Peanut Can Be Used as a Reference Allergen for Hazard Characterization in Food Allergen Risk Management: A Rapid Evidence Assessment and Meta-Analysis

Paul J. Turner, Nandinee Patel, Barbara K. Ballmer-Weber, Joe L. Baumert, W. Marty Blom, Simon Brooke-Taylor, Helen Brough, Dianne E. Campbell, Hongbing Chen, R. Sharon Chinthrajah, René W.R. Crevel, Anthony E.J. Dubois, Motohiro Ebisawa, Arnon Elizur, Jennifer D. Gerdts, M. Hazel Gowland, Geert F. Houben, Jonathan O.B. Hourihane, André C. Knulst, Sébastien La VieilleMaría Cristina López, E. N.Clare Mills, Gustavo A. Polenta, Natasha Purington, Maria Said, Hugh A. Sampson, Sabine Schnadt, Eva Södergren, Stephen L. Taylor, Benjamin C. Remington

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Regional and national legislation mandates the disclosure of “priority” allergens when present as an ingredient in foods, but this does not extend to the unintended presence of allergens due to shared production facilities. This has resulted in a proliferation of precautionary allergen (“may contain”) labels (PAL) that are frequently ignored by food-allergic consumers. Attempts have been made to improve allergen risk management to better inform the use of PAL, but a lack of consensus has led to variety of regulatory approaches and nonuniformity in the use of PAL by food businesses. One potential solution would be to establish internationally agreed “reference doses,” below which no PAL would be needed. However, if reference doses are to be used to inform the need for PAL, then it is essential to characterize the hazard associated with these low-level exposures. For peanut, there are now published data relating to over 3000 double-blind, placebo-controlled challenges in allergic individuals, but a similar level of evidence is lacking for other priority allergens. We present the results of a rapid evidence assessment and meta-analysis for the risk of anaphylaxis to a low-level allergen exposure for priority allergens. On the basis of this analysis, we propose that peanut can and should be considered an exemplar allergen for the hazard characterization at a low-level allergen exposure.

Original languageEnglish (US)
Pages (from-to)59-70
Number of pages12
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number1
StatePublished - Jan 2022


  • Anaphylaxis
  • Eliciting dose
  • Food allergy
  • Precautionary allergen labeling
  • Reference dose
  • Threshold

ASJC Scopus subject areas

  • Immunology and Allergy


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