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International Food Risk Analysis Journal

Quantitative Risk Assessment Relating


to the Inadvertent Presence of Peanut
Allergens in Various Food Products

Regular Paper



Loup Rimbaud
1
, Fanny Hraud
1
, Sbastien La Vieille
2
,
Jean-Charles Leblanc
1
and Amlie Crpet
1,*


1 Risk Assessment Department (DER), French Agency for Food, Environmental and Occupational Health Safety (ANSES), Maisons-Alfort, France
2 Bureau of Chemical Safety / Food Directorate, Health Canada, Ottawa, ON, Canada
* Corresponding author E-mail: amelie.crepet@anses.fr

Received 14 Dec 2012; Accepted 12 Apr 2013



DOI: 10.5772/56646

2013 Rimbaud et al.; licensee InTech. This is an open access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract Since 2005, European food regulations require
major allergens, including peanut, to be declared on the
label where the allergen is intentionally present in the
food. However, even if not mentioned in the list of
ingredients,peanutallergenmaybeinadvertentlypresent
inalargerangeofpackaged foodandconsequentlymay
affectmanypeanutallergicindividuals.
This work is an exercise in quantifying the allergic risk
forpeanutallergicindividualsinFrancewhenexposedto
foodproductsthatmaycontainlowlevelofpeanutsdue
to crosscontamination. This quantification is based on a
probabilistic approach published by Rimbaud et al. in
2010 (Rimbaud et al. 2010). Food products analysed for
the possible presence of peanut traces in scientific
literature were selected. For each foodstuff, the allergic
risk associated with their consumption was estimated
using the French individual food consumption survey,
representative of the general French population. An
internet survey on the attitudes of peanutallergic
individuals toward food precautionary labelling was
conducted.Forthreefoodstuffs,theallergicriskwasthen
refined integrating the information on specific food
behavioursofFrenchallergicindividuals.
Considering the mean probability, inadvertent presence
of peanuts was identified in 20% to 37% of products.
Adults were exposed to up to 12.5 mg of peanut protein
on 97.5% of their eating occasions. The mean risk of
reaction ranged from 0.2% to 2.4%. Considering eating
occasionsforalltheproducts,1.5%ofthepeanutallergic
adultswouldhaveatleastoneallergicreactioninaweek.
In undertaking this modelling exercise, we have
demonstrated the benefits of integrating all available
informationtounderpindecisionmakingintheareaoffood
allergen crosscontamination. We have also highlighted the
need to generate more data to further refine the risk
assessmentforthebenefitofallergicconsumers.

Keywords Allergen Exposure, Food Risk Assessment,


Peanut Allergy, Precautionary Labelling, Statistical
Modelling

1 Loup Rimbaud, Fanny Hraud, Sbastien La Vieille, Jean-Charles Leblanc and Amlie Crpet: Quantitative Risk
Assessment Relating to the Inadvertent Presence of Peanut Allergens in Various Food Products
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ARTICLE
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Int. food risk anal. j., 2013, Vol. 3, 3:2013

1.Introduction
In westernized countries, food allergies are estimated at
levels up to 56% for young children and 34% for adults
(Zuberbier et al. 2004; Osterballe et al. 2005; Luccioli et al.
2008; Venter et al. 2008).

In France, food allergy affects


approximately3.2%ofthepopulation,i.e.nearly2million
people (Kanny et al. 2001). Among the different food
allergens, peanut is the most commonly reported cause of
severe and fatal allergic reactions (e.g. Bock et al. (2007)
report16fatalitiesfrompeanut,followedbytreenuts,milk
and shrimp). Peanut is associated with half of food
anaphylaxis cases and the majority of consequent deaths
(Ranc and Bidat 2000; Werfel 2008). Furthermore, the
elicitingdoseofpeanutproteinforanallergicreactioncan
beextremelylow,aslittleas1mg(Hourihaneetal.2005).
ThepeanutallergyprevalenceinFranceisestimatedtobe
0.3% of adults aged 18 to 79 years and 0.6% of children
aged3to17years,combiningtheobservationsofRancet
al.(2005)andMoneretVautrin(2008).

The European Directive 2003/89/EC, amended by the


Directive 2007/68/EC, requires labelling of 14 allergens,
including peanut, when used in the formulations of pre
packaged foods. This measure allows peanutallergic
individuals to avoid peanutcontaining foods and
consequently improves the prevention of allergic reactions
(ANSES2008).Nevertheless,ariskofreactiontopeanutstill
remains, as small amounts of peanut allergens may
inadvertently occur in commercially packaged food
products.Lowlevelpresenceofpeanutproteinsmayresult
from contamination of the raw material or from cross
contamination by the shared use of processing equipment
(Rder et al. 2008). In such situations, peanut is not
mentioned on the required list of ingredients but products
canhaveaprecautionarystatementlabelledasmaycontain
peanut. The impact of the masked allergens (including
misunderstanding labelling, missing information, new
formulation, error of labelling and crosscontamination) is
important,sinceitisestimated to have induced 8.6% of the
seriousallergicreactionsreportedbytheFrenchfoodallergy
network between 2001 and 2006 (ANSES 2008). In
attempting to prevent inadvertent exposure to allergen
crosscontamination among allergic consumers, food
manufacturersfrequentlyuseprecautionarylabellingtoalert
consumers to potential allergen hazards in food products.
However,duetooveruseoftheseprecautionarystatements,
such labelling leads to a dilemma for allergic individuals:
eithertheybecomelessobservantofhazardsbyconsuming
such products, or they accept a drastic reduction in dietary
choice. Additionally, it has been shown that allergic
consumers are increasingly ignoring precautionary labels
(Hefleetal.2007).

Allergen crosscontamination also presents a challenge for


theriskassessmentduetointerindividualheterogeneityin
allergen thresholds, and the wide range of allergen
concentrations in food products. In an exposure model
based on the classic deterministic approach, input values
are expressed as single values or point estimates, usually
representing a worst case scenario. Quantitative risk
assessmentbasedonprobabilisticprinciplesisemergingas
the preferred approach (Madsen et al. 2009). Probabilistic
modelling has the capacity to use data distributions
representing variability and uncertainty in input
parameters which increases the understanding and clarity
oftherelationshipbetweenvaluesandrisk.

A probabilistic model for quantifying the risk of allergic


reaction to peanut due to the consumption of chocolate
tablets(i.elargebarsofwhite,darkormilkchocolate)has
been previously developed (Rimbaud et al. 2010). This
model couples Bayesian inference of input variables and
secondorder Monte Carlo simulations to separately
propagate variability, i.e. for one side natural
heterogeneityor diversity, and for other side uncertainty
duetomeasurementerrorsormodelhypotheses(Pouillot
etal.2007).

This paper demonstrates the process of capturing and


incorporating data from various sources, in a structured
way, to support riskbased decisionmaking in relation to
allergencrosscontamination.Theobjectiveofthisstudyis
toapplythismodeltoarangeoffoodproductswhichhave
been analysed for peanut contamination in scientific
literature,suchaschocolatetablets,chocolatebars,biscuits,
breakfast cereals, bakery products, confectionery, snacks
andprocesseddesserts.Theallergicriskwasestimatedfor
each product separately. To take into account the specific
consumptionbehavioursofpeanutallergicindividuals,an
internet survey was also conducted in order to document
theirattitudestowardfoodprecautionarylabelling.
2.Materialsandmethod
2.1Dataandvariablesofthemodel
2.1.1Presenceandconcentrationofpeanuttracesinfoodproducts
Data relating to inadvertent presence of peanut allergens
in food products were collected from the scientific
literature (PubMed and Scopus databases). Eight articles
relating to the detection and quantification of peanut
allergens in food using commercially available test kits
(the EnzymeLinked ImmunoSorbent Assay method,
ELISA,andthePolymeraseChainReactionmethod,PCR)
were considered. Results on 926 samples purchased on
European and NorthAmerican markets were gathered
and classified into eight food groups: chocolate tablets,
chocolate bars, biscuits, cereals, bakery products,
confectionery, snacks and processed desserts (Table 1).
When the information was available, the products were
also classified according to the presence or absence of a
precautionarylabelling.
2 Int. food risk anal. j., 2013, Vol. 3, 3:2013 www.intechopen.com

Total
With traces of
peanut (%)
Total Min Max Total Min Max
Chocolate
tablets
b
275 100 (36.4%) 202 81 40.1% 0.17 24.1 72 19 26.4% 0.17 74
(Holzhauser and Vieths, 1999; Keck-
Gassenmeier et al., 1999; Pel et al., 2007;
Stephan and Vieths, 2004)
h
Chocolate bars
c
69 25 (36.2%) 27 8 29.6% 4 72.5 37 17 45.9% 5 245
(Vadas and Perelman, 2003; Yeung and
Collins, 1996)
Biscuits 317 80 (25.2%) 138 29 21.0% 0.17 5.8 175 51 29.1% 0.17 5.8
(Holzhauser and Vieths, 1999; Keck-
Gassenmeier et al., 1999; Pel et al., 2007;
Schppi et al., 2001; Stephan and Vieths,
2004; Yeung and Collins, 1996)
h
Cereals
d
78 15 (19.2%) 69 29 42.0% 0.72 1160 9 4 44.4% - -
(Hefle et al., 2007; Holzhauser and Vieths,
1999; Schppi et al., 2001; Stephan and
Vieths, 2004)
h
Bakery products 56 0 (0.0%) 47 0 0.0% - - 6 0 0.0% - - (Hefle et al., 2007; Schppi et al., 2001)
h
Confectionery
e
43 8 (18.6%) 38 8 21.1% 0.72 945.4 2 0 - -
(Hefle, 2007; Holzhauser and Vieths,
1999;Keck-Gassenmeier, 1999;Stephan and
Vieths, 2004 )
h
Snacks
f
64 12 (18.8%) 37 1 2.7% 2.9 18.3 22 11 50.0% - -
(Yeung and Collins 1996; Schppi et al. 2001;
Hefle et al. 2007)
h
Processed
desserts
g
24 0 (0.0%) 9 0 0.0% - - 5 0 0.0% - -
(Yeung and Collins 1996; Holzhauser and
Vieths 1999; Keck-Gassenmeier et al. 1999;
Stephan and Vieths 2004; Hefle et al. 2007)
h
Total 926 240 (25.9%) 567 156 27.5% 0.17 1160 328 102 31.1% 0.17 245
Number of samples
Concentra-
tion
With traces
of peanut
Number of samples Number of samples
References
Concentra-
tion
(mgkg
-1
)
a
(mgkg
-1
)
a
With traces
of peanut
Product
groups
All data Labelling related to peanut traces No reference to peanut

a
incontaminatedproducts,Min=minimum,Max=maximum
b
(tabletssuchasplainchocolate,wholemilkchocolate,semisweetchocolate,etc.)
c
(suchasMars,Bounty,Lion,etc.)
d
(breakfastcerealsandcerealbars)
e
(candies,confectionery,etc.)
f
(potatochips,corncrackers,instantmeals,etc.)
g
(nougatbars,yoghurt,pudding,applesauce,etc.)
h
concentration values originally expressed in mgkg
1
of total peanut material and converted into a protein equivalent using a factor uniformly drawn
between24%and29%(cf.Rimbaudetal.(2010))
Table 1. Contamination of 926 samples by peanut in published data: number of samples containing detected traces of peanut and
concentration of peanut protein in contaminated samples for each of the eight product categories and detailed per labelling when the
informationwasavailable.Inonearticle(Schppietal.2001),onlytheprobabilityofpresencewasretainedbecausetheconcentrationof
peanutallergensincontaminatedsampleswasinsufficientlyprecise.
The binary variable P indicating whether the product
containspeanuttraces(P=1)ornot(P=0)ismodelledbya
Bernoulli distribution with probability p (Table 2). The
probabilitypismodelleditselfbyaBetadistributionwith
parameters (; ). If the product contains peanut traces,
theconcentrationlevelsCexpressedmg.kg
1
isconsidered
distributedwithanexponentialdistributionwithparameter
representingtheinverseofthemean.ismodelledbya
Gamma distribution with parameters (; ). The
parameters of the distributions were estimated through
theBayesianapproachdevelopedinRimbaudetal.(2010)
applied to all data presented in Table 1. It results in
valuesof(;)and(;)presentedinthecolumnAll
inTable2foreachproductsgroup.Forchocolatetablets,
chocolate bars and biscuits, the number of data per type
of precautionary labelling was sufficient to provide a
specific distribution related to the labelling (columns
precautionarylabellingandnoreferencetopeanutin
Table2).
2.1.2Consumptionpattern
The consumption pattern is provided by the French
individual food consumption survey INCA2, conducted
in 20062007 by the French Food Safety Agency (ANSES
2009; ANSES 2009a). 2624 adults aged 18 to 79 years and
1455 children aged 3 to 17 years, representative of the
general French population, were asked to complete a
sevenconsecutiveday food diary. Participants estimated
portion sizes through comparison of their actual
consumption with photographs compiled in a manual
adapted from the SuViMax picture booklet (Hercberg et
al. 1994). Consumed quantities of products by allergic
individuals were considered to be equivalent to those
consumedbytheINCA2populationgroup.Inthecontext
3 Loup Rimbaud, Fanny Hraud, Sbastien La Vieille, Jean-Charles Leblanc and Amlie Crpet: Quantitative Risk
Assessment Relating to the Inadvertent Presence of Peanut Allergens in Various Food Products
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ofanacuteriskassessment,thelargestamountofproduct
ingested by each individual on a single eating occasion
during the sevenday period recorded was used. The
descriptive statistics of the empirical distribution of this
largest amount are shown in Table 3 for both adults and
childrenpopulations.

Description Distributionorequation
Whether the product is
contaminated (P=1) or not
(P=0)
P~Bernoulli(p)withE(P)=p
Probabilityofpresence
ofpeanut(%)
p~Beta(;)withE(p)=/(+)
Labellingrelatedtopeanuttraces
Parameters
(; ) of the
distribution
ofp
Product
groups
Precautionarylabelling Noreferencetopeanut All
Chocolate
tablets
(82;122) (20;54) (101;176)
Chocolate
bars
(9;20) (18;21) (26;45)
Biscuits (30;110) (52;125) (81;238)
Cereals (16;64)
Confectionery (9;46)
Snacks (13;53)
Peanut
concentration
(mgkg
1
)
C~Exp()withE(C)=
1
Parameter of the
distributionofC
~Gamma(;)withE()=/
Labellingrelatedtopeanuttraces
Parameters
(; ) of the
distribution
of
Product
groups
Precautionarylabelling Noreferencetopeanut All
Chocolate
tablets
(42;279) (11;152) (53;420)
Chocolate
bars
(8;297) (17;846) (24;1143)
Biscuits (11;86) (31;97) (42;183)
Cereals (22;1277)
Confectionery (16;1578)
Snacks (8;20)
Consumedportionof
product(kg)
Q:largestobservedquantitiesduringthesevendayperiodrecordedinINCA2survey
Equationofthedose
responsecurve(cumulative
distributionfunctionofthe
thresholdofreactionT)
( )
a
d
b
DR d 1 e
| |

|
\ .
=
Thresholdofreaction(mg) T~Weibull(a;b)withE(T)=b(1+1/a)
Parameters(a;b)ofthe
distributionofT
a~ED
*

b~ED
*

Exposuretopeanut
allergens(mg)
E=PxCxQ
Risk(probabilityofallergic
reactionin%)
R=DR(E)
Occurrenceofatleast1
allergicreaction
intheweek
S=1ifET
S=0otherwise
Whethertheconsumerpays
attentiontoprecautionary
labelling(PA=1)ornot
(PA=0)
PA~Bernoulli(p)withE(PA)=p
Observedprobabilityof
payingattentiontolabelling
p
*
EmpiricalDistributionobtainedinTable4of(Rimbaudetal.2010).
Table2.Descriptionofthevariablesandtheparametersoftheallergenriskmodel
4 Int. food risk anal. j., 2013, Vol. 3, 3:2013 www.intechopen.com

Product Variable Population Mean SD


a
p2.5
b
Median p97.5
b
Chocolatetablets
p (%) 36% 3% 31% 36% 42%
C(mgkg
1
) 8.3 8.3 0.2 5.7 30.1
Q(g)
Adults 25.0 32.0 3.0 13.0 111.0
Children 26.0 23.0 5.0 20.0 93.0
E(mg)
Adults 0.2 0.4 2.4E03 0.08 1.1
Children 0.2 0.3 2.8E03 0.09 1.1
Chocolatebars
p (%) 37% 6% 26% 37% 48%
C(mgkg
1
) 49.6 51.4 1.2 33.7 188.9
Q(g)
Adults 53.0 36.0 5.0 50.0 150.0
Children 42.0 26.0 7.0 40.0 112.0
E(mg)
Adults 2.9 3.3 0.08 1.7 11.4
Children 2.0 2.6 0.05 1.1 8.6
Biscuits
p (%) 25% 2% 21% 25% 30%
C(mgkg
1
) 4.6 4.8 0.1 3.1 17.5
Q(g)
Adults 49.0 44.0 5.0 36.0 168.0
Children 53.0 35.0 10.0 50.0 140.0
E(mg)
Adults 0.2 0.4 2.4E03 0.1 1.2
Children 0.2 0.3 4.1E03 0.1 1.1
Cereals
p (%) 20% 4% 12% 20% 29%
C(mgkg
1
) 65.4 68.7 1.6 44.0 250.4
Q(g)
Adults 53.0 33.0 15.0 45.0 125.0
Children 48.0 24.0 15.0 45.0 100.0
E(mg)
Adults 2.9 3.6 0.08 1.8 12.5
Children 2.9 3.5 0.06 1.7 11.8
Confectionery
p (%) 20% 6% 10% 20% 33%
C(mgkg
1
) 104.3 110.1 2.6 69.4 400.8
Q(g)
Adults 24.0 36.0 3.0 13.0 80.0
Children 24.0 25.0 3.0 20.0 80.0
E(mg)
Adults 2.2 4.1 0.03 0.8 11.4
Children 2.1 3.2 0.03 1.0 10.8
Snacks
p (%) 20% 5% 11% 19% 30%
C(mgkg
1
) 2.8 3.3 0.1 1.7 11.5
Q(g)
Adults 28.0 28.0 5.0 20.0 87.0
Children 32.0 33.0 5.0 20.0 132.0
E(mg)
Adults 0.08 0.1 1.4E03 0.04 0.4
Children 0.07 0.1 1.3E03 0.03 0.3
p:probabilityofpresenceofpeanutallergens
C:Peanutconcentration
Q:Consumedportionofproduct
E:Strictlypositivelevelsofexposuretopeanutallergens
a
standarddeviation

b
2.5
th
and97.5
th
percentilesofthedistribution
Table 3. Descriptive statistics of the model variables for each of the six products: probability of the presence of peanut allergens,
concentrationofpeanutproteinincontaminatedproducts,largestportionoffoodingested,andexposuretopeanutproteinsfollowing
theconsumptionofacontaminatedproduct
2.1.3Attitudesofpeanutallergicconsumerstowards
precautionarylabelling
Attitudes of peanutallergic consumers were described
through an internet survey conducted from January to
June2009onchocolateproductsandbiscuits.Theallergic
individualsvisitingthewebsiteoftheFrenchAssociation
for Allergy Prevention (AFPRAL) were invited to
respond to a questionnaire. Individuals were first asked
whether they had eliminated chocolate products and
biscuits from their diet. Then, subjects who had not
eliminated these products were asked whether they pay
attention to food labelling, and, if so, to detail their
relative consumption frequency of: i) products bearing
labelling such as peanutfree, ii) products with
precautionary labelling such as may contain peanut and
iii) products without any reference to peanut on their
packaging. One hundred and thirty five peanutallergic
children aged 1 to 17 years old and 68 peanutallergic
adults completed the questionnaire.Respondents
attitudes were assumed to be representative of those of
thepeanutallergicpopulationinFrance.
2.1.4Doseresponseforpeanutallergen
The doseresponse curve is defined by the relationship
betweentheintakeofagivenamountofallergenandthe
proportion of allergic individuals that are likely to react.
5 Loup Rimbaud, Fanny Hraud, Sbastien La Vieille, Jean-Charles Leblanc and Amlie Crpet: Quantitative Risk
Assessment Relating to the Inadvertent Presence of Peanut Allergens in Various Food Products
www.intechopen.com

It is statistically represented by the cumulative


distribution function of the threshold of reaction. The
modelling of a doseresponse curve from published
thresholds of reaction of the DoubleBlind Placebo
Controlled Food Challenge (DBPCFC) tests developed in
Rimbaud et al., 2010, was retained and summarized in
Table 2. As proposed by the authors, one dose response
curve based on pooled data for both adults and children
populationswasusedinthisstudy.
2.2Exposureandriskassessment
Theindividualexposureisdefinedbytheamountinmgof
peanut allergen ingested per eating occasion of a product
among the six groups. It is estimated in combining the
probability that the consumed product contains peanut
allergen, its corresponding peanut concentration and the
consumed quantity. The allergic risk to peanut is then
defined as the probability that an allergic consumer reacts
following an exposure to peanut allergen. Practically the
exposure is null when the consumed product is not
contaminated (P=0). Otherwise (P=1), the exposure level E
results from the multiplication of the largest portion of
product ingested in one eating occasion by an individual,
Q, with a level of peanut C randomly selected in its
correspondingdistribution.Then,theprobabilityofreaction
associatedwiththisindividualexposureleveliscalculated
usingtheequationofthedoseresponsecurveDR(E)given
in Table 2. These calculations are repeated for each
individualofthesurveyINCA2andeachproductgroupto
obtainadistributionoftheriskassociatedwithoneeating
occasion. This process is performed 100 times using 100
different values of parameters distributions and leading
with a 95% credible interval for each estimate of the risk
distribution.

Inordertoestimatethenumberofconsumerswhowould
have at least one allergic reaction to peanutin one week,
the exposures related to each eating occasion of the six
product groups in one week were calculated for each
individual. In parallel, a threshold of reaction selected in
its corresponding Weibull distribution (Table 2) was
attributed to those individuals. If at least one exposure
level related to the different eating occasions equalled or
exceededthethreshold,theindividualwasconsideredto
have one allergic reaction during the week. Note that
each eating occasion was taken into account
independently. The simultaneous consumption of
different products during a meal and therefore their
associatedriskwerenotconsidered.

Usingthisdata,twoscenarioswerestudied:thefirstone
considered that allergic consumers had no specific
attitudetowardthedifferentprecautionarylabelling;and
the second one integrated their specific attitude as
declared in the internet survey. In the first scenario, the
probabilityofcontaminationandtheconcentrationlevels
weresimulatedregardlessofthetypeoffoodlabelling.In
this way, the common distributions of these variables
fitted from all the data (column All in Table 2) were
used to simulate the exposure. In the second scenario, a
supplementary variable, PA, indicates whether the
consumer pays attention to labelling (PA=1), or not
(PA=0). The variable PA was generated by a Bernouilli
distributionwithparameterp,estimatedbytheobserved
frequencyofcarefulbehaviourobtainedfromtheinternet
survey. If PA=1, the probability of peanut presence and
the concentration level were simulated given the
frequencies of consuming product bearing labelling or
not, from the specific contamination distributions
(columns precautionary labelling and no reference to
peanut in Table 2). The guaranteed peanutfree
productswereassumedtonotcontainanytraceofpeanut
and therefore the risk associated with this type of
productsisnull.Thesecondscenariowasappliedonlyon
chocolate tablets, chocolate bars and biscuits for which
specificconsumerattitudedistributionswereavailable.
2.3Computingtools
To estimate the parameters of the input variable
distributions of the model, Bayesian computations were
performed using the WinBUGS software (version 1.4,
Imperial College & Medical Research Council (MRC),
UK) as described by Rimbaud et al., 2010. Using the R
software (version 2.5.0, R Foundation for Statistical
Computing),peanutexposureandriskweresimulatedby
secondorder Monte Carlo algorithm as described by
Rimbaudetal.(2010).
3.Results
3.1Contaminationandconsumptionestimates
Basedondatausedinthisstudy,chocolatebarswerethe
most likely contaminated products (Table 3), with an
average probability of peanut presence of 37%. This
probabilityhasa95%chance offallingbetween26%and
48%, which represents its uncertainty. Chocolate tablets
contamination was of the same order of magnitude.
Concerningtheotherproducts,onequarterofthebiscuits
and one fifth of the cereals, the confectionery and the
snacks contained peanut allergens and may therefore
induceariskofallergicreaction.

When traces of peanut were present in a product sample,


theconcentrationofpeanutproteinreachedheterogeneous
levels,dependingontheproduct.Forinstance,theaverage
incontaminatedconfectionerywas104.3mgkg
1
ofpeanut
protein, i.e. the equivalent of one peanut kernel in one
kilogramoffood.Theconcentrationlevelwasgreaterthan
400.8 mgkg
1
for 2.5% of the contaminated confectionery.
In contrast, the concentration averaged 2.8 mgkg
1
for the
contaminatedsnacks,and2.5%ofthemhadconcentrations
greaterthan11.5mgkg
1
.
6 Int. food risk anal. j., 2013, Vol. 3, 3:2013 www.intechopen.com

Regarding the consumption pattern, the largest amount


consumed by adults in any one sitting in a week averaged
approximately 50 g for the chocolate bars, the biscuits and
thecereals.Thesewerefollowedbythesnacks,thechocolate
tabletsandtheconfectionery,averaging28g,25gand24
g,respectively.Thechildrenconsumedsimilarquantities
totheadultpopulationgroup.
3.2Estimatesoftheexposure,risk,andnumberofallergic
reactionspereatingoccasionwithoutintegratingspecific
attitudestowardthedifferentprecautionarylabelling
When the consumed sample is contaminated, the
highestexposurelevelisfromcereals,withanaverage
of 2.9 mg for adults and 2.9 mg for children (Table 3).

Adultsandchildrenwereexposedtomorethan12.5mg
and 11.8 mg of peanut protein, respectively, from 2.5%
of the contaminated cereal portions. Concerning the
other products, the average exposure level ranged from
0.08 mg (snacks) to 2.9 mg (chocolate bars) of peanut
protein for adults, and from 0.07 mg (snacks) to 2.1 mg
(confectionery) for children. It is important to note that
97.5% of the population is exposed to a level below the
peanut concentration of 12.5 mg reached in one eating
portion of contaminated cereals. Nevertheless, 12.5 mg
of peanut protein is sufficient to trigger an allergic
reaction in 15.5% to 16.5% of the peanutallergic
population, according to the doseresponse curve
previouslyestablished(Rimbaudetal.2010).

Product Population Estimator Mean SD


a
Median p97.5
b
Positiveriskmean
d
Chocolatetablets
Adults
Median 0.6% 1.1% 0.0% 3.6% 1.5%
2.5%
c
0.4% 0.9% 0.0% 2.9% 1.3%
97.5%
c
0.7% 1.3% 0.0% 4.4% 1.9%
Children
Median 0.6% 1.1% 0.0% 3.9% 1.7%
2.5%
c
0.5% 0.9% 0.0% 3.1% 1.5%
97.5%
c
0.8% 1.3% 0.0% 4.7% 2.0%
Chocolatebars
Adults
Median 2.4% 4.0% 0.0% 12.8% 6.6%
2.5%
c
1.5% 3.0% 0.0% 9.6% 5.0%
97.5%
c
3.6% 5.2% 0.0% 17.2% 8.1%
Children
Median 2.0% 3.3% 0.0% 10.7% 5.4%
2.5%
c
1.3% 2.6% 0.0% 8.3% 4.3%
97.5%
c
2.8% 4.1% 0.0% 13.6% 6.8%
Biscuits
Adults
Median 0.4% 1.0% 0.0% 3.3% 1.7%
2.5%
c
0.3% 0.8% 0.0% 2.6% 1.4%
97.5%
c
0.5% 1.2% 0.0% 4.0% 2.0%
Children
Median 0.5% 1.0% 0.0% 3.4% 1.8%
2.5%
c
0.4% 0.8% 0.0% 2.9% 1.5%
97.5%
c
0.6% 1.2% 0.0% 4.3% 2.2%
Cereals
Adults
Median 1.4% 3.3% 0.0% 11.4% 6.8%
2.5%
c
0.7% 2.3% 0.0% 8.2% 5.2%
97.5%
c
2.3% 4.6% 0.0% 15.8% 9.2%
Children
Median 1.4% 3.2% 0.0% 11.2% 6.6%
2.5%
c
0.8% 2.4% 0.0% 8.3% 5.3%
97.5%
c
2.1% 4.1% 0.0% 14.2% 8.2%
Confectionery
Adults
Median 1.0% 2.8% 0.0% 9.5% 5.2%
2.5%
c
0.5% 1.9% 0.0% 6.0% 4.0%
97.5%
c
2.0% 4.4% 0.0% 13.7% 6.7%
Children
Median 1.1% 2.8% 0.0% 9.6% 5.3%
2.5%
c
0.5% 2.0% 0.0% 7.1% 4.3%
97.5%
c
2.1% 4.3% 0.0% 14.4% 6.9%
Snacks
Adults
Median 0.2% 0.5% 0.0% 1.7% 1.0%
2.5%
c
0.1% 0.3% 0.0% 1.1% 0.7%
97.5%
c
0.4% 1.0% 0.0% 3.3% 1.8%
Children
Median 0.2% 0.5% 0.0% 1.5% 0.9%
2.5%
c
0.1% 0.3% 0.0% 1.0% 0.7%
97.5%
c
0.3% 0.7% 0.0% 2.4% 1.4%
a
standarddeviation
b
97.5
th
percentilesofthedistribution
c
2.5%and97.5%valuesdefinea95%credibleintervalaroundtheestimatewiththemedian
d
meanofthestrictlypositiveriskvalues
Table4.Descriptivestatisticsoftheriskofallergicreactiontopeanutpereatingoccasionassociatedwitheachofthesixproducts,for
adultandchildpeanutallergicpopulationgroups
7 Loup Rimbaud, Fanny Hraud, Sbastien La Vieille, Jean-Charles Leblanc and Amlie Crpet: Quantitative Risk
Assessment Relating to the Inadvertent Presence of Peanut Allergens in Various Food Products
www.intechopen.com

Population
Numberof
individuals
Estimator
Individualswith
reaction
a

Number %
Adults
(1879
years)
2624
Median 40 1.5%
2.5%
b
29 1.1%
97.5%
b
56 2.1%
Children
(317years)
1455
Median 54 3.7%
2.5%
b
36 2.5%
97.5%
b
77 5.3%
a
individualswithatleastonereactionduringtheweek
b
2.5% and 97.5% values define a 95% credible interval around the
estimatewiththemedian
Table 5. Number of consumers who would have at least one
allergic reaction to peanut in one week from among the 2624
adults and 1455 children, considering all the eating occasions of
alltheproductsthroughouttheweek
Focusing on the chocolate bars, and including both
contaminated and noncontaminated samples, the
probability of allergic reaction to peanut averaged 2.4%
pereatingoccasion,witha95%credibleinterval(CI95)of
[1.5; 3.6]% for adults (Table 4). The median of the risk
equalled zero, meaning that at least 50% of the eating
occasions induced no risk of reaction. However, 2.5% of
the adults had a risk greater than 12.8% (CI95:
[9.6;17.2]%).Theprobabilityofallergicreactionfollowing
the consumption of a contaminated chocolate bar
averaged6.6%(CI95:[5.0;8.1]%).Nosignificantdifference
wasobservedbetweenchildrenandadults.Inthismodel,
the chocolate bars induced the higher risk, followed by
cereals, confectionery, chocolate tablets, biscuits and
finallysnacks.
The risk for the whole French peanutallergic population
canbeextrapolatedtakingintoaccounttheprevalenceof
peanut allergy in the general population. The 11,792,146
French children aged between 3 and 17 years and the
46,758,489 French adults aged between 18 and 79 years
(INSEE 2009) were multiplied by the prevalence and the
mean risk of allergic reaction per eating occasion.
Therefore, assuming that the whole allergic population
consumeschocolatebars,3,713adults(CI95:[2,312;5,485])
and 1,372 children (CI95: [900; 1,974]) would have a
reaction to peanut, including severe and nonsevere
incidents. This corresponds to respectively 2.0%
(CI95:[1.3;2.8]%) and 2.4% (CI95:[1.5;3.6]%) of the total
adult and child peanutallergic population groups in
France.
3.3Numberofindividualswithallergicreactioninoneweek
Considering all the eating occasions of all the studied
products, 40 adults and 54 children among the INCA2
population group would have at least one reaction to
peanutinoneweek(Table5).Thisrepresentsrespectively
1.5% (CI95: [1.1;2.1]%) and 3.7% (CI95: [2.5;5.3]%) of the
adultandchildpeanutallergicpopulationgroups.

Product Population Estimator Mean SD


a
Median p97.5
b
Positiveriskmean
d
Chocolatetablets
Adults
Median 0.4% 1.0% 0.0% 3.4% 1.7%
2.5%
c
0.3% 0.8% 0.0% 2.6% 1.4%
97.5%
c
0.5% 1.3% 0.0% 4.4% 2.0%
Children
Median 0.4% 1.1% 0.0% 3.5% 1.8%
2.5%
c
0.3% 0.9% 0.0% 2.9% 1.5%
97.5%
c
0.6% 1.3% 0.0% 4.5% 2.1%
Chocolatebars
Adults
Median 1.9% 3.7% 0.0% 12.0% 6.6%
2.5%
c
1.2% 2.6% 0.0% 8.6% 5.0%
97.5%
c
2.8% 4.8% 0.0% 15.9% 8.3%
Children
Median 1.3% 2.8% 0.0% 9.4% 5.2%
2.5%
c
0.9% 2.1% 0.0% 7.3% 4.3%
97.5%
c
1.9% 3.6% 0.0% 12.3% 6.6%
Biscuits
Adults
Median 0.3% 0.9% 0.0% 2.9% 1.7%
2.5%
c
0.2% 0.7% 0.0% 2.3% 1.4%
97.5%
c
0.4% 1.1% 0.0% 3.8% 2.1%
Children
Median 0.3% 0.9% 0.0% 3.1% 1.8%
2.5%
c
0.2% 0.7% 0.0% 2.4% 1.5%
97.5%
c
0.5% 1.2% 0.0% 4.3% 2.4%
a
standarddeviation
b
97.5
th
percentileofthedistribution
c
2.5%and97.5%valuesdefinea95%credibleintervalaroundtheestimatewiththemedian
d
meanofthestrictlypositiveriskvalues
Table6.Descriptivestatisticsoftheriskofallergicreactiontopeanutpereatingoccasionforchocolatetablets,chocolatebarsand
biscuitsincludingtheattitudestowardsfoodprecautionarylabelling
8 Int. food risk anal. j., 2013, Vol. 3, 3:2013 www.intechopen.com

3.4Riskestimateintegratingtheattitudestowardsfood
precautionarylabelling
Of the surveyed peanutallergic individuals 10% and
4% drastically avoid chocolate products and biscuits,
respectively.Incontrast,2%donotpayattentiontothe
labelling of these three products before consumption
(ANSES 2009b). Among the consumers who read the
labelling carefully (88% and 94% for chocolate products
and biscuits, respectively), the reported attitudes are
multiple, and behaviour favouring products labelled as
peanutfree and avoiding products labelled as may
containpeanutissurprisinglynotthemostfrequent.

Theintegrationoftheattitudestowardsthelabellinginto
theriskquantificationledtoadecreaseintheprobability
of allergic reaction (Table 6). Results on attitude toward
chocolate products were used indiscriminately for
chocolate tablets and bars. For example, the mean risk
associatedwithchocolatebarsdecreasefrom2.4%(Table4)
to 1.9% (Table 6) for adults and from 2.0% (Table 4) to
1.3%(Table6)forchildren.Conversely,theprobabilityof
reaction following the consumption of a contaminated
product (Positive risk mean) remained stable for
chocolate bars and even increased for chocolate tablets
and biscuits. Nevertheless, all these changes are not
statistically significant since the CI95 of the risk estimates
forthetwoscenariosoverlap.

The risk for the whole peanutallergic French population


can be extrapolated once again. As a result, 2,624 adults
(CI95: [1,587; 3,886]) and 841 children (CI95: [546; 1,198])
wouldhaveareactiontopeanutaftertheconsumptionof
a chocolate bar. This represents respectively 1.2%
(CI95:[0.8;1.7]%) and 1.7% (CI95: [1.0;2.5]%) of the adult
andchildpeanutallergicpopulationgroups.
4.Discussion
In a context of increasing awareness of the possible
presence of allergens in industrial food products, and a
growing prevalence of food allergy notably in children,
this study applied a model for quantifying the risk of
reaction due to inadvertent presence of peanut allergens
in various food products. Different data from various
sourceshavebeengatheredandmodelledtoestimatethis
allergenic risk. As a result, the eight most likely
contaminated products were identified, and peanut was
found in six of them, in line with the observations of
Madsenet al. (2009). Peanut is not commonly used in the
processeddessertsandbakeryproductsindustries,which
could explain the absence of reported contamination in
data relating to these product. The list of the products
which may inadvertently contain peanut allergen was
builtconsideringavailabledataonpeanutcontamination
frominternationalliterature.Therefore,thislistcouldnot
be exhaustive. To complete it in further works, food
products can be selected considering those consumed by
peanut allergic individuals, and those processed in the
same environment as products containing peanut,
notablythosecarryingthelabelmaycontainpeanut.

The estimates of the probability of reaction per eating


occasion,andofthenumberofallergicindividualswitha
reaction in one week showed that a majority of the
peanutallergic population group incurs no risk by
consumingthestudiedproducts.However,reactionscan
occur for a part of the peanutallergic individuals who
havealowclinicalthresholdwhilebeinghighlyexposed
to peanut allergens. Our modelling indicates that
chocolate bars, cereals and confectionery present the
highest risk to peanut allergic consumers. However, we
acknowledgethatthepeanutcontaminationdata usedin
this study date from 1995 to 2006 and may not reflect
currentallergencontrolpracticesfortheseproducts.

The results of the internet survey on attitudes of the


allergicpopulationgroupsuggestedthatallergicindividuals
are very careful with regard to food product labelling,
although attitudes are very different from one consumer
to another. Indeed, some allergic individuals will favour
peanutfree products and avoid may contain peanut
products, whereas others will consume products bearing
may contain peanut in spite of the potential presence of
allergens.Theresultsofthissurveyshouldbemoderated
bythefactthatsurveyedindividualsmaybeparticularly
concernedbytheirallergicstatussincetheyarevisitorsto
thewebsiteofaFrenchfoodallergyassociation.

Taking into account the various attitudes toward


precautionary labelling led to a decrease in the risk
estimates, except in the mean of the strictly positive risk
values. The decrease in the probability of reaction
between the two scenarios (in the first one, allergic
consumers have no specific attitude toward the different
precautionary labelling and the second one integrates
their specific attitude as declared in the internet survey)
was mainly due to the fact that in the second scenario
some individuals can eat product carrying peanutfree
labelling,forwhichpeanutcontaminationistheoretically
considered absent. For both scenarios, positive risks are
similar because the peanut concentration levels in
contaminatedproductsbearingthedifferentprecautionary
labellingwereofthesameorderofmagnitude.

Several sources of risk overestimation have to be


considered. We made the assumption that bibliographic
contamination data from European and NorthAmerican
markets were representative of the French market.
However, some differences can be observed between
concentration levels extracted from NorthAmerican
studies(cerealsandconfectionery)andtheothercategories
collected from European surveys, with higher
9 Loup Rimbaud, Fanny Hraud, Sbastien La Vieille, Jean-Charles Leblanc and Amlie Crpet: Quantitative Risk
Assessment Relating to the Inadvertent Presence of Peanut Allergens in Various Food Products
www.intechopen.com

concentrations for the formers. If these differences also


exist with the French market, the risk may have been
overestimated. This points to the need for data on the
presence of allergens in food at the national level.
Moreover,riskcalculationscanalsoberefinedifsufficient
datacanbecollectedtodistinguishcontaminationbetween
productswithandwithoutprecautionarylabelling.

Anothersourceofoverestimationisduetotheselectionof
patients in the DBPCFC tests. Indeed, patients who
participate in clinical tests often feel very concerned by
their food allergy and they may be more reactive (have
lower thresholds) than the general allergic population
group.AsdiscussedbyRimbaudetal.(2010),thisseemsto
be particularly the case for adults. Based on the data we
collated from the published literature, we found the
thresholdsofreactionforadultstobelowerthanthosefor
children(datanotshown),whichisnotinaccordancewith
clinicaldata(MoneretVautrinandKanny2004;Hourihane
etal.2005).Toreducethisimpact,theresultsofadultsand
childrenDBPCFCtestswerepooledtoestablishonesingle
doseresponse curve. Moreover, the results of this study
have to be moderated because all thresholds associated to
various types of reaction from nonsevere incidents (oral
itching for example) to serious event (anaphylaxis), were
treated equivalently inthiswork. Effortstoacquire dataon
thresholds of reaction will permit to refine allergic risk
assessment by integrating data on the severity of allergy.
Moreover,thisstudyhasrevealedanimpactofconsumption
behaviours on risk estimates, therefore a survey combining
consumptionbehavioursandthresholdsofallergicsufferers
willbethemostappropriatetorefineriskassessment.

This approach can be implemented as a tool for risk


managers, manufacturers or public administrations.
Indeed, a retrocalculation based on the definition of an
acceptable risk could help to decide whether to use
precautionary labelling. Moreover, for physicians, the
exposure estimates can act as a guideline when defining
allergen doses for DBPCFC tests, a dosing scheme
corresponding to the real exposure scheme. Finally, this
approachcouldalsobeappliedtoguidethephysiciansto
make recommendations to their patients based on
quantified results such as to avoid specific products
consideringtheirindividualclinicalthreshold.
5.Acknowledgment
The authors wish to thank the French Association for
Allergy Prevention (AFPRAL) for their joint effort to the
internet survey on food behavior of people with food
allergies.
6.Disclosureofpotentialconflictofinterest
The authors have declared that they have no conflict of
interest
7.Abbreviations
AFPRALFrenchAssociationforAllergyPrevention
ANSES French Agency for Food, Environmental and
OccupationalHealthSafety
CI9595%credibleinterval
DBPCFCDoubleBlindPlaceboControlledFoodChallenge
ELISA:EnzymeLinkedImmunoSorbentAssay
PCR:PolymeraseChainReaction
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11 Loup Rimbaud, Fanny Hraud, Sbastien La Vieille, Jean-Charles Leblanc and Amlie Crpet: Quantitative Risk
Assessment Relating to the Inadvertent Presence of Peanut Allergens in Various Food Products
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