Impacts of Milk Fraud on Food Safety and Nutrition with Special Emphasis on Developing Countries : Health impacts of milk fraud . . .

Food fraud, including the more defined subcategory of economically motivated adulteration, is a food risk that is gaining recognition and concern. Regardless of the cause of the food risk, adulteration of food is both an industry and a government responsibility. Food safety, food fraud, and food defense incidents can create adulteration of food with public health threats. Food fraud is an intentional act for economic gain, whereas a food safety incident is an unintentional act with unintentional harm, and a food defense incident is an intentional act with intentional harm. Economically motivated adulteration may be just that-economically motivated-but the food-related public health risks are often more risky than traditional food safety threats because the contaminants are unconventional. Current intervention systems are not designed to look for a near infinite number of potential contaminants. The authors developed the core concepts reported here following comprehensive research of articles and reports, expert elicitation, and an extensive peer review. The intent of this research paper is to provide a base reference document for defining food fraud-it focuses specifically on the public health threat-and to facilitate a shift in focus from intervention to prevention. This will subsequently provide a framework for future quantitative or innovative research. The fraud opportunity is deconstructed using the criminology and behavioral science applications of the crime triangle and the chemistry of the crime. The research provides a food risk matrix and identifies food fraud incident types. This project provides a starting point for future food science, food safety, and food defense research.

Peanut (PN) and tree nut (TN) allergies are potentially life-threatening, rarely outgrown, and appear to be increasing in prevalence. However, there is relatively little reported about the clinical features of acute reactions to these foods and their potential association. To describe the clinical features of acute reactions during initial and subsequent accidental ingestions of PN and TN among children with a history of at least one acute allergic reaction to these foods. Questionnaire survey, examination, and serologic testing for specific IgE antibody of patients with convincing histories of acute reactions (at least one organ system involved within 60 minutes of ingestion) to PN or TN. A total of 122 patients (63% males; median age, 8 years at time of study) had acute reactions; 68 had reactions only to PN, 20 only to TN, and 34 to both PN and TN. Of those reacting to TN, 34 had reactions to one, 12 to two, and 8 to three or more different TN, the most common being walnut, almond, and pecan. Initial reactions usually occurred at home (median age, 24 months for PN and 62 months for TN) and were considered to result from a first exposure in 72% of cases. Eighty-nine percent of the reactions involved the skin (urticaria, angioedema), 52% the respiratory tract (wheezing, throat tightness, repetitive coughing, dyspnea), and 32% the gastrointestinal tract (vomiting, diarrhea). Two organ systems were affected in 31% of initial reactions, and all three in 21% of reactions. Thirty-eight of 190 first reactions to PN or TN were treated with epinephrine. Accidental ingestions occurred in 55% of PN-allergic children (average of two accidents per patient with an accidental ingestion) and in 30% of TN-allergic children over a median period of 5.5 years. On average, symptoms after accidental exposure were generally similar to those at initial exposure. Accidents occurred commonly in school but also at home and in restaurants. Modes of accidental ingestion included sharing food, hidden ingredients, cross-contamination, and school craft projects using peanut butter. Eighty-three percent of the children were breastfed, with >90% of the mothers ingesting PN and at least one TN during lactation. Among patients reporting no history of exposure (>60% of patients for each TN), IgE antibodies were found to a particular TN in 50% to 82% of patients and to PN in 100% of patients. Acute allergic reactions to PN occur early in life. PN and TN allergic reactions coexist in one third of PN-allergic patients, frequently occur on first known exposure, and may be life-threatening, requiring emergency treatment. Accidental ingestions are common, occur frequently outside of the home, and often require emergency treatment. Consequently, early diagnosis followed by education on avoidance and treatment measures (including self-administered epinephrine) is imperative.