Time to ACT-UP: Update on precautionary allergen labelling (PAL)

Paul J Turner; Antonio Bognanni; Stefania Arasi; Ignacio J Ansotegui; Sabine Schnadt; Sébastien La Vieille; Jonathan O'B Hourihane; Torsten Zuberbier; Philippe Eigenmann; Motohiro Ebisawa; Mario Morais-Almeida; Julie Barnett; Bryan Martin; Linda Monaci; Graham Roberts; Gary Wong; Ruchi Gupta; Sophia Tsabouri; Clare Mills; Simon Brooke-Taylor; Joan Bartra; Michael Levin; Marion Groetch; Luciana Tanno; Elham Hossny; Barbara Ballmer Weber; Vincenzo Fierro; Ben Remington; Jennifer Gerdts; M Hazel Gowland; Derek Chu; Marjan Van Ravenhorst; Jennifer Koplin; Alessandro Fiocchi; World Allergy Organization Consensus on the Use of PAL (ACT-UP!) Working Group

doi:10.1016/j.waojou.2024.100972

Time to ACT-UP: Update on precautionary allergen labelling (PAL)

World Allergy Organ J. 2024 Sep 25;17(10):100972. doi: 10.1016/j.waojou.2024.100972. eCollection 2024 Oct.

Authors

Paul J Turner¹, Antonio Bognanni^{2

3

4}, Stefania Arasi⁵, Ignacio J Ansotegui⁶, Sabine Schnadt⁷, Sébastien La Vieille^{8

9}, Jonathan O'B Hourihane^{10

11}, Torsten Zuberbier¹², Philippe Eigenmann¹³, Motohiro Ebisawa¹⁴, Mario Morais-Almeida¹⁵, Julie Barnett¹⁶, Bryan Martin¹⁷, Linda Monaci¹⁸, Graham Roberts¹⁹, Gary Wong²⁰, Ruchi Gupta^{21

22}, Sophia Tsabouri²³, Clare Mills²⁴, Simon Brooke-Taylor²⁵, Joan Bartra^{26

27}, Michael Levin²⁸, Marion Groetch²⁹, Luciana Tanno³⁰, Elham Hossny³¹, Barbara Ballmer Weber³², Vincenzo Fierro⁵, Ben Remington^{33

34}, Jennifer Gerdts³⁵, M Hazel Gowland³⁶, Derek Chu^{37

38}, Marjan Van Ravenhorst³⁹, Jennifer Koplin^{40

41}, Alessandro Fiocchi⁵; World Allergy Organization Consensus on the Use of PAL (ACT-UP!) Working Group

Affiliations

¹ National Heart & Lung Institute, Imperial College London, London, UK.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
³ Clinical Epidemiology and Research Center (CERC), Humanitas University & Humanitas Research Hospital, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milano, Italy.
⁴ Department of Medicine, Evidence in Allergy Group, McMaster University, Hamilton, ON, Canada.
⁵ Allergy Unit, Pediatric Hospital Bambino Gesù IRCCS, Rome, Italy.
⁶ Hospital Quironsalud Bizkaia, Bilbao, Spain.
⁷ Deutscher Allergie- und Asthmabund (DAAB), Moenchengladbach D, Germany.
⁸ Food Directorate, Health Canada, Ottawa, ON, Canada.
⁹ Food Science Department, Laval University, Québec, QC, Canada.
¹⁰ Paediatrics and Child Health, Royal College of Surgeons Ireland, Dublin, Ireland.
¹¹ Children's Health Ireland, Dublin, Ireland.
¹² Charite University, Berlin, Germany.
¹³ Pediatric Allergy Unit, University of Geneva, Switzerland.
¹⁴ Sagamihara National Hospital, Sagamihara, Japan.
¹⁵ Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
¹⁶ Department of Psychology, University of Bath, UK.
¹⁷ Medicine and Pediatrics, The Ohio State University in Columbus, Columbus, OH, USA.
¹⁸ Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy.
¹⁹ University Hospital Southampton, Southampton, UK.
²⁰ The Chinese University of Hong Kong, Hong Kong, PR China.
²¹ Northwestern University, Chicago, IL, USA.
²² Food Allergy Research & Education (FARE), McLean, VA, USA.
²³ EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) and Child Health Department, University of Ioannina School of Medicine, Ioannina, Greece.
²⁴ University of Manchester, Manchester, UK.
²⁵ Brooke-Taylor & Co Pty Ltd, Milawa, Victoria, Australia.
²⁶ Allergy Department, Hospital Clinic and IDIBAPS. Universitat de Barcelona, Spain.
²⁷ RICORS de Enfermedades Inflamatorias (ISCIII), Madrid, Spain.
²⁸ Division of Paediatric Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
²⁹ Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³⁰ Sanas Epidemiology and Research, Sao Paulo, Brazil.
³¹ Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.
³² Department of Dermatology, University Hospital Zürich, Zürich, Switzerland and Clinic for Dermatology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
³³ Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska, Lincoln, NE, USA.
³⁴ Remington Consulting Group B.V, Utrecht, the Netherlands.
³⁵ Food Allergy Canada, Toronto, Ontario, Canada.
³⁶ Allergy Action, St Albans, UK.
³⁷ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
³⁸ Department of Medicine, Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada.
³⁹ Allergenen Consultancy BV, Scherpenzeel (Gld), the Netherlands.
⁴⁰ Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.
⁴¹ Centre for Food and Allergy Research, Melbourne, Victoria, Australia.

Abstract

Background: Precautionary Allergen ("may contain") Labelling (PAL) is used by industry to communicate potential risk to food-allergic individuals posed by unintended allergen presence (UAP). In 2014, the World Allergy Organization (WAO) highlighted that PAL use was increasing, but often applied inconsistently and without regulation - which reduces its usefulness to consumers with food allergy and those purchasing food for them. WAO proposed the need for a regulated, international framework to underpin application of PAL. In 2019, the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) of the United Nations convened an expert consultation to address the issue of PAL, the outputs of which are now being considered by the Codex Committee on Food Labelling (CCFL).

Objectives: To summarise the latest data to inform the application of PAL in a more systematic way, for implementation into global food standards.

Methods: A non-systematic review of issues surrounding precautionary labelling and food allergens in pre-packaged products.

Results: Approximately, 100 countries around the world have legislation on the declaration of allergenic ingredients. Just a few have legislation on UAP. Given the risks that UAP entails, non-regulated PAL creates inconvenience in real life due to its unequal, difficult interpretation by patients. The attempts made so far to rationalize PAL present lights and shadows.

Conclusions: At a time when CCFL is considering the results of the FAO/WHO Expert Consultation 2020-2023, we summarise the prospects to develop an effective and homogeneous legislation at a global level, and the areas of uncertainty that might hinder international agreement on a regulated framework for PAL of food allergens.

Keywords: Anaphylaxis; Codex; Food hypersensitivity; Food labelling; Food labelling legislation and jurisprudence; Precautionary allergen labelling; Prepacked; Risk communication; Risk management.

Publication types

Review