Current and Future Status of Food Allergens

Gary C. Smith, Colorado State University

An allergy is a state of hypersensitivity induced by exposure to a particular antigen (allergen) resulting in harmful immunologic reactions on subsequent exposures. ¹ Sensitivity is abnormal response (too quick or too acute) to stimulation; hypersensitivity is a state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. ¹ Anaphylaxis is the manifestation of immediate hypersensitivity in which exposure of a sensitized individual to a specific antigen results in life-threatening respiratory distress followed by vascular collapse and shock. ¹ Intolerance is a sensitivity – but not a hypersensitivity – because the symptoms (e.g., bloating, nausea, abdominal discomfort, flatulence, diarrhea) are not life-threatening. ¹

A food allergen reaction is a body’s immunological response to proteins in the food that the body sees as foreign. ² Food allergy symptoms are these: (a) mouth: swelling and tingling of lips, mouth, or tongue. (b) gastro-intestinal tract: cramping, vomiting, and diarrhea. (c) skin: hives and eczema. (d) airway: wheezing, coughing and swelling of throat. (e) cardiovascular: loss of blood pressure. (f) anaphylaxis: most dangerous, and life-threatening. Reactions usually occur 1 to 30 minutes after exposure, but may take up to 2 hours. ² Technically, a food allergy is a medical condition in which exposure to a specific protein in a food triggers a harmful immune response. ³ Allergens can trigger everything from mild discomfort to gastric or respiratory distress to full-blown – and potentially fatal – anaphylactic shock. ³

Many foods can cause an allergic reaction in people, but eight foods are responsible for over 90% of the food allergy reactions in the US. These are cow’s milk, egg, peanut, tree nut, fish, crustacean shellfish, wheat, and soy. ² In 2004, the US Congress passed the Food Allergen Labeling and Consumer Protection Act (FALCPA) which mandates labeling of FDA’s “Big 8” allergens; for product groups like tree nuts, fish, and shellfish, the specific type of tree nut, fish, and shellfish must also be identified on the label. ^4,5

The “Big 8” food allergens recognized (as of 2021) in the USA are: (1) peanuts, (2) tree nuts, (3) eggs, (4) milk/dairy products, (5) soy, (6) wheat, (7) fish, and (8) crustacean shellfish. ² Canada adds four more – (9) sesame, (10) sulfites, (11) mustard, and (12) molluscan shellfish. ⁶ The European Union uses 7 of the Big 8 allergens, substitutes “cereals containing gluten” for “wheat”, plus (9), (10), (11), (12), plus (13) celery, and (14) lupin. ⁷ The Global Food Safety Initiative benchmarking schemes (e.g., BRCGS⁸ and SQF⁹) use the European’s “14 allergens” list.

There are some interesting nuances in the food allergen descriptors used by the US, Canada, and the EU: (a) FDA originally used the term “shellfish” but began to use “crustacean shellfish” when the Canadians and Europeans divided the category into crustaceans (lobster, crab, shrimp) and molluscans (oyster, snail, clam, squid). (b) Canadians include “sulfites” and Europeans include “sulfur dioxide and sulfites” even though they are not –technically speaking – allergens (because they are not proteins). (c) The European Union uses “sesame seeds” rather than just “sesame”, thereby allowing “sesame oil” (if it is free of protein) to avoid being declared as an allergen on a product’s label. (d) The European Union, by changing “wheat” to “cereals containing gluten” has now extended its food allergens list, because 4 cereal grains (wheat, rye, oats, and barley) can contain gluten. ⁷ (e) Inclusion of “Lupin” by the EU seems an odd choice. Lupins are legumes with a long upright cluster of pea-like flowers; their seeds contain a poison that can destroy the liver of livestock. The Texas Bluebonnet is a Lupin. ¹

Not all allergens are created equal. For example: (a) Shrimp and lobster are the main causes of anaphylaxis in adults.¹⁰ (b) Seafood allergies can be triggered by something as seemingly innocuous as essence of shrimp from a pre-made component of an ingredient used in an Asian cooking sauce. ¹¹ (c) Food allergy incidence in American children has been growing four times faster than in the adult population for at least the last 20 years.¹² Most of the increase among children is attributed to peanut and tree nut allergies¹¹, but also because city kids grow-up in “too sterile” environments (in comparison to farm kids who have stronger immune systems due to their regular exposure to the land and livestock).¹³

Of interest is how many Americans have a food allergy. Prior to 2020, most people cited a 2012 CDC study which said that 15 million Americans have food allergies (including 5.9 million children under 18 YOA) and that tens of millions more are “intolerant to” or “have sensitivities to” certain foods and ingredients.^10,11,14 Things have happened since 2012. Hospital admissions for severe allergic reactions or anaphylaxis doubled¹⁵, or tripled¹², in the last decade. By 2020, the estimates were: (a) Food allergens affect up to 10% of the world population; more than 26 million US adults have food allergies¹⁶. (b) 32 million Americans suffer from food allergies^12,17 with 22 million being allergic to one of the Big 8 allergens and 10 million being allergic to other allergens.¹² The food allergen testing market is poised to grow by $783 million during 2020 through 2024, largely because of an expected further increase in allergic reactions among individuals.¹⁸

Half a billion people globally, including one-fourth of all Americans (85 million), avoid allergens when shopping for food.¹² More than 26 million US adults¹⁶ or 32 million persons of all ages^12,17 have food allergies; another 24 million¹⁶ or 53 million persons¹² believe they have an allergy, sensitivity, or intolerance… but they don’t (they have no medical diagnosis to support their belief).^12,16 Food products bearing labels stating “Gluten-Free” or “Dairy-Free” have experienced tremendous sales growth as more consumers have a physically or psychologically negative reaction to certain foods, or change in their diets to achieve healthier lifestyles, weight loss, increased energy, or greater immunity.^11,12

With regard to celiac disease, gluten sensitivity, and lactose intolerance: (a) Only 4% of those eating “Gluten-Free” actually need to be.¹¹ (b) 1% of US consumers have celiac disease and slightly more have gluten sensitivity yet 20% of today’s consumers seek to limit gluten in their diet.^10,16 (c) Banning gluten from your diet is not a wise nutrition or health decision; rather than diagnosing yourself, you should work with an MD or RD who specializes in gastro-intestinal disorders.^19,20 (d) After infancy, approximately 65% of the world’s adults have a reduced ability to digest lactose (i.e., milk sugar) but that’s an “intolerance” – not an allergy – because lactose is not a protein.²¹

People can be allergic to any of more than 160 ingredients in food¹²; so, should other allergens be added to FALCPA’s mandated labeling list? For several years, FDA has considered adding “sesame”, due to the number of people with sesame allergies.¹¹ The Asthma and Allergy Foundation says 1 million Americans have a sesame allergy¹⁷ which is similar to the prevalence of people who have soy or fish allergies.²² In 2018, FDA issued a Notice asking for data on the severity and prevalence of sesame allergies.²³ In 2020, FDA moved a step closer to making “sesame” a major allergen by issuing a Draft Guidance for voluntary declaration of “sesame seeds” in the Ingredient List and “sesame oil” as a parenthetical if it is a component of a spice or flavoring.²⁴ In 2021, the US Congress passed and the President signed the Food Allergy, Safety, Treatment, Education, and Research (FASTER) Act.²⁵ On January 1, 2023, “sesame” will be the ninth major allergen that must be identified by law on food labels.^25,26 The “Big 8” will become the “Big 9”.

Matayoshi and Lopez said: (a) The FASTER Act strongly suggests that additional ingredients will be added to the Major Food Allergens list moving forward. (b) We believe that FDA will look closely at the 14 ingredients in the EU list, and the 12 ingredients used by Canada. (c) Our guess is that “mustard” will be the next additional ingredient on the US Major Food Allergens list.²⁷

REFERENCES:

1. Dorland’s Medical Dictionary. 1988. W.B. Saunders Company, Philadelphia, PA
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3. Drayer, Lisa. 2018. CNN. December 13 Issue.
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21. Readers Digest. 2018. October Issue.
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27. Matayoshi, J. and M. Lopez. 2021. Food Safety Magazine. June 29 Issue.