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  • The lack of labeling for some foods (restaurant items and individual candies are examples).
  • The numerous and often confusing terms used to describe these foods and ingredients derived from them (casein and whey are not known as milk components to many consumers).
  • The existence of cross-reacting foods. For example, milk from all species and eggs from all species tend to be cross-reactive (21, 22); however, peanuts are legumes, but most peanut-allergic individuals can eat other legumes without difficulty (23).

Cell-Mediated Food Allergies

Celiac disease is an example of a cell-mediated type of food allergy. Cell-mediated food allergies are sometimes called delayed hypersensitivity reactions because symptoms develop 2472 hours after ingestion of the offending food (24). Celiac disease is associated with a cell-mediated, localized inflammatory reaction in the intestinal tract (25). Wheat, rye, barley, triticale, spelt and kamut are the offending foods in celiac disease (15, 26). Oats were once thought to be associated with celiac disease as well, but recent evidence discounts their role (27). The illness manifests as a malabsorption syndrome, because the localized inflammatory process destroys the absorptive functions of epithelial cells lining the small intestine. The symptoms include body wasting, anemia, bone pain and diarrhea; in children, failure to thrive is another noteworthy symptom (28, 29). The risk of death from celiac disease is quite low (30); untreated celiac disease is associated with considerable discomfort. Individuals who suffer from celiac disease for prolonged time periods are at increased risk for development of T-cell lymphoma (29). The prolamine protein fraction of wheat, rye and barley has been implicated in the causation of celiac disease, although the precise protein segments have not been conclusively identified (31). With wheat, these specific fractions are the gluten, or more specifically the gliadin, fraction. Individuals must totally avoid the gluten fraction of wheat, rye, barley, triticale, spelt and kamut in their diet (32). Ingredients made from these grains must also be avoided if the ingredients contain protein residue (32). While the tolerance for the offending grains has not been conclusively demonstrated, a few isolated studies have concluded that levels of 10 mg of gliadin per day will be tolerated by most patients with celiac disease (33). The prevalence of celiac disease is likely underestimated but has been estimated to be as high as 1 in every 250 people in some European groups (28).

Celiac disease is likely not a major concern to chocolate manufacturers, because wheat, rye, barley and the other responsible grains are not incorporated into most chocolate products. However, celiac sufferers also try to avoid ingredients derived from these grains (32). Only ingredients containing protein residues from these grains would be expected to elicit symptoms. However, celiac

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