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ALLERGIC REACTIONS TO FOOD IN SWEDEN
National Food Administration, Box 622, SE 751 26 Uppsala, Sweden
Proteins from milk, egg, tree nuts, peanuts and other legumes are common allergens for a large group of allergic individuals, both children and adults. Ingestion of the offending food may lead to severe allergic reactions that can even become life threatening.
In Sweden, the National Food Administration (NFA) since 1990 has registered 143 cases of adverse reactions to food. In all cases the offending foods were compound products were the ingredient were either hidden to the consumer as a cause of inadequate labelling (69 cases) or because the food was contaminated with the ingredient (50 cases). In 24 of the cases, the ingredient was inadvertently consumed.
The highest numbers of cases are caused by milk (36 cases), followed by peanuts (24 cases), tree nuts (22 cases) and egg (19 cases). However, the most severe reactions are caused by peanuts (17 cases) and soy (9 cases), followed by hazelnuts (8 cases). Typical foods where peanuts have been detected are bakery products, chocolate and ice cream. In most cases the products were mislabelled. Recently also Asian foods account for a growing number of reactions to peanuts.
Tree nuts and seeds are most often detected as contaminants in chocolate but also in bakery products, bread, müsli and ice cream.Soy has caused severe anaphylactic reaction leading to deaths in peanut allergic individuals inadvertently consuming meatballs, hamburgers and sausages containing high amounts of soy protein.
In egg allergic children and adults, five of the recorded 19 reactions were caused by lysozyme, added as preservative in cheese. In some of the cases the lysozyme was not declared. However, even when declared as preservative E 1105 it was not easily recognised as an egg allergen by the consumer.
Methods to detect proteins involved in allergic reaction are mainly based on specific antibodies raised in rabbits. Levels of protein at 10-20 ppm are typically detected by simple immunoassays as immunodiffusion and immunoblotting. For quantitative purposes rocket immunoelectrophoresis and ELISA are being used. However, the availability of antiserum to single proteins as well as the specificity might be a problem. Adsorption of the antiserum is a necessary step to reduce overlapping specificity.
Recently we have introduced real-time PCR and specific primers to detect DNA from tree nuts, legumes, sesame seeds and cereals as a complement to protein methods. The technique, based on melting curve analysis, is highly specific for the target and can thus be used as a confirmatory method to protein assays. However, currently the method is only qualitative or semi-quantitative. For quantitative purposes only protein methods can be used. In some of the cases reported to the NFA, we have had the possibility of not only detecting the causative protein but also to estimate the dose causing the allergic reaction. For hazelnut protein, a dose of about 1 mg of corylin in chocolate caused asthma, vomiting, urticaria and emergency treatment in both children and adults. For casein, the dose ranged from less than 1 mg of casein in candies causing emergency treatment of a 6 years old girl to several hundreds of mg causing stomach pain, vomiting and diarrhoea. A dose equivalent to 60 mg of casein in a sausage caused fatal
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