How does Dose Impact on the Severity of Food-Induced Allergic Reactions, and Can this Improve Risk Assessment for Allergenic Foods?

Allergy 2018;1–10.

This paper reviews the current knowledge around the relationship between dose and severity of food-induced allergic reactions and what data are still needed to improve quantitative risk assessment.

Quantitative risk assessment for food allergens has made considerable progress in recent years, yet acceptability of its outcomes remains stymied because of the limited extent to which it has been possible to incorporate severity as a variable. The severity of reaction, particularly following accidental exposure, depends on multiple factors, related to the allergen, the host and any treatments which may have been administered. Some of these factors are plausibly still unknown. Quantitative risk assessment shows that limiting exposure through control of dose reduces the rates of reactions in allergic populations, but its impact on the relative frequency of severe reactions at different doses is unclear. Food challenge studies suggest that the relationship between dose of allergenic food and severity of reaction is complex even under relatively controlled conditions. Because of these complexities, epidemiological studies provide very limited insight into this aspect of the dose-response relationship. Emerging data from single-dose challenges suggest that graded food challenges may overestimate the rate of severe reactions. It may be necessary to generate new data (such as those from single dose-challenges) to reliably identify the effect of dose on severity for use in quantitative risk assessment. Success will reduce uncertainty in the susceptible population and improve consumer choice.

The paper is available here as open access.

For more information please visit the Food Allergy Task Force webpage.