Evidence mapPaperPMID 42598065Full record

ReviewThe World Allergy Organization journal2026

World Allergy Organization (WAO) Consensus on the use and practice of precautionary allergen labelling: The international ACT-UP! e-Delphi.

Antonio Bognanni, Bernardo Sousa-Pinto, Mario Morais-Almeida, Bryan Martin, Motohiro Ebisawa, Ignacio J Ansotegui, Gary Wong, Alexandro W L Chu, Antonio Quartucci, Barbara Ballmer Weber and 29 more

Abstract readReview
In one paragraph

Review in The World Allergy Organization journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

39 authors.

Antonio BognanniDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Bernardo Sousa-PintoMEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
Mario Morais-AlmeidaAllergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
Bryan MartinMedicine and Pediatrics, The Ohio State University in Columbus, Columbus, OH, USA.
Motohiro EbisawaSagamihara National Hospital, Sagamihara, Japan.
Ignacio J AnsoteguiHospital Quironsalud Bizkaia, Bilbao, Spain.
Gary WongThe Chinese University of Hong Kong, Hong Kong, China.
Alexandro W L ChuEvidence in Allergy Group, McMaster, Canada.
Antonio QuartucciObstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, Milan, Italy.
Barbara Ballmer WeberDepartment of Dermatology, University Hospital Zürich, Zürich, Switzerland and Clinic for Dermatology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Elizabeth N Clare MillsUniversity of Manchester, Manchester, United Kingdom.
Derek K ChuDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Elham HossnyPediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.
Graham RobertsUniversity Hospital Southampton, Southampton, United Kingdom.
Jennifer GerdtsFood Allergy Canada, Toronto, Ontario, Canada.
Jennifer KoplinChild Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.
Joan BartraAllergy Department, Hospital Clinic and IDIBAPS. Universitat de Barcelona, Spain.
Lapo Alvise DetassisHumanitas University, Milano Italy.
Edoardo CavagliàDepartment of Biomedical Sciences, Humanitas University, Milano, Italy.
Jonathan O'B HourihanePaediatrics and Child Health, Royal College of Surgeons Ireland, Dublin, Ireland.
Juan J Yepes-NuñezSchool of Medicine, Universidad de Los Andes, Bogotá, Colombia.
Julie BarnettDepartment of Psychology, University of Bath, United Kingdom.
Linda MonaciInstitute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy.
Luciana TannoSanas Epidemiology and Research, Sao Paulo, Brazil.
M Hazel GowlandAllergy Action, St Albans, United Kingdom.
Marion GroetchIcahn School of Medicine at Mount Sinai, New York, NY, USA.
Marjan Van RavenhorstAllergenen Consultancy BV, Scherpenzeel (Gld), the Netherlands.
Michael LevinDivision of Paediatric Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
Philippe EigenmannPediatric Allergy Unit, University of Geneva, Switzerland.
Ruchi GuptaNorthwestern University, Chicago, IL, USA.
Sabine SchnadtDeutscher Allergie- und Asthmabund (DAAB) (Moenchengladbach, D), Germany.
Sébastien La VieilleFood Directorate, Health Canada, Ottawa, ON, Canada.
Simon Brooke-TaylorBrooke-Taylor & Co Pty Ltd, Milawa, Victoria, Australia.
Sophia TsabouriEFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) and Child Health Department, University of Ioannina School of Medicine, Ioannina, Greece.
Stefania ArasiAllergy Unit, Pediatric Hospital Bambino Gesù IRCCS, Rome, Italy.
Torsten ZuberbierInstitute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Vincenzo FierroAllergy Unit, Pediatric Hospital Bambino Gesù IRCCS, Rome, Italy.
Paul J TurnerImperial College London, London, United Kingdom.
Alessandro FiocchiAllergy Unit, Pediatric Hospital Bambino Gesù IRCCS, Rome, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: The Food and Agriculture Organization (FAO) of the United Nations and the World Health Organization (WHO) recently convened an expert consultation to address the increasing but inconsistent use of Precautionary Allergen ("may contain") Labelling (PAL). Objectives: We conducted a Delphi study to explore the perspectives of clinicians, patient representatives, and other interest-holders on PAL practice. Methods: We followed previous guidance on Delphi study development and reporting. A narrative review exploring the FAO/WHO Expert Consultation informed the Delphi process. The working group generated 35 items based on the review of FAO/WHO consultation, categorized into 7 domains: (i) Importance of the issue, (ii) Informing use of PAL, (iii) Action level cut-offs, (iv) Communication, (v) Liability considerations, (vi) Free From statements, and (vii) Areas for further research. Items underwent 3 iterative Delphi rounds involving a panel of 35 experts who rated their agreement narratively and on a 5-point Likert scale. Consensus was defined as ≥70% consistency in agreement or disagreement (excluding neutral responses); stability was defined as <10% variation in average scores across rounds. A public consultation was held to collect different viewpoints arising from the consensus activity. Results: The Delphi was concluded after 3 rounds with consensus achieved for 33/35 items. Response rate was 100% across all 3 rounds. The panel strongly agreed that PAL should only be applied when an unintended allergen may be present above a cut-off (action level) and that it should always be based on a formal risk assessment, preferably quantitative, and mandated through legislation. Furthermore, action levels should be based on "reference doses" (amount of total allergenic protein), rather than on a concentration (eg, 10 ppm), and more specifically on population-adjusted eliciting doses ED Conclusions: This Delphi explored a comprehensive set of statements across multiple aspects of PAL development, application, and communication. On the one hand, it provides systematically derived considerations, aligned with the FAO/WHO consultation recommendations, to support future harmonization of practices. On the other, it highlights several areas of uncertainty to prioritize for future research.

Indexed as

AnaphylaxisCodexFAO/WHOFood allergyFood labellingPrecautionary allergen labellingPrepackedRisk communicationRisk management

Identifiers

PMID42598065
PMCPMC13470184

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.