Frequency and Severity of Allergic Reactions to Non‐Mandatory Labelled Allergenic Foods—Data From Two Large European Cohorts
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The consumption of plant-based food has lately largely increased, raising concerns about allergic reactions from ingredients which are currently not subject to mandatory labelling. METHODS: We analysed the frequency and severity of allergic reactions to non-mandatory labelled allergenic foods (pea, lentil, bean, chickpea, fenugreek, pine nut, sunflower-, poppy-, pumpkin seed, buckwheat) from two large European cohorts: The Anaphylaxis Registry (NORA) and EuroPrevall outpatient clinic study. Severity was assessed using the Food Allergy Severity Score (FASS) and compared with reactions to mandatory labelled allergenic foods. RESULTS: Among 589 reactions from both cohorts, sunflower seed was the most frequent trigger (n = 126). In NORA, pine nut (1.0% of food-induced allergic reactions) was most common followed by pea and buckwheat (0.7% each); in EuroPrevall, sunflower seed (1.2%), poppy seed (0.6%) and lentil (0.6%) predominated. After adjusting for age and sex, the severity of reactions to mandatory labelled seeds and legumes (excluding peanut) were not different (nFASS median: 4.39 vs. 4.43 and 4.56 vs. 4.49). Whereas, cereal-induced reactions (6.47) were significantly more severe than buckwheat (4.77). In Nora, the number of reactions to fenugreek and pumpkin seed were 7.4- and 3.7-fold higher in 2015-2022 versus 2007-2014. CONCLUSION: Non-mandatory labelled allergenic foods were identified to cause severe allergic reactions in two large European cohorts. The frequent involvement of sunflower seed, pine nut, pea and lentil, but also rising numbers of reactions to fenugreek and pumpkin seed, indicates their potential risk. These allergenic foods warrant close monitoring and consideration in future allergen labelling revisions.
Source: Allergy
DOI: 10.1111/all.70308
Authors: Sabine Dölle‐Bierke, Alejandro Gonzalo‐Fernández, Dominique Sabouraud‐Leclerc, Laura Barreales‐Tolosa, Barbara Ballmer‐Weber, Simona Belohlavkova, Maria B. Bilò, Ruta Dubakiene, Karin Hartmann, Monika Jedrzejczak‐Czechowicz, Thuy‐My Le, Lars Lange, Nikolaos G. Papadopoulos, Guillaume Pouessel, Isabel Reig, Athanasios Sinaniotis, E. N. Clare Mills, Margitta Worm, Montserrat Fernández‐Rivas
Institutions: Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Centre Hospitalier Universitaire de Reims, Hospital Clínico San Carlos, Kantonsspital St. Gallen, University Hospital Zurich, Marche Polytechnic University, Azienda Ospedaliero-Universitaria delle Marche, Vilnius University, University of Basel, University Hospital of Basel, Medical University of Lodz, Utrecht University, University Medical Center Utrecht, St. Marien-Hospital Bonn, National and Kapodistrian University of Athens, University of Manchester, Université de Lille, Centre Hospitalier Universitaire de Lille, Centre Hospitalier de Roubaix, Hôpital Jeanne de Flandre, Réseau d'Allergo-Vigilance, Evaluation des technologies de santé et des pratiques médicales, Hospital Universitario Doctor Peset, University of Surrey, Wythenshawe Hospital
Language: English
Subfield: Immunology and Allergy
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,300
OpenAlex ID: W7140212034