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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).
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
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
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.
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).
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.
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.
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.
[12] INSEE.(2009).Bilandmographique2008.Retrieved
Jun15,2009,from
http://www.insee.fr/fr/themes/detail.asp?reg_id=99&
ref_id=bilandemo.
[13] Kanny, G., D. A. MoneretVautrin, J. Flabbee, E.
Beaudouin, M. Morisset and F. Thevenin (2001).
Population study of food allergy in France. J
AllergyClinImmunol108(1):133140.
[14] KeckGassenmeier, B., S. Bnet, C. Rosa and C.
Hischenhuber (1999). Determination of peanut traces
infoodbyacommerciallyavailableELISAtest.Food
andAgriculturalImmunology11(3):243250.
[15] Luccioli, S., M. Ross, J. LabinerWolfe and S. B. Fein
(2008). Maternallyreportedfoodallergiesandother
foodrelated health problems in infants:
Characteristics and associated factors. Pediatrics
122(2):105112.
[16] Madsen,C.B.,S.Hattersley,J.Buck,S.M.Gendel,G.
F.Houben,J.O.Hourihane,A.Mackie,E.N.Mills,P.
Norhede, S. L. Taylor and R. W. Crevel (2009).
Approaches to risk assessment in food allergy:
report from a workshop developing a framework
for assessing the risk from allergenic foods. Food
ChemToxicol47(2):480489.
[17] MoneretVautrin, D. A. (2008). Epidmiologie de
lallergiealimentaire.RevueFranaisedallergologie
etdimmunologieclinique48:171178.
[18] MoneretVautrin,D.A.andG.Kanny(2004).Update
onthresholddosesoffoodallergens:implicationsfor
patients and the food industry. Curr Opin Allergy
ClinImmunol4(3):215219.
[19] Osterballe, M., T. K. Hansen, C. G. Mortz, A. Hst
and C. BindslevJensen (2005). The prevalence of
food hypersensitivity in an unselected population of
children and adults. Pediatric Allergy and
immunology16:567573.
[20] Pel,M.,M.Brohee,E.AnklamandA.J.VanHengel
(2007). Peanut and hazelnut traces in cookies and
chocolates: relationship between analytical results
and declaration of food allergens on product labels.
FoodAdditContam24(12):13341344.
[21] Pouillot, R., N. Miconnet, A. L. Afchain, M. L.
DelignetteMuller, A. Beaufort, L. Rosso, J. B. Denis
and M. Cornu (2007). Quantitative risk assessment
of Listeria monocytogenes in French coldsmoked
salmon: I. Quantitative exposure assessment. Risk
Anal27(3):683700.
[22] Ranc, F. and E. Bidat (2000). Allergie alimentaire
chezlenfant,Mdecine&Hygine,Chapter5,p71.
[23] Ranc, F., X. Grandmottet and H. Grandjean (2005).
Prevalence and main characteristics of
schoolchildren diagnosed with food allergies in
France.ClinExpAllergy35(2):167172.
[24] Rimbaud, L., F. Hraud, S. La Vieille, J. C. Leblanc
and A. Crpet (2010). Quantitative risk assessment
related to adventitious allergens in food: a
probabilistic model applied to peanut in chocolate.
RiskAnalysis30(1):719.
[25] Rder, M., A. Ibach, I. Baltruweit, H. Gruyters, A.
Janise, C. Suwelack, R. Matissek, S. Vieths and T.
Holzhauser (2008). Pilot plant investigations on
cleaning efficiencies to reduce hazelnut cross
contamination in industrial manufacture of cookies.
JFoodProt71(11):22632271.
[26] Schppi, G. F., V. Konrad, D. Imhof, R. Etter and B.
Wuthrich (2001). Hidden peanut allergens detected
in various foods: findings and legal measures.
Allergy56(12):12161220.
[27] Stephan, O. and S. Vieths (2004). Development of a
realtimePCRandasandwichELISAfordetectionof
potentially allergenic trace amounts of peanut
(Arachishypogaea)inprocessedfoods.JAgricFood
Chem52(12):37543760.
[28] Vadas, P. and B. Perelman (2003). Presence of
undeclaredpeanutproteininchocolatebarsimported
fromEurope.JFoodProt66(10):19321934.
[29] Venter, C., B. Pereira, K. Voigt, J. Grundy, C. B.
Clayton,B. Higgins,S. H.Arshadand T. Dean (2008).
Prevalence and cumulative incidence of food
hypersensitivity in the first 3 years of life.Allergy 63
354359.
[30] Werfel, T. (2008). Food allergy. J Dtsch Dermatol
Ges6(7):573583.
[31] Yeung, J. M. and P. G. Collins (1996). Enzyme
immunoassay for determination of peanut proteins
infoodproducts.JAOACInt79(6):14111416.
[32] Zuberbier, T., G. Edenharter, M. Worm, I. Ehlers, S.
Reimann, T. Hantke, C. C. Roehr, K. E. Bergmann
and B. Niggemann (2004). Prevalence of adverse
reactions to food in Germany A population study.
Allergy59:338345.
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
www.intechopen.com