, Dept Dermatol, Zurich, Switzerland.;Kantonsspital St Gallen, Clin Dermatol & Allergol, St Gallen, Switzerland
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- Bartra, J. (author)
- Hosp Clin Barcelona, Serv Neumol & Allergia Resp, Unitat Allergia, Barcelona, Spain.;Inst Invest Biomed August Pi & Sunyer IDIBAPS, Barcelona, Spain
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- Beck, L. (author)
- Univ Rochester, Dept Dermatol, Med Ctr, New York, NY USA
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- Begin, P. (author)
- CHU St Justine, Montreal, PQ, Canada
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- Janson, Christer (author)
- Uppsala universitet,Lung- allergi- och sömnforskning,Klinisk fysiologi
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- Bislimovska, J. (author)
- Ss Cyril & Methodius Univ Skopje, Fac Med, WHO Collaborating Ctr, Inst Occupat Hlth RNM, Skopje, North Macedonia
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- Bousquet, J. (author)
- Charite Univ Med Berlin, Dept Dermatol & Allergy, Berlin, Germany.;Humboldt Univ, Berlin, Germany.;Berlin Inst Hlth, Comprehens Allergy Ctr, Berlin, Germany.;Univ Hosp Montpellier, Montpellier, France.;MACVIA France, Montpellier, France
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- Brockow, K. (author)
- Tech Univ Munich, Sch Med, Dept Dermatol & Allergy Biederstein, Munich, Germany
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- Bush, A. (author)
- Imperial Coll, London, England.;Royal Brompton Hosp, London, England
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- Cianferoni, A. (author)
- Univ Penn, Dept Pediat, Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA
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- Cork, M. J. (author)
- Univ Sheffield, Sheffield, S Yorkshire, England,European Acad Allergy & Clin Immunol, Zurich, Switzerland,Helsinki Univ Hosp, Skin & Allergy Hosp, Helsinki, Finland.;Univ Helsinki, Helsinki, Finland,Natl & Kapodistrian Univ Athens, Attikon Univ Hosp, Dept Dermatol & Venereol 2, Allergy Unit, Athens, Greece,Charite Univ Med Berlin, Dept Dermatol & Allergy, Berlin, Germany.;Humboldt Univ, Berlin, Germany.;Berlin Inst Hlth, Comprehens Allergy Ctr, Berlin, Germany,Ss Cyril & Methodius Univ Skopje, Fac Med, WHO Collaborating Ctr, Inst Occupat Hlth RNM, Skopje, North Macedonia,Univ Barcelona, Hosp Clin, ENT Dept, Rhinol Unit,CIBERES, Barcelona, Catalonia, Spain.;Univ Barcelona, CIBERES, IDIBAPS, Smell Clin,ENT Dept,Hosp Clin, Barcelona, Catalonia, Spain
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- Custovic, A. (author)
- Imperial Coll London, Natl Heart & Lung Inst, London, England
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- Darsow, U. (author)
- Tech Univ Munich, Sch Med, Dept Dermatol & Allergy Biederstein, Munich, Germany
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- Jong, N. (author)
- Erasmus MC, Sect Allergol & Clin Immunol, Dept Internal Med, Rotterdam, Netherlands
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- Deleanu, D. (author)
- Univ Med & Pharm Iuliu Hatieganu, Allergy, IRGH, Cluj Napoca, Romania
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- Del Giacco, S. (author)
- Univ Cagliari, Dept Med Sci & Publ Hlth, Cagliari, Italy,Ss Cyril & Methodius Univ Skopje, Fac Med, WHO Collaborating Ctr, Inst Occupat Hlth RNM, Skopje, North Macedonia
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- Deschildre, A. (author)
- Univ Lille, CHU Lille, Lille, France.;Hop Jeanne de Flandre, Pediat Pulmonol & Allergy Unit, Lille, France
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- Galvin, A. D. (author)
- Univ Coll Cork, Cork, Ireland.;Sechenov Univ Moscow, Moscow, Russia.;Anaphylaxis Ireland, Cork, Ireland
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- Ebisawa, M. (author)
- Natl Hosp Org Sagamihara Natl Hosp, Clin Res Ctr Allergy & Rheumatol, Sagamihara, Kanagawa, Japan
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- Fernandez-Rivas, M. (author)
- Univ Complutense UCM, Hosp Clin San Carlos, Fac Med, Allergy Dept,IdISSC, Madrid, Spain
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- Ferrer, M. (author)
- Clin Univ Navarra, Dept Allergy, Pamplona, Spain
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- Fiocchi, A. (author)
- Bambino Gesu Hosp IRCCS, Pediat Allergol Unit, Rome, Italy
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- van Wijk, R. G. (author)
- Erasmus MC, Sect Allergol & Clin Immunol, Dept Internal Med, Rotterdam, Netherlands,Univ Bologna, Dept Med & Surg Sci, Pediat Unit, Bologna, Italy,Univ Amsterdam, Acad Med Ctr, Dept Expt Immunol, Amsterdam, Netherlands.;Univ Amsterdam, Acad Med Ctr, Dept Otorhinolaryngol, Amsterdam, Netherlands
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- Gotua, M. (author)
- Ctr Allergy & Immunol, Tbilisi, Georgia
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- Grimshaw, K. (author)
- Salford Royal Fdn Trust, Dietet Dept, Salford Care Org, Salford, Lancs, England
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- Grunhagen, J. (author)
- Charite Univ Med Berlin, Dept Dermatol & Allergy, Berlin, Germany.;Humboldt Univ, Berlin, Germany.;Berlin Inst Hlth, Comprehens Allergy Ctr, Berlin, Germany
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- Heffler, E. (author)
- IRCCS Humanitas Res Hosp, Personalized Med Asthma & Allergy, Rozzano, MI, Italy.;Humanitas Univ, Dept Biomed Sci, Pieve Emanuele, MI, Italy
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- Hide, M. (author)
- Hiroshima Citizens Hosp, Dept Dermatol, Hiroshima, Japan
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- Hoffmann-Sommergruber, K. (author)
- Med Univ Vienna, Dept Pathophysiol & Allergy Res, Vienna, Austria
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- Incorvaia, C. (author)
- ASST Pini CTO, Cardiac Pulm Rehabil, Milan, Italy
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Janson, C. (author)
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- John, S. M. (author)
- Univ Osnabrueck, Dept Dermatol Environm Med Hlth Theory, Osnabruck, Germany.;Univ Osnabrueck, Inst Interdisciplinary Dermatol Prevent & Rehabil, Osnabruck, Germany
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Jones, C. (author)
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Jutel, M. (author)
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- Katoh, N. (author)
- Kyoto Prefectural Univ Med, Dept Dermatol, Kyoto, Japan
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- Kendziora, B. (author)
- Ludwig Maximilians Univ Munchen, Dept Dermatol & Allergy, Univ Hosp, Munich, Germany
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- Kinaciyan, T. (author)
- Med Univ Vienna, Dept Dermatol, Vienna, Austria
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- Knol, E. (author)
- Univ Med Ctr Utrecht, Dept Dermatol & Allergol, Utrecht, Netherlands.;Univ Med Ctr Utrecht, Lab Translat Immunol, Utrecht, Netherlands
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- Kurbacheva, O. (author)
- NRC Inst Immunol FMBA, Moscow, Russia
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- Lau, S. (author)
- Charite Univ Med Berlin, Pediat Resp Med Immunol & Crit Care Med, Berlin, Germany
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- Loh, R. (author)
- Univ Western Australia, Perth Childrens Hosp, Dept Immunol, Perth, WA, Australia
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- Lombardi, C. (author)
- Ente Osped Fdn Poliambulanza, Unita Dipartimentale Allergol Immunol Clin & Mala, Brescia, Italy
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- Makela, M. (author)
- Asthma & Allergy Assoc, Stockholm, Sweden
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- Marchisotto, M. J. (author)
- MJM Advisory, New York, NY USA.;Univ Michigan Med, Mary H Weiser Food Allergy Ctr, Ann Arbor, MI USA
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Makris, M. (author)
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Maurer, M. (author)
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- Meyer, R. (author)
- Imperial Coll, Dept Paediat, London, England
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- Mijakoski, D. (author)
- Ss Cyril & Methodius Univ Skopje, Fac Med, WHO Collaborating Ctr, Inst Occupat Hlth RNM, Skopje, North Macedonia
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Minov, J. (author)
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Mullol, J. (author)
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- Nilsson, C. (author)
- Karolinska Institutet
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- Nowak-Wegrzyn, A. (author)
- Icahn Sch Med Mt Sinai, Div Allergy & Immunol, Dept Pediat, Jaffe Food Allergy Inst,Kravis Childrens Hosp, New York, NY 10029 USA
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- Nwaru, Bright I, 1978 (author)
- Gothenburg University,Göteborgs universitet,Krefting Research Centre,Institutionen för medicin,Institute of Medicine,Univ Gothenburg, Krefting Res Ctr, Inst Med, Gothenburg, Sweden
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Odemyr, M. (author)
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- Pajno, G. B. (author)
- Univ Messina, Pediat Unit, Policlin Hospitsl, Messina, Italy
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- Paudel, S. (author)
- Civil Serv Hosp, Kathmandu, Nepal
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- Papadopoulos, N. G. (author)
- Univ Athens, Allergy Dept, Pediat Clin 2, Athens, Greece
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- Renz, H. (author)
- Philipps Univ Marburg, Inst Lab Med & Pathobiochem, Univ Hosp Giessen & Marburg, Mol Diagnost, Marburg, Germany.;Sechenov Univ, Dept Clin Immunol & Allergol, Lab Immunopathol, Moscow, Russia
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Ricci, G. (author)
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- Ring, J. (author)
- Tech Univ Munich, Sch Med, Dept Dermatol & Allergy Biederstein, Munich, Germany.;Christine K Hne Ctr Allergy Res & Educ CK Care, Davos, Switzerland
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- Rogala, B. (author)
- Univ Silesia, Dept Internal Dis Allergol & Clin Immunol Med, Katowice, Poland
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- Sampson, H. (author)
- Elliot & Roslyn Jaffe Food Allergy Inst, New York, NY USA.;Kravis Childrens Hosp, Div Allergy & Immunol, New York, NY USA.;Icahn Sch Med Mt Sinai, Dept Pediat, New York, NY 10029 USA
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- Senna, G. (author)
- Verona Univ & Gen Hosp, Asthma Ctr & Allergy Unit, Verona, Italy
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- Sitkauskiene, B. (author)
- Lithuanian Univ Hlth Sci, Dept Immunol & Allergol, Kaunas, Lithuania
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- Smith, P. K. (author)
- Griffith Univ, Southport, Qld, Australia
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- Stevanovic, K. (author)
- Charite Univ Med Berlin, Dept Dermatol & Allergy, Berlin, Germany.;Humboldt Univ, Berlin, Germany.;Berlin Inst Hlth, Comprehens Allergy Ctr, Berlin, Germany
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Stoleski, S. (author)
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- Szajewska, H. (author)
- Med Univ Warsaw, Dept Paediat, Warsaw, Poland
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- Tanaka, A. (author)
- Hiroshima Univ, Grad Sch Biomed & Hlth Sci, Dept Dermatol, Hiroshima, Japan
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- Todo-Bom, A. (author)
- Ctr Hosp & Univ Coimbra, Allergy & Clin Immunol Unit, Coimbra, Portugal
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- Topal, F. A. (author)
- Charite Univ Med Berlin, Dept Dermatol & Allergy, Berlin, Germany.;Humboldt Univ, Berlin, Germany.;Berlin Inst Hlth, Comprehens Allergy Ctr, Berlin, Germany
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- Valovirta, E. (author)
- Univ Turku, Dept Lung Dis & Clin Allergol, Turku, Finland.;Terveystalo Turku, Allergy Clin, Turku, Finland
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Van Ree, R. (author)
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- Venter, C. (author)
- Univ Colorado Denver, Sch Med, Aurora, CO USA.;Childrens Hosp Colorado, Aurora, CO USA
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- Wohrl, S. (author)
- Floridsdorf Allergy Ctr FAZ, Vienna, Austria
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- Wong, G. W. K. (author)
- Chinese Univ Hong Kong, Dept Paediat, Hong Kong, Peoples R China
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- Zhao, Z. T. (author)
- Peking Univ, Hosp 1, Dept Dermatol, Beijing, Peoples R China
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- Worm, M. (author)
- Charite Univ Med Berlin, Dept Dermatol & Allergy, Berlin, Germany.;Humboldt Univ, Berlin, Germany.;Berlin Inst Hlth, Comprehens Allergy Ctr, Berlin, Germany
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Charite Univ Med Berlin, Dept Dermatol & Allergy, Berlin, Germany;Humboldt Univ, Berlin, Germany.;Berlin Inst Hlth, Comprehens Allergy Ctr, Berlin, Germany Med Univ Graz, Dept Dermatol, Graz, Austria (creator_code:org_t)
- 2021-11-24
- 2022
- English.
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In: Allergy. - : Wiley. - 0105-4538 .- 1398-9995. ; 77:6, s. 1736-1750
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Abstract
Subject headings
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- Background Food anaphylaxis is commonly elicited by unintentional ingestion of foods containing the allergen above the tolerance threshold level of the individual. While labeling the 14 main allergens used as ingredients in food products is mandatory in the EU, there is no legal definition of declaring potential contaminants. Precautionary allergen labeling such as "may contain traces of" is often used. However, this is unsatisfactory for consumers as they get no information if the contamination is below their personal threshold. In discussions with the food industry and technologists, it was suggested to use a voluntary declaration indicating that all declared contaminants are below a threshold of 0.5 mg protein per 100 g of food. This concentration is known to be below the threshold of most patients, and it can be technically guaranteed in most food production. However, it was also important to assess that in case of accidental ingestion of contaminants below this threshold by highly allergic patients, no fatal anaphylactic reaction could occur. Therefore, we performed a systematic review to assess whether a fatal reaction to 5mg of protein or less has been reported, assuming that a maximum portion size of 1kg of a processed food exceeds any meal and thus gives a sufficient safety margin. Methods MEDLINE and EMBASE were searched until 24 January 2021 for provocation studies and case reports in which one of the 14 major food allergens was reported to elicit fatal or life-threatening anaphylactic reactions and assessed if these occurred below the ingestion of 5mg of protein. A Delphi process was performed to obtain an expert consensus on the results. Results In the 210 studies included, in our search, no reports of fatal anaphylactic reactions reported below 5 mg protein ingested were identified. However, in provocation studies and case reports, severe reactions below 5 mg were reported for the following allergens: eggs, fish, lupin, milk, nuts, peanuts, soy, and sesame seeds. Conclusion Based on the literature studied for this review, it can be stated that cross-contamination of the 14 major food allergens below 0.5 mg/100 g is likely not to endanger most food allergic patients when a standard portion of food is consumed. We propose to use the statement "this product contains the named allergens in the list of ingredients, it may contain traces of other contaminations (to be named, e.g. nut) at concentrations less than 0.5 mg per 100 g of this product" for a voluntary declaration on processed food packages. This level of avoidance of cross-contaminations can be achieved technically for most processed foods, and the statement would be a clear and helpful message to the consumers. However, it is clearly acknowledged that a voluntary declaration is only a first step to a legally binding solution. For this, further research on threshold levels is encouraged.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Medicinska och farmaceutiska grundvetenskaper -- Immunologi inom det medicinska området (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Basic Medicine -- Immunology in the medical area (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Lungmedicin och allergi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Respiratory Medicine and Allergy (hsv//eng)
Keyword
- anaphylaxis
- food allergy
- nutrition
- exercise-induced anaphylaxis
- cows milk
- oral immunotherapy
- peanut
- allergy
- challenge
- children
- diagnosis
- adolescents
- sesame
- tests
- Allergy
- Immunology
- anaphylaxis
Publication and Content Type
- ref (subject category)
- art (subject category)
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Allergy
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To the university's database
- By the author/editor
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Zuberbier, T.
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Dorr, T.
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Aberer, W.
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Alvaro, M.
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Angier, E.
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Arasi, S.
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Arshad, H.
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Ballmer-Weber, B ...
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Bartra, J.
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Beck, L.
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Begin, P.
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Janson, Christer
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Bislimovska, J.
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Bousquet, J.
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Brockow, K.
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Bush, A.
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Cianferoni, A.
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Cork, M. J.
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Custovic, A.
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Darsow, U.
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Jong, N.
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Deleanu, D.
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Del Giacco, S.
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Deschildre, A.
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Galvin, A. D.
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Ebisawa, M.
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Fernandez-Rivas, ...
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Ferrer, M.
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Fiocchi, A.
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van Wijk, R. G.
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Gotua, M.
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Grimshaw, K.
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Grunhagen, J.
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Heffler, E.
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Hide, M.
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Hoffmann-Sommerg ...
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Incorvaia, C.
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Janson, C.
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John, S. M.
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Jones, C.
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Jutel, M.
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Katoh, N.
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Kendziora, B.
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Kinaciyan, T.
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Knol, E.
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Kurbacheva, O.
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Lau, S.
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Loh, R.
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Lombardi, C.
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Makela, M.
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Marchisotto, M. ...
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Makris, M.
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Maurer, M.
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Meyer, R.
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Mijakoski, D.
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Minov, J.
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Mullol, J.
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Nilsson, C.
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Nowak-Wegrzyn, A ...
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Nwaru, Bright I, ...
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Odemyr, M.
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Pajno, G. B.
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Paudel, S.
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Papadopoulos, N. ...
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Renz, H.
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Ricci, G.
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Ring, J.
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Rogala, B.
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Sampson, H.
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Senna, G.
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Sitkauskiene, B.
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Smith, P. K.
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Stevanovic, K.
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Stoleski, S.
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Szajewska, H.
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Tanaka, A.
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Todo-Bom, A.
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Topal, F. A.
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Valovirta, E.
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Van Ree, R.
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Venter, C.
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Wohrl, S.
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Wong, G. W. K.
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Zhao, Z. T.
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Worm, M.
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Basic Medicine
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and Immunology in th ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Respiratory Medi ...
- Articles in the publication
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Allergy
- By the university
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University of Gothenburg
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Uppsala University
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Karolinska Institutet