Frequency and severity of allergic reactions to non-mandatory labelled allergenic foods—data from two large European cohorts

Sabine Dölle-Bierke; Alejandro Gonzalo-Fernández; Dominique Sabouraud-Leclerc; Laura Barreales-Tolosa; Barbara Ballmer-Weber; Simona Belohlavkova; Maria B Bilò; Rūta Dubakienė; 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

doi:10.1111/all.70308

Title	Frequency and severity of allergic reactions to non-mandatory labelled allergenic foods—data from two large European cohorts
Authors	Dölle-Bierke, Sabine ; Gonzalo-Fernández, Alejandro ; Sabouraud-Leclerc, Dominique ; Barreales-Tolosa, Laura ; Ballmer-Weber, Barbara ; Belohlavkova, Simona ; Bilò, Maria B ; Dubakienė, Rūta ; Hartmann, Karin ; Jedrzejczak-Czechowicz, Monika ; Le, Thuy-My ; Lange, Lars ; Papadopoulos, Nikolaos G ; Pouessel, Guillaume ; Reig, Isabel ; Sinaniotis, Athanasios ; Mills, E. N. Clare ; Worm, Margitta ; Fernández-Rivas, Montserrat
DOI	10.1111/all.70308
Full Text
Is Part of	Allergy.. European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.. 2026, Early Access, p. [1-12].. ISSN 0105-4538. eISSN 1398-9995
Keywords [eng]	anaphylaxis ; codex ; non-mandatory labelling ; pea ; seeds ; severity
Abstract [eng]	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.
Published	European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd
Type	Journal article
Language	English
Publication date	2026
CC license

„Frequency and severity of allergic reactions to non-mandatory labelled allergenic foods—data from two large European cohorts“