1. Svetlana Sergejeva, MD, PhD allergofood@ut.ee

2. Estonian Biotechnology Programme

3. Preamble In accordance to the requirements set by the European parliament and the council in the regulation (EU) no 1169/2011 on the provision of food information to consumers, food producers are obligated to assess and appropriately notify consumers about 13 potential allergies or intolerances causing substances and products in their manufacture.

4. MANDATORY FOOD INFORMATION List of mandatory particulars 1. In accordance with Articles 10 to 35 and subject to the exceptions contained in this Chapter, indication of the following particulars shall be mandatory: (1) the name of the food; (2) the list of ingredients; (3) any ingredient or processing aid listed in Annex II or derived from a substance or product listed in Annex II causing allergies or intolerances used in the manufacture or preparation of a food and still present in the finished product, even if in an altered form; ….. (12) European parliament and the council in the regulation (EU) no 1169/2011

5. Food allergy A true rise in prevalence over the past 10 to 20 years The symptoms can range from mild to severe and, in rare cases, can lead to anaphylaxis, a severe and potentially life-threatening allergic reaction Currently, the only treatment is the management of symptoms as they appear and avoidance of the causative food Most common food allergens are highly prevalent in the diet, patients and their families must remain constantly vigilant. This may occasionally lead to malnutrition that is of major importance in childhood and it changes quality of life in a profoundly negative way causing anxiety about severe reactions Food labelling regarding food allergens is essential to help allergic consumers manage their conditions

6. Problem in Estonia? The last data about childhood food allergy more than 10 years old. Published data on adults not available!

7. Atopic dermatitis In 93/94: at the age of 1 10.5% In 93/94 at the age of 2 15% In 93/94 at the age of 6-7 12% In 93/94 at the age of 13-14 8% In 96/97 at the age of 1 7% In 96/97 at the age of 2 12% In 96/97 at the age of 10-12 6% In 01/02 at the age of 6-7 13.5% In 01/02 at the age of 13-14 9.5% Born 07/08 at the age of 1 30% (unpublished)

8. Sensibilisation in kids till 5 y.o Milk: –born 93/94 2% –born 97/98 7% Egg white: –born 93/94 5% –born 97/98 6.5%

9. Aim I Determination of food allergy and sensitization causing food allergens in Estonian population

10. Allergofood Started on 20.05.13, evaluated 2 y.o kids Atopic dermatitis 29.2%, up to 50% (currently unconfirmed; in query on demand) Urticaria 2%, up to 10.5 % (currently unconfirmed; in query on demand) Gastroenteritis 4% 35%! Asthma 6.25%, up to 18.75% (currently unconfirmed; in query on demand)

11. Allergens Egg white 12.5% Nuts 4% Fish 2% Fruits and vegetables 16%

12. Adults 20-44 (2001, unpublished) Self reported: Milk 22.5% Egg 7.5% Hazelnut 1.5% 2013 Allergofood study: same people are evaluated by the specialist regarding food allergy

13. Gluten 1976-2010 156 people (up to 19 years old) has been diagnosed. Prior 1976 incidence rate 0.1/100 000 person- years, 2010 3.14/100 000 person-years Estimate (born 1940-2013) ~ 350 people

14. Aim II Development of quantitative and qualitative allergen testing on protein and DNA level in food

15. Annex II: to be labeled Cereals (gluten) Crustaceans Molluscs Egg Fish Peanuts Soybeans Milk Nuts: Almonds, Hazelnuts, Walnuts, Cashews, pecan nuts, Brazil nuts, pistachio nuts, macadamia nuts Celery Mustard Sesame Lupin European parliament and the council in the regulation (EU) no 1169/2011

16. Thresholds 0 -1.0 mg of protein 10% responders For instance: –Peanuts 0,78mg ~ 38ng DNA (1 peanut weights ~ 1g) –Hazelnuts 0,43mg ~ 16ng DNA (1 hazelnut weights ~ 2g) Recent data indicate that more severe patients can react to traces of allergen!!!

17. Currently developed (not yet accredited) Cereals (gluten) Crustaceans Molluscs Egg Fish Peanuts Soy (DNA) Milk Nuts: Almonds, Hazelnuts, Walnuts, Cashews, Pecan nuts, Brazil nuts, Pistachio nuts (DNA), macadamia nuts Celery Mustard (DNA) Sesame (DNA) Lupin ALERGOFOOD 01.11.2012-01.08.2013

18. Make your food safer! Allergofood@ut.ee