Countries without single-payer (universal) health insurance have higher mean direct medical costs than those with single-payer health insurance.Household-level estimates of lost opportunity costs impose the largest economic burden of food allergy, with mean costs of $4881 across several studies.Standardized instruments and methods are necessary to fully understand the economic effect of food allergies across the world.Out-of-pocket costs, including the costs of special diets, are an important component of the economic burden in several studies.

RATIONALE: Peanut allergy is a public health concern causing severe reactions. Food allergen labeling poorly represents risk, with limited data on thresholds of reactivity and the influence of everyday factors. We estimated peanut threshold doses for a UK peanut-allergic population and examined the effect of sleep deprivation and exercise. METHODS: In a crossover trial, following confirmation of peanut allergy by blinded challenge, participants underwent three open peanut challenges in random order: one with exercise following each dose, one with sleep deprivation preceding challenge, and one with no intervention. The dose triggering symptoms (mg peanut protein) was measured. Primary analysis estimated the difference between non-intervention challenge and each intervention in log-dose, expressed as percentage change. Dose distributions were modeled to derive eliciting doses in the peanut-allergic population. RESULTS: Baseline challenges were performed in 126 peanut-allergic subjects, 100 were randomized and 81 (mean age 25y) completed at least one further challenge. The mean (SD) dose triggering symptoms was 214 mg (330mg) for non-intervention challenges and this was reduced by 45% (95% CI 21-61 p50.001) and 45% (22-62 p50.001) for exercise and sleep deprivation, respectively. Mean (95% CI) eliciting doses for 1%, 5% and 10% of the population during baseline challenge (n5126) were 1.3mg (0.8, 2.0), 3.8mg (2.4,5.7) and 7.0mg of peanut protein (4.5,10.5), respectively. CONCLUSIONS: Exercise and sleep deprivation each significantly reduce the threshold of reactivity in people with peanut allergy, putting them at greater risk of a reaction. Incorporating these data into allergen risk management is critical for optimal protection of peanut-allergic consumers.

RATIONALE: Ovomucoid-specific IgE (OVM-sIgE) levels and OVM-sIgE/total IgE ratio are reportedly predict IgE-mediated egg allergy among children with positive serum OVM-sIgE. Affinity of sIgE was known to critically regulate basophil/mast cell degranulation in vitro, however little is known whether avidity of sIgE is involved in IgE-mediated heated egg allergy in young children in vivo. METHODS: This cross-sectional case-control study enrolled 59 children (2 to 3 yo) with low levels of OVM-sIgE (0.7 to 17.5 UA/mL) as measured by ImmunoCAP who underwent an oral food challenge test (OFC) at the National Center for Child Health and Development in Tokyo between November 2013 and January 2019. The avidity of OVM-sIgE (IC 50-OVM-sIgE (nM)) was measured by competitive binding inhibition assay using densely carboxylated protein (DCP)-chip (Immun Inflamm Dis 2019, 7:74-85). RESULTS: The avidity of OVM-sIgE was significantly higher in children who were allergic to, than in those who were tolerant of heated egg. Receiver operating characteristic analysis showed that a combination of the serum OVM-sIgE level and the avidity of OVM-sIgE ratio (OVM-sIgE/IC 50-OVM-sIgE) had a larger AUC (0.913; 95%CI 0.842-0.983) than OVM-sIgE level or OVM-sIgE/total IgE ratio alone (0.777; 95%CI 0.623-0.931, 0.763; 95%CI 0.63-0.897, respectively) in predicting heated egg allergy. CONCLUSIONS: Our findings suggested that not only the quantity of sIgE but also the quality of sIgE is involved in heated egg allergy, and a combination of these two factors may help more accurate diagnosis of egg allergy.