The threshold concept in food safety and its applicability to food allergy.

Down the years there have been many clinical reports of exquisite sensitivity to low doses of food allergens. There are many factors that may contribute to a variation of threshold in an individual exposed to an allergen during the course of his or her daily life. Some of these factors are intrinsic and unavoidable. Other factors may be predictable but not easily controllable, such as asthma, exposure to allergens during the pollen season and predicting situations that may be risky. Other factors may be out of the control of the individual. The most important one of these is the adequate training and awareness of manufacturers and caterers who aim to provide safe and nutritious meals to their allergic and non-allergic customers alike. Clinical histories of reactions in the community and the use of labial exposure during food challenge show that most non-ingestion exposures to peanut usually result in easily treated minor reactions. Formal, oral food challenges have shown that low dose reactivity is relatively common but studies have not yet had the power to investigate whether peanut allergy is more commonly associated with very low dose reactivity than other foods. This means that industry must not concentrate only on peanut and tree nuts when looking at issues of contamination just because they are associated with the majority of severe reactions. There are more milk and egg allergic children in the general population and they deserve the same protection from allergen exposure as sufferers of peanut or tree nut allergies.