Understanding Global Food Allergens: FAO/WHO Risk Assessment

Food allergies have become a significant public health issue, affecting over 220 million people globally. In response to this, international efforts have been made to identify and manage food allergens that pose the greatest risk to public health. Among these efforts, the Joint Food and Agriculture Organization of the United Nations (FAO) and World Health Organization (WHO) Expert Consultation on Risk Assessment of Food Allergens has played a critical role. This article provides an overview of the key findings from the first part of their comprehensive risk assessment of food allergens, including the development of a priority list of allergens based on global prevalence, potency, and severity.

What are Food Allergies?

Food allergies arise from adverse health effects triggered by a specific immune response to certain foods. The majority of these reactions are IgE-mediated, meaning they involve immunoglobulin E (IgE) antibodies. IgE-mediated food allergies are particularly concerning due to their potential to cause life-threatening conditions such as anaphylaxis. Although coeliac disease, a chronic digestive condition caused by a non-IgE mediated immune response to proteins in grains like wheat, rye, and barley, is distinct from common food allergies, it is often included in discussions on food allergens due to its prevalence and the severity of its symptoms in genetically predisposed individuals.

The Scope and Importance of Food Allergen Management

Managing food allergens is a multifaceted challenge. To safeguard individuals who suffer from food allergies, a collective effort is required. This effort involves providing clear and accessible information to consumers, ensuring that healthcare professionals are well-equipped to diagnose and treat food allergies, and implementing strong regulatory frameworks. Furthermore, the food industry must adhere to these frameworks to ensure food safety. Given the life-threatening nature of some food allergies and the limited treatment options available, it is essential to identify and prioritise the foods most associated with severe allergic reactions.

The Risk Assessment Framework

The FAO/WHO food allergen risk assessment utilised a structured, quantitative approach to determine which foods should be included in a global priority list of allergens. This process was based on three main criteria: prevalence, potency, and severity.

Prevalence: This criterion focuses on the proportion of the population affected by immune-mediated adverse reactions to food. The prevalence is determined by studies conducted in different geographic regions and among diverse populations. These studies provide insight into how widespread food allergies are in relation to specific foods.

Potency: Potency refers to the strength of the relationship between exposure to a particular food and the resulting allergic reaction. This criterion is supported by scientific studies that assess the doses of the food allergen required to provoke a reaction and how these doses vary across populations.

Severity: This criterion evaluates the potential of a food allergen to cause severe reactions, such as anaphylaxis. To be considered a common cause of severe allergic reactions, a food allergen must be responsible for at least 5% of all anaphylaxis cases reported to emergency services in three or more geographic regions.

These criteria formed the foundation for prioritising food allergens at the global level. Importantly, the risk assessment process was designed to be transparent and repeatable, allowing for re-evaluation as new data becomes available.

Global Priority Food Allergens

As part of the FAO/WHO’s ongoing consultations, which began in 2020, a global priority list of food allergens was established. This list includes foods that are widely recognised for their potential to cause severe allergic reactions across different regions:

• Milk
• Eggs
• Peanut
• Tree nuts (including hazelnut, cashew, walnut, pistachio, pecan, and almond)
• Sesame
• Fish
• Crustacea
• Cereals containing gluten (including wheat, rye, barley, and their hybridised strains)

These foods were identified based on the comprehensive risk assessment, which included reviewing scientific data from multiple regions and populations. The goal of this global priority list is to provide a standardised approach for managing food allergens, helping to ensure food safety and facilitate fair trade practices internationally.

Regionally Important Allergens

In addition to the global priority list, the FAO/WHO report recognises that certain allergens may be more significant in specific regions or countries. Some foods, while not global priorities, can pose serious risks in localised contexts. These foods include:

• Soy
• Certain tree nuts (such as Brazil nuts, macadamia nuts, and pine nuts)
• Celery
• Buckwheat
• Lupin
• Mustard
• Oats

Countries or regions where these foods are more commonly consumed or associated with food allergies may adopt specific measures to manage them. This regional flexibility allows for a more tailored approach to food allergen risk management while maintaining a global framework for food safety.

Hazard Prioritization and Its Role in Food Safety

Hazard prioritisation is a quantitative analysis methodology used to assess food allergens’ potential risk. In the context of the FAO/WHO’s risk assessment, this methodology has been adapted to guide decision-making on which foods should be included on the global priority list. A clear prioritisation process ensures transparency, consistency, and the ability to re-evaluate allergens as new information becomes available.

This methodology is particularly valuable in ensuring that food allergen management is based on science and data rather than anecdotal or historical perceptions. By quantifying risk factors like prevalence, potency, and severity, the FAO/WHO framework provides a robust foundation for global and national food safety policies.

The Importance of Harmonised International Standards

One of the most significant outcomes of the FAO/WHO food allergen risk assessment is the potential for harmonisation of food safety standards. The global priority list of allergens serves as a scientific basis for updating the Codex Alimentarius, a set of internationally recognised guidelines and standards related to food safety. The inclusion of updated allergen information in the Codex Alimentarius helps ensure that countries around the world adhere to consistent food labelling and safety practices, reducing the risk of allergenic reactions in susceptible individuals and facilitating fair trade.

Harmonised international standards are crucial not only for protecting public health but also for supporting the global food trade. When all countries follow the same guidelines for allergen management, it becomes easier to maintain safe food supplies and ensure that food products are properly labelled to inform consumers about potential allergens.

Key Takeaways

The FAO/WHO’s comprehensive risk assessment of food allergens represents a critical step forward in managing food allergies at the global level. By prioritising allergens based on prevalence, potency, and severity, the FAO/WHO has developed a transparent, science-based approach to food allergen risk management. The resulting global priority list of allergens provides a foundation for harmonised international food safety standards, ensuring that allergic individuals are protected from harm while facilitating fair and equitable trade.

As food allergies continue to pose significant public health challenges, efforts to update and refine food allergen risk assessments must continue. The FAO/WHO’s work in this area will likely serve as a model for future efforts to safeguard public health in the face of evolving risks associated with food allergens.

Here you can access all the documents

Part 1: In brief: Priority food allergens

https://openknowledge.fao.org/handle/20.500.14283/cd1091en

Part 2: In brief: Food allergen reference doses

https://openknowledge.fao.org/handle/20.500.14283/cd1093en

Part 3: In brief: Precautionary allergens labelling (PAL)

https://openknowledge.fao.org/handle/20.500.14283/cd1097en

Part 4: In brief: Exemptions from mandatory food allergen declaration

https://openknowledge.fao.org/handle/20.500.14283/cd1096en