Tree nut allergy and anxiety related factors modulate food consumption behaviour in peanut-allergic patients: Results of the MIRABEL survey

Abstract Background In the absence of specific data on food consumption of allergic consumers, general population surveys are used for risk assessment. Most of allergy risk assessment's experts advise that an understanding of the food consumption habits of people with food allergies is crucial for correctly estimate the risk. Objective This study aims to detail the food consumption of patients with peanut allergy including products with precautionary allergen labelling (PAL) and to identify the factors influencing their consumption behaviour. Methods The MIRABEL study is a multi-center survey of peanut-allergic patients from France, Belgium and Luxemburg. It includes data on medical, socio-demographic, and consumption of different food categories, including products with PAL. Anxiety score and allergy severity level variables were constructed and studied as potential consumption determinants. To study the association of modulator variables with food consumption, a logistic regression model was built to test the association with food category and ingredient choice. Results 443 of the 785 patients from MIRABEL survey were included in the consumption study. Tree nut allergy, knowledge of threshold dose, label reading and anxiety score significantly influenced the consumption of products which may contain unintended traces of peanut. The direction of influence depended on food categories and ingredient choices. Diet advice by allergists, severity of the allergy and threshold dose determined by oral food challenge did not significantly impact consumption. Conclusions and clinical relevance: It showed, for the first time, that consumption of food products by peanut-allergic patients, including those with PAL, is modulated by factors related to anxiety such as label reading and knowledge of threshold and concomitant tree nut allergy. Knowledge of peanut-allergic food behaviours will make it possible to improve risk assessment and help allergists and risk managers to make diet advices.