Global ethylene oxide uses in foods and considerations for food safety

Ethylene oxide (EtO) is a sterilant widely used for medical devices, but its use is controversial due to its carcinogenicity. In some countries, EtO is also used to fumigate food to eliminate foodborne pathogens, though this practice is banned in others. National regulations on EtO use in food vary widely; exporting countries prioritize trade facilitation and prevention of foodborne illness, while importing countries emphasize maintaining food safety and promoting domestic public health. These divergent public health priorities present challenges to establishing universal maximum residue limits (MRLs) for EtO and 2-chloroethanol (2-CE) and have resulted in the rejection of food items treated with EtO by some importing national authorities. In response, exporters have advocated for internationally harmonized tolerance levels for EtO and its derivatives to facilitate trade. This paper reviews the use of EtO in food products and the potential health effects, describes conflicting perspectives among global stakeholders, and explores the need for harmonized international standards.