Out-of-hospital health care costs of childhood food allergy in Australia: A population-based longitudinal study

Emergency department presentations related to asthma and allergic diseases in Central Queensland, Australia: a comparative analysis between First Nations Australians and Australians of other descents

OBJECTIVE

To examine the overall incidence rate and trends in emergency department (ED) presentations related to asthma and allergic diseases in regional Australia with a particular focus on First Nations Australians.

DESIGN

A retrospective analysis of data from the Emergency Department Information System.

SETTING

This study used data from 12 public hospitals in Central Queensland, Australia, a region encompassing regional, rural and remote outback areas.

PARTICIPANTS

A total of 813 112 ED presentations between 2018 and 2023.

OUTCOME MEASURE

Asthma and allergic diseases were identified using the International Classification of Diseases-Tenth Revision-Australian Modification codes.

RESULTS

There were 13 273 asthma and allergic disease-related ED presentations, with an overall prevalence of 1.6% (95% CI 1.6, 1.7). There was a significantly higher incidence rate of asthma and allergic disease-related ED presentations among First Nations Australians at 177.5 per 10 000 person-years (95% CI 169.3, 186.0) compared with 98.9 per 10 000 person-years (95% CI 97.2, 100.8) among Australians of other descents. The incidence rates, with corresponding 95% CIs, of the four most common cases among First Nations Australians and Australians of other descents, respectively, were as follows: asthma (87.8 (82.0, 93.8) and 40.2 (39.0, 41.3)), unspecified allergy (55.3 (50.8, 60.2) and 36.0 (34.9, 37.1)), atopic/allergic contact dermatitis (17.1 (14.6, 19.9) and 10.6 (10.0, 11.2)) and anaphylaxis (7.2 (5.6, 9.1) and 6.2 (5.7, 6.6)).

CONCLUSION

Our findings highlight a significantly higher rate of asthma and allergic disease-related ED presentations among First Nations Australians compared with Australians of other descents. This underscores the urgent need for targeted healthcare interventions integrating culturally appropriate approaches, alongside additional research to understand causality.

Neonatal BCG Vaccination for Prevention of Allergy in Infants: The MIS BAIR Randomised Controlled Trial

BACKGROUND

The beneficial off-target effects of Bacille Calmette-Guérin (BCG) vaccination potentially include protection against allergy.

OBJECTIVE

In the MIS BAIR trial, we aimed to determine whether neonatal BCG vaccination reduces atopic sensitisation and clinical food allergy in infants.

METHODS

In this randomised controlled trial, 1272 neonates were allocated to BCG-Denmark vaccine (0.05 mL intradermal dose) or no BCG at birth. Randomisation was stratified by recruitment site, mode of delivery and plurality of birth. The primary outcome was the incidence of atopic sensitisation determined by skin prick test at 1 year of age. Food allergy was determined by 3-monthly online questionnaires and oral food challenges. Data were analysed by intention-to-treat using binary regression.

CLINICALTRIALS

gov (NCT01906853).

RESULTS

Atopic sensitisation during the first year of life was 22.9% among infants in the BCG group and 18.9% in the control group (adjusted risk difference (aRD) 3.8% (95% CI -1.5 to 9.1) after multiple imputation). Clinical food allergy was similar between infants in the BCG and control groups (9.8% vs. 9.6%; aRD 0.2, 95% CI -3.4 to 3.8). An interaction was observed between the primary outcome and maternal history of BCG vaccination. No interaction was observed for the additional prespecified potential effect modifiers tested (sex, delivery mode, family history of any allergy, season of birth, hepatitis B vaccination at randomisation, BCG scar and age at BCG administration).

CONCLUSIONS AND CLINICAL RELEVANCE

Neonatal BCG-Denmark vaccination does not protect against atopic sensitisation or clinical food allergy in the first year of life.

Oral administration of egg ovalbumin allergen induces dysregulation of tryptophan metabolism in sensitized BALB/c mice

Food allergy (FA), triggered by specific dietary allergens, has emerged as a substantial global concern for food safety and public health. While studies have elucidated changes in immune cells and cytokines associated with allergen exposure, a comprehensive analysis of the host's metabolic features and the interaction between metabolites and the gut microbiota has not been conducted. In this study, egg allergen ovalbumin (OVA) was administered by the oral route to sensitized BALB/c mice to faithfully replicate key aspects of human FA, including severe allergic diarrhea, mast cell infiltration, and elevated levels of serum IgE, mMCPT-1, and Th2 cell hallmark cytokines (such as IL-4, IL-5, and IL-13). Furthermore, the untargeted and targeted metabolomic analyses indicated that FA in mice precipitated a substantial decrease in the tryptophan metabolites indole-3-acrylic acid (IA) and indole-3-lactic acid (ILA). The integration of shotgun metagenome and metabolome data further unveiled that the dysregulation of indole metabolism is related to a decline in the abundance of beneficial bacteria such as Lactobacillus and Bifidobacterium. Additionally, disruption of the tryptophan indole derivative pathway compromises the maintenance of intestinal mucosal function through the AHR signaling pathway, manifested by decreased expression of Reg3g and IL22. Taken together, this study demonstrated that the anaphylaxis triggered by oral ingestion of food allergens can lead to disruptions in tryptophan metabolism, consequently impairing intestinal immune homeostasis.

The Natural History and Risk Factors for the Development of Food Allergies in Children and Adults

PURPOSE OF REVIEW

This narrative review explores food allergy prevalence and natural history stratified by life stages, especially in context of evolving knowledge over the last few decades.

RECENT FINDINGS

The prevalence of food allergy remains highest in early childhood with common food triggers being cow's milk, soy, hen's egg, wheat, peanut, tree nuts, sesame, fish, and shellfish. This correlates with certain risk factors especially pertinent in the postnatal period which appear to predispose an individual to developing a food allergy. Some allergies (such as milk and egg) were previously thought to be easily outgrown in early life; however, recent studies suggest increasing rates of persistence of these allergies into young adulthood; the reason behind this is unknown. Despite this, there is also evidence demonstrating that food allergies can be outgrown in adolescents and adults. An understanding of the paradigm shifts in the natural history of food allergy allows clinicians to provide updated, age-appropriate, and tailored advice for patients on the management and prognosis of food allergy.

Health care resource use and costs in patients with food allergies: a United States insurance claims database analysis

AIMS

Food allergies impose a large clinical and financial burden on patients and the health care system. However, little is known about the factors associated with health care resource use and costs. The aim of this study was to investigate health care resource use and costs in individuals with food allergies utilizing health care in the United States.

METHODS

We conducted a retrospective analysis of insurance claims data from the Merative MarketScan Research Databases (indexed from 1 January 2015 to 30 June 2022). All-cause and food allergy-related health care resource use, direct medical, and out-of-pocket costs for medical services were estimated for 12 months post-index using International Classification of Diseases [ICD] codes.

RESULTS

Of 355,520 individuals with food allergies continuously enrolled in a health insurance plan for ≥12 months pre- and post-index, 17% had a food allergy-related emergency department visit and 0.9% were hospitalized. The top patient characteristic associated with all-cause and food allergy-related hospitalizations, all-cause costs, and food allergy-related outpatient visit costs was a Charlson Comorbidity Index score of ≥2. Food allergy-related direct medical and out-of-pocket costs were high among patients with a food allergy-related visit. Out-of-pocket cost per patient per year for outpatient visits, emergency department visits, and hospitalizations had an estimated mean of $1631 for patients with food allergy-related visits, which is ∼11% of the total costs for these services ($14,395 per patient per year).

LIMITATIONS

Study limitations are primarily related to the nature of claims databases, including generalizability and reliance on ICD codes. Nevertheless, MarketScan databases provide robust patient-level insights into health care resource use and costs from a large, commercially insured patient population.

CONCLUSION

The health care resource use of patients with food allergies imposes a burden on both the health care system and on patients and their families, especially if patients had comorbidities.

A review of food allergy-related costs with consideration to clinical and demographic factors

PURPOSE OF REVIEW

To provide an overview of the magnitude and sources of food allergy-related costs, with a particular emphasis on the recent literature. We also aim to identify clinical and demographic factors associated with differences in food allergy-related costs.

RECENT FINDINGS

Recent research has expanded upon previous studies by making greater use of administrative health data and other large sample designs to provide more robust estimates of the financial burden of food allergy on individuals and the healthcare system. These studies shed new light on the role of allergic comorbidities in driving costs, and also on the high costs of acute food allergy care. Although research is still largely limited to a small group of high-income countries, new research from Canada and Australia suggests that the high costs of food allergy extend beyond the United States and Europe. Unfortunately, as a result of these costs, newly emerging research also suggests that individuals managing food allergy, may be left at greater risk of food insecurity.

SUMMARY

Findings underscore the importance of continued investment in efforts aimed at reducing the frequency and severity of reactions, as well as programs designed towards helping offset individual/household level costs.