Hidden allergens in foods and implications for labelling and clinical care of food allergic patients.

The prevalence of precautionary labelling remains high. This prevalence restricts food choices, in some cases perhaps unnecessarily, for food allergic consumers. During processing, cross-contamination does often occur in food products due to the way that modern processing facilities operate; however, zero risk of cross contamination is not a realistic expectation. There is evidence to suggest that threshold levels below which reactions are not provoked in allergic individuals do exist and these have been established in the literature for peanuts. Additional information such as understanding threshold levels will be important to this field of research. The data that will be obtained from future clinical trials will help to underpin action plans for precautionary labelling. This paper will review the current literature that is available regarding: consumer behaviour and attitudes regarding precautionary labelling; risk to the consumer and analytical results of products that bear advisory labelling; the current debate regarding whether a tolerable level of risk can be obtained in food allergy; and finally, the newly introduced Voluntary Incidental Trace Allergen Labelling (VITAL) system operating in Australia.