Food Anaphylaxis: Eight Food Allergens Without Mandatory Labelling Highlighted by the French Allergy-Vigilance Network.

Background: The European Regulation list on mandatory labelling of foods includes 14 allergenic foods; however, other foods are also frequently implicated in food-induced anaphylaxis (FIA).

Methods: We analysed FIA cases reported to the Allergy Vigilance Network from 2002 to 2023. Allergenic foods involved in ≥ 1% of cases and not included in the list were assessed as emerging food allergens (EFA). We assessed their frequency, severity (Ring classification), recurrence, and potential presence in hidden form to determine which allergens might warrant inclusion on the list.

Results: Among 2999 FIA cases (Ring grades 2-4), 413 cases (13.8%) met the selection criteria, divided into eight allergenic foods or food groups: goat's and sheep's milk (GSM, n = 84; 2.8% of the cases), buckwheat (n = 71; 2.4%), peas and lentil (n = 55; 1.8%), alpha-gal (n = 50; 1.7%), pine nut (n = 49; 1.6%), kiwi (n = 44; 1.5%), beehive products (n = 30; 1.0%), and apple (n = 30; 1.0%). Severe reactions (Ring grades 3 and 4) were reported with GSM (46.8% and 4.8%, respectively, including two fatalities), buckwheat (46.5% and1.4%), peas-lentil (20% and 1.8%), alpha-gal (54% and 8%), and Grade 3 reactions were reported with pine nut in 49%, kiwi 54.5%, beehive products 33.3% and apple 46.7%. Recurrent reactions and hidden exposures were reported with GSM (56% and 15.5%), buckwheat (49.3% and 16.9%), peas-lentil (7.3% and 9.0%) and pine nut (12.2% and 4.1%).

Conclusion: We identified eight foods frequently involved in FIA and not currently listed in the European regulation. Given their frequency, severity, recurrence, and potential for hidden exposure, we propose that four-goat's and sheep's milk, buckwheat, peas-lentil, and pine nut-be considered for inclusion in the list.