Mandatory Labeling Research Articles

Calorie accounting: The introduction of mandatory calorie labelling on menus in the UK food sector

Obesity has become a topic of public discourse in Britain with claims that it is now one of the major causes of ill health and premature death. In an effort to tackle this obesity ‘crisis’, the UK government has introduced mandatory calorie labelling on menus. This legislation requires that the number of calories associated with a meal option, together with the recommended calorie consumption per day, be displayed on menus. Such ‘calorie accounting’ seeks to prompt the consumer to make menu choices consistent with public health ambitions and to encourage food establishments to reformulate lower calorie menu offerings. Drawing on the concepts of technologies of government (Miller & Rose, 1990; Rose & Miller, 1992) and biopedagogy (Harewood, 2009; Wright, 2009), this paper suggests that calorie accounting operates as a technology of biopedagogy which seeks to discipline and govern the body in contemporary neoliberal society. The paper also contributes to recent accounting scholarship on counter-conduct (Foucault, 2007) by highlighting how calorie accounting produces a form of counter-conduct that coexists with conformity to governmental goals. The paper draws upon three primary data sources: a documentary analysis of 44 policy documents on obesity and calorie reduction, an analysis of 112 responses to a public consultation exercise on calorie labelling, and 20 interviews with relevant actors.

Kilocalorie labelling in the out-of-home sector: an observational study of business practices and consumer behaviour prior to implementation of the mandatory calorie labelling policy in England, 2022

BackgroundRegulations mandating kilocalorie (kcal) labelling for large businesses in the out-of-home food sector (OHFS) came into force on 6th April 2022 as a policy to reduce obesity in England. To provide indicators of potential reach and impact, kcal labelling practices were studied in the OHFS, and customer purchasing and consumption behaviours prior to implementation of the mandatory kcal labelling policy in England.MethodsFrom August-December 2021, large OHFS businesses subject to the kcal labelling regulations were visited prior to regulations coming into force on 6th April 2022. 3308 customers were recruited from 330 outlets and collected survey information on the number of kcal purchased and consumed by customers, customers’ knowledge of the kcal content of their purchases, and customers noticing and use of kcal labelling. In a subset of 117 outlets, data was collected on nine recommended kcal labelling practices.ResultsThe average number of kcals purchased (1013 kcal, SD = 632 kcal) was high with 69% of purchases exceeding the recommendation of a maximum of 600 kcal per meal. Participants underestimated the energy content of their purchased meals by on average 253 kcal (SD = 644 kcals). In outlets providing kcal labelling in which customer survey data was collected, a minority of customers reported noticing (21%) or using (20%) kcal labelling. Out of the 117 outlets assessed for kcal labelling practices, 24 (21%) provided any in-store kcal labelling. None of the outlets met all nine aspects of recommended labelling practices.ConclusionsPrior to implementation of 2022 kcal labelling policy, the majority of sampled OHFS large business outlets in England did not provide kcal labelling. Few customers noticed or used the labels and on average customers purchased and consumed substantially more energy than recommended in public health guidelines. The findings suggest that reliance on voluntary action for kcal labelling implementation failed to produce widespread, consistent, and adequate kcal labelling practices.

Are adverse effects of cannabidiol (CBD) products caused by tetrahydrocannabinol (THC) contamination?

Cannabidiol (CBD)-containing products are widely marketed as over the counter products, mostly as food supplements. Adverse effects reported in anecdotal consumer reports or during clinical studies were first assumed to be due to acid-catalysed cyclization of CBD to psychotropic Δ 9tetrahydrocannabinol (Δ 9-THC) in the stomach after oral consumption. However, research of pure CBD solutions stored in simulated gastric juice or subjected to various storage conditions such as heat and light with specific liquid chromatographic/tandem mass spectrometric (LC/MS/MS) and ultra-high pressure liquid chromatographic/quadrupole time-of-flight mass spectrometric (UPLC-QTOF) analyses was unable to confirm THC formation. Another hypothesis for the adverse effects of CBD products may be residual Δ 9-THC concentrations in the products as contamination, because most of them are based on hemp extracts containing the full spectrum of cannabinoids besides CBD. Analyses of 362 hemp-based products of the German market (mostly CBD oils) confirmed this hypothesis: 39 products (11%) contained Δ 9-THC above the lowest observed adverse effect level (2.5 mg/day). Hence, it may be assumed that the adverse effects of some commercial CBD products are based on a low-dose effect of Δ 9-THC, with the safety of CBD itself currently being unclear with significant uncertainties regarding possible liver and reproductive toxicity. The safety, efficacy and purity of commercial CBD products is highly questionable, and all of the products in our sample collection showed various non-conformities to European food law such as unsafe Δ 9-THC levels, hemp extracts or CBD isolates as non-approved novel food ingredients, non-approved health claims, and deficits in mandatory food labelling requirements. In view of the growing market for such lifestyle products, the effectiveness of the instrument of food business operators' own responsibility for product safety and regulatory compliance must obviously be challenged, and a strong regulatory framework for hemp products needs to be devised.

Front-of-package label in Brazil: Comparison of guideline daily amounts, traffic-light and warning systems

Chronic non-communicable diseases (NCDs) are considered a global public health problem related to dietary factors. In this sense, front-of-package (FOP) labeling is a valuable tool to help consumers assess food products’ composition and make healthier choices. The mandatory FOP labeling adoption process in Brazil was initiated in 2014 and ended in 2020. This work aims to evaluate consumer’s perception and preference towards three different FOP label systems (Guideline Daily Amounts (GDA), Traffic-Light (TL), and Triangular Warnings (TW)) and identify which one is more effective in improving consumer’s understanding. An online survey with 1671 participants was conducted with a nutrient quiz, a healthiest product quiz, and questions about perception and preference. Data were analyzed using chi-square tests, analysis of variance, and logistic regression. TL performed better on the nutrient quiz than GDA. On the healthiest product quiz, TL and TW had a higher rate of correct answers. GDA was considered helpful in deciding which product to buy. TL was considered easy and quick to understand. TW was considered incomplete but helpful in deciding which product to buy. TL was the preferred label, followed by GDA and TW. The evidence from the present study highlights TL and TW’s potential to help consumers understand the products’ nutritional profile. However, any FOP label implementation must be accompanied by educational campaigns to ensure the population can understand and use it effectively.

Consumer responses to nutrition labels in China

AbstractAs a cost‐effective way to promote healthy eating habits and prevent obesity, nutrition labeling has drawn great public interest around the world. China implemented its first mandatory nutrition labeling regulation under the National Food Safety Standard for Nutrition Labeling of Pre‐packaged Foods (GB28050‐2011) in 2013. Focusing on the Chinese carbonated soft drinks market and using a mixed logit model based on 132,849 purchase records from over 40,000 households, this study investigates consumers' responses to nutrition labels. Empirical results show that nutrition labeling induces Chinese consumers to select relatively healthier products and could be a prominent policy tool for sugar reduction.

Study on the quality of honey from different botanical sources and one re-gional origin

Research on honey is important from the standpoint of product quality and consumer protection. According to legislation in many countries, including Ukraine, honey is considered a food product and is subject to mandatory certification and labeling. Research on the physicochemical properties of honey is important for determining its quality and detecting falsification. This article is dedicated to the study of the quality of honey from various botanical and one regional source. Organoleptic and physicochemical properties of the honey were determined, as well as a comparison with a falsified sample. The results of the analysis showed that different varieties of honey have different physicochemical properties. The highest diastase number was found in buckwheat honey, while the lowest was found in linden honey. The mass fraction of sucrose was highest in buckwheat honey and lowest in sunflower honey. The water content was in the range of 18.4–21 %, with buckwheat and sunflower honey having similar values. The pH value was lowest in buckwheat honey and highest in linden honey. Research on the organoleptic properties showed that buckwheat honey has a dark brown color, pleasant aroma and taste without foreign flavors, and a viscous consistency. Sunflower honey has a golden-yellow color, bright and delicate aroma, sweet taste without foreign flavors, and a viscous consistency. Linden honey has a pale yellow color, pleasant and delicate aroma, sweet taste without foreign flavors, and a viscous consistency. Flower honey has a light brown color, pleasant aroma and taste without foreign flavors, sweet and tart, and a viscous consistency. The results of the comparison of buckwheat honey with falsified honey showed that the diastase number, mass fraction of sucrose and water, as well as the pH value in the honey were within normal range, while in the falsified sample the values of these indicators were different. These results indicate that falsified honey based on sugar syrup can be detected using physicochemical analysis. Therefore, a study of honey from various botanical and one regional origin showed that its physicochemical properties differ depending on the variety. Comparison of buckwheat honey with counterfeit honey based on sugar syrup has shown that the counterfeit can be detected by physicochemical analysis.

Assessing public perception and awareness of UK mandatory calorie labeling in the out-of-home sector: Using Twitter and Google trends data.

In 2021 the UK government announced a new obesity policy requiring large out-of-home food outlets to provide mandatory in-store calorie labeling on food and drink items. Public acceptability and engagement with obesity policies could influence the level of impact on wider public health particularly with population-level policies such as calorie labeling. This study aimed to examine public responses and awareness of the policy using social media (Twitter) comments and Google trends data. This study examined responses to social media posts on Twitter (tweets) from the UK Department of Health and Social Care detailing the policy, implementation date and post-implementation information about the policy's enforcement. The sentiments of the tweets were coded and the number of likes and replies extracted. This study utilized google trends to examine public awareness of the policy by extracting weekly relative search volume for relevant phrases such as "calorie labeling." From the 276 replies/quote-tweet extracted, the majority expressed a negative sentiment toward the policy (N=197/71.4%). There were fewer tweets expressing a positive sentiment (N=25/8.7%) and a neutral/no sentiment (N=54/19.6%). There was no difference in the number of "likes" or retweets between tweets expressing positive or negative sentiments. Five themes were identified expressing negative sentiments (most common being negative impacts on eating disorders). Google trends data revealed increased searches for "calorie labels/labeling" during the week of the policy enforcement compared to previous weeks in the last 5years but no significant differences in searches for specific menu calorie labeling. This analysis revealed negative sentiment toward and increased searching of calorie labeling information during the announcement and implementation of the 2021 mandatory calorie labeling policy in England. A greater understanding of public responses to calorie labeling policies may help tailor future policies and public communication strategies.

Consumers' Preferences for Chicken Fed on Different Processed Animal Proteins: A Best-Worst Analysis in Italy.

The increase in meat consumption expected in the next decade will require more and more proteins for animal feeding. The recent amendments to the European "BSE Regulation" allow the use of insects and porcine-based meals in poultry farming, providing novel, sustainable substitutes for vegetable fodder. While the technological and nutritional properties of novel feeds containing processed animal proteins are widely recognized, far less is known about consumers' acceptance of meat produced by animals fed on animal-based meals. In the present research, a best-worst survey was applied to estimate consumers' preferences for chicken fed on plants, insects, or porcine-based meals using a sample of 205 Italian consumers. Furthermore, product price, type of farming, and "Free-from" labeling were considered in the analysis to evaluate the relative importance of feed ingredients compared to other important attributes of meats. The results show that the most relevant attributes are type of farming and "Free-from" claims, while type of feed represents the third attribute in order of importance. Notably, both insect and porcine flour are considered as negative characteristics of the product, suggesting that mandatory labeling signaling the use of these feeds would negatively impact on the value of chicken meat.

The future of carbon labeling – Factors to consider

AbstractCompared to other policy instruments that aim to change consumer behavior, information provision is perhaps the least controversial. An important question is how information in the form of carbon labels can contribute to direct food consumption toward reduced climate impact. From a policy guidance perspective, there is a need to identify how the labeling strategy affects consumers’ ability to identify lower emitting food products and the behavioral change due to carbon information. Key aspects of a carbon label are discussed, as well as the implications of different labeling schemes. Drawing on economic and behavioral theories, we propose that, to assist consumers in identifying changes in consumption that contribute to significant reductions in their climate impact, a carbon label must enable comparisons between product groups and not only within narrowly defined product groups. This suggests mandatory labeling, since producers of high-emission products are less likely to display such labels. However, it is important to consider both costs and benefits of labeling schemes and to consider complementing labeling with other policy instruments.

Loopholes for Underage Access in E-Cigarette Delivery Sales Laws, United States, 2022.

Objectives. To comprehensively catalog and review state e-cigarette delivery sales laws as well as capture their scope and dimensions. Methods. We conducted an in-depth review to determine whether states had at least 1 form of e-cigarette delivery sales law. We coded laws for 5 key policy domains: (1) delivery terminology used in laws, (2) age verification requirements, (3) packaging label requirements, (4) permit or registration requirements, and (5) fines and penalties for violations. Results. Overall, 34 states had e-cigarette delivery sales laws with varying scopes and dimensions. In 27 states, these laws required at least 1 form of age verification requirements. We identified mandatory packaging labels in 12 states, and 7 states where permits were required. There were considerable differences among states on the scale of fines and penalties for violations. Conclusions. Our findings reveal extensive heterogeneity in e-cigarette delivery sales laws among states, particularly regarding the scope and dimensions of these laws. Public Health Implications. The mapping of e-cigarette delivery sales policies showed several potential loopholes that may diminish their effectiveness. (Am J Public Health. 2023;113(5):568-576. https://doi.org/10.2105/AJPH.2023.307228).

Abstract P607: What Do Consumers See? Nutrients Listed on Packaged Foods and Beverages in Addis Ababa, Ethiopia

Introduction: Noncommunicable diseases (e.g. type 2 diabetes, hypertension, cardiovascular disease) are the leading cause of death globally and among adults in Ethiopia. Suboptimal diet (with high intake of sugar, salt, and saturated fat) is a major risk factor for such diseases and the consumption of processed foods rich in these nutrients is rising globally. Mandatory nutrition information on packaged foods, potentially with warning labels, can guide consumers and create healthier food environments. However, such information is lacking in many countries, including Ethiopia. Hypothesis: We assessed the hypothesis that the display of nutrition information (including sugar, sodium, and saturated fat) would be low on packaged foods and beverages in Ethiopia. Methods: A database of packaged foods was created in 2021 from an assessment across 18 markets within Addis Ababa, Ethiopia. The analysis included 1388 products in four major food categories (cereals; snack foods; sweets; and beverages). Results: In total, 880 (63%) products displayed nutrient content information. This was most common among cereals (73%), and least common in snack food (43%) (Table 1). For specific nutrients, the display of sodium/salt (38%) was similar to sugar (35%) and saturated fat (34%). This discrepancy was highest in the beverages category. Conclusion: Nutrition labeling was incomplete in four major packaged food categories in Ethiopia. Fewer than half of snack foods displayed any nutrient content information, and while nearly three-fourths of cereals had some label, data on all three nutrients (sugar, sodium, and saturated fat) was missing on more than half of these products. Mandatory warning labels will allow consumers to assess the nutrient content of packaged foods and may encourage reformulation by industry to meet consumer demand and avoid placement of warning labels on their products.

Beer labeling is planned to begin on April 1, 2023

On April 1, 2023, mandatory labeling of beer will start working in Russia. The article presents how the new labeling system will work and what requirements manufacturers need to comply with in the new conditions.

Mandatory social label system as a super‐nudge to reduce intention‐behaviour gap and increase responsible consumption

AbstractIn this paper I discuss the proposal of a mandatory and internationally recognised system of social labelling as an attempt to at least partially reconcile free trade and democracy, modifying the Rodrik trilemma. A mandatory social labelling system can be seen as a super‐nudge in the sense of Thaler and Sunstein. I argue that only a mandatory social labelling system can do the job. The current voluntary system is structurally unable to increase socially responsible consumption and to power up an endogenous race to the top in labour standards. I analyse the difference between a voluntary and a mandatory labelling system and discuss the advantages of the latter. It emerges that there are reasons to claim that a mandatory system could sharply reduce the intention‐behaviour gap and increase socially responsible consumption, reducing the negative effect of the Rodrick trilemma. A mandatory social labelling system can therefore determine a race to the top in labour regulation, instead of the race to the bottom witnessed in recent decades, with some useful by‐products in terms of within‐country income distribution and fostering the democratic process in emerging economies.

МАРКЕТИНГОВЫЙ АНАЛИЗ УСТОЙЧИВОСТИ ЦЕПИ ПОСТАВОК РОССИЙСКОЙ ФАРМАЦЕВТИЧЕСКОЙ ОТРАСЛИ В УСЛОВИЯХ ВНЕШНИХ ШОКОВ

The article reveals the results of an analysis of resilience of the supply chain at the stage of distribution of finished pharmaceutical products in the Russian pharmaceutical industry against an ag-gressive external marketing environment. The key destabilizing factors for the external environment of the pharmaceutical market are identified and characterized: the Covid-19 epidemic, introduction of man-datory labeling of medicines, overstocking of the pharmaceutical market with the stabilization of the pandemic situation, a sharp increase in geopolitical tensions, and an increase in the sanctions pressure. The decrease in the supply chain resilience at the distribution stage in the Russian pharmaceutical indus-try is proven on the example of the non-prescription drugs segment under the influence of external shocks to the industry. The stability of this trend has been revealed against the background of deepening geopolitical tensions, tightening of the sanctions restrictions, transformation of the Russian advertising market, and the decrease in the purchasing power of the population. The authors have substantiated the need for pharmaceutical companies to adapt to the described situation through developing the automa-tion and digitalization of business, increasing the role of tactical marketing planning, and digitalization of sales and changing the composition of analytical departments.

Elemental Analysis of Propolis Tinctures by Microwave Plasma – Atomic Emission Spectrometry (MP-AES)

Propolis tinctures are popular alternative medicines, but mandatory labeling requirements relating to the inorganic content or percentage of ethanol are absent. Knowing the elemental content is useful for quality assurance/quality control of the tinctures between batches, as well as the safety of the products for consumers. Microwave plasma – atomic emission spectrometry (MP-AES) is a relatively low-cost, robust, multielemental technique that can analyze ethanolic extracts of propolis following minimum sample preparation. However, there are no published papers using MP-AES for this application. The technique was evaluated for the determination of sixteen elements in lab-made preparations and in 23 products from markets in Mexico. The matrix effects of the ethanol content of the samples were also evaluated and were found to affect the detection limit of some elements. There was high variability in the elemental composition of the major (K, Fe, Mg, and Na) and minor (Al, Cd, Co, Cr, Cu, Mn, Ni, and Zn) elements among the samples. The median concentrations of cadmium, and lead in the propolis tinctures were below 0.28 µg·L−1 and 2.8 µg·L−1, respectively.

Nutri-Score: Its Benefits and Limitations in Children's Feeding.

Reducing the burden of noncommunicable diseases (NCDs) is one of the top priorities of public health policies worldwide. One of the recognized means of achieving this objective is to improve the diet quality. The Nutri-Score (N-S) is a [five-color-A, B, C, D, E letters] front-of-pack labeling logo intended to help consumers quickly identify the healthier prepackaged foods within a food category. Available studies have shown that the N-S is an efficient tool to achieve this aim in terms of consumers' awareness, perception, understanding, and purchasing and that its use may help to reduce the prevalence of NCDs. The N-S is currently implemented on a voluntary basis in 7 European countries and a discussion is underway within the European Commission to achieve a harmonized mandatory label. However, no study on the putative impact of the N-S on children's dietary patterns and health is available. The N-S is not applicable to infants' and young children's formulas and to specific baby foods, the compositions of which are already laid down in European Union regulations. The N-S does not replace age-appropriate dietary guidelines. As children consume an increasing number of adult type and processed foods, the relevance of the N-S for children should be evaluated considering the children's high specific requirements, especially in younger children. This is especially necessary for fitting fat and iron requirements, whereas protein-rich foods should be better framed. Moreover, efforts should be made to inform on how to use the N-S and in education on healthy diets.

Deepfakes as a Threat to Human Rights

The paper is devoted to such a new threat to human rights arising amid digitalization as deepfake technologies. The author shows that the use of such technologies is a tool that can have both positive and negative effects. In particular, the use of dipfakes entails a threat to privacy, violations of the honor and dignity of citizens. In this regard, the legislator is faced with the task of developing and implementing a set of measures, the application of which will minimize the possibility of violation of citizens’ rights by deepfake technologies. It is proposed to direct the efforts of the state: to create automated tools for detecting deepfakes with the ability to determine the date, time and physical origin of their contents, and, if there are signs of potential danger, capable of stopping the placement and distribution of deepfakes; development of fact-checking services and tools; regulatory consolidation of requirements according to which mandatory marking of deepfake content should be carried out in social networks and messengers; formation of a regulatory framework providing for responsibility for the creation and distribution of deepfake materials that can damage business reputation, humiliate the honor and dignity of a person. From the standpoint of copyright, it is proposed to consider deepfakes through the prism of a derivative work, in which the use of the original work without the consent of its copyright holder will be illegal. Taking into account the threats of deepfake technologies to human rights, a set of measures has been proposed. Its use will minimize the possibility of violating citizens’ rights by means of these technologies. These measures are: the introduction of a fact-checking mechanism, the development of its services and tools; mandatory labeling of deepfake content in social networks and messengers; the creation of a regulatory framework providing for responsibility for the creation and distribution of deepfake materials capable of damage the business reputation, humiliate the honor and dignity of a person.

Are adverse effects of cannabidiol (CBD) products caused by tetrahydrocannabinol (THC) contamination?

Cannabidiol (CBD)-containing products are widely marketed as over the counter products, mostly as food supplements. Adverse effects reported in anecdotal consumer reports or during clinical studies were first assumed to be due to hydrolytic conversion of CBD to psychotropic Δ 9-tetrahydrocannabinol (Δ 9-THC) in the stomach after oral consumption. However, research of pure CBD solutions stored in simulated gastric juice or subjected to various storage conditions such as heat and light with specific liquid chromatographic/tandem mass spectrometric (LC/MS/MS) and ultra-high pressure liquid chromatographic/quadrupole time-of-flight mass spectrometric (UPLC-QTOF) analyses was unable to confirm THC formation. Another hypothesis for the adverse effects of CBD products may be residual Δ 9-THC concentrations in the products as contamination, because most of them are based on hemp extracts containing the full spectrum of cannabinoids besides CBD. Analyses of 293 food products of the German market (mostly CBD oils) confirmed this hypothesis: 28 products (10%) contained Δ 9-THC above the lowest observed adverse effect level (2.5 mg/day). Hence, it may be assumed that the adverse effects of some commercial CBD products are based on a low-dose effect of Δ 9-THC, with the safety of CBD itself currently being unclear with significant uncertainties regarding possible liver and reproductive toxicity. The safety, efficacy and purity of commercial CBD products is highly questionable, and all of the products in our sample collection showed various non-conformities to European food law such as unsafe Δ 9-THC levels, hemp extracts or CBD isolates as non-approved novel food ingredients, non-approved health claims, and deficits in mandatory food labelling requirements. In view of the growing market for such lifestyle products, the effectiveness of the instrument of food business operators' own responsibility for product safety and regulatory compliance must obviously be challenged, and a strong regulatory framework for hemp products needs to be devised.

PMON260 Cost-Effectiveness of Testosterone Treatment for Men with Hypogonadism

Abstract Background Testosterone replacement therapy is the standard treatment for male hypogonadism (MH). Prescribing rates of testosterone in the UK have risen between 2001 and 2010 without an observable increase in the prevalence of hypogonadism, which may reflect increasing media awareness among men about hypogonadism. Currently, there is uncertainty about the safety and efficacy of testosterone treatment for MH, especially regarding its impact on cardiovascular risk, which has led to mandatory safety labelling in some countries. Aim We conducted an economic evaluation of testosterone therapy in men with hypogonadism, using individual patient data (IPD) of safety and efficacy outcomes in over 3000 participants as part of an international collaboration of investigators of 17 existing placebo-controlled RCTs assessing the safety and efficacy of testosterone treatment for MH (TestES Consortium). Methods A cost-utility analysis of the use of testosterone treatment for MH was conducted using a cohort Markov model developed following best practice. The model care pathway was informed by existing clinical guidelines, the results of the TestES Consortium individual patient data (IPD) meta-analysis, and discussions with clinical and methodological experts. Five Markov states were included: no complications, post-Cardiac pathology, post-Peripheral Vascular System Pathology, post-Cerebrovascular System Pathology, and Death. All-cause mortality, cardiovascular and cerebrovascular complications, and utility weights were obtained from the TestES IPD analyses. The UK NHS and personal and social services perspective was adopted for costs. Ten-year and lifetime time horizons were considered with costs and effects discounted annually at 3.5% rate. The model was run probabilistically using 10,000 Monte Carlo simulations. Three starting ages were defined (40, 60, and 75 years). Mean total cost, mean QALYs and incremental cost-effectiveness ratios were calculated. Results Cost-effectiveness of testosterone treatment appears to be dependent on the relative risk (RR) of all-cause mortality - favouring TRT - and the methods used to derive health state utility scores (i.e., SF-6D or a mapping between Beck Depression Inventory -BDI- score and EQ-5D score) for testosterone treatment versus standard care. When the RR of mortality and the BDI utilities were used, ICERs remained below the £20,000 ($27,400) UK conventional threshold, irrespective of the cohort starting age. However, ICERs increased above the £20,000 threshold when the difference in all-cause mortality was dropped, and the SF-6D utility scores were used. Conclusions We report the most in-depth economic analysis of male hypogonadism treatment to date. There remains limited data for generating preference-based health-related quality of life (HRQoL) weights for economic evaluation. Further clarity on the long-term cardiovascular safety of testosterone treatment in men with hypogonadism, and more in-depth mapping of clinical outcomes to generic preference-based measures of HRQoL will be crucial to inform robust estimates of the cost-effectiveness of testosterone treatment for MH. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

IS PEA OUR HIDDEN ALLERGEN? AN AMERICAN PEDIATRIC CASE SERIES

<h3>Introduction</h3> With the growing scope of the health-food industry, efforts are made to incorporate protein into food to attract consumers. Recently, plant-based diets consisting of legumes are becoming a diet trend, thus a focus as a source of protein. Those allergenic legumes (Soybeans,Lupins,Peanuts) are part of the mandatory labeling in the EU and the US, allowing consumers to easily identify and avoid them. Dun-pea proteins are found in minced steak, breadcrumbs that coat meats, pharmaceutics, and specialized food for athletes⁸. Allergies to green and dun-pea have been emerging and reported in several case reports. The two main allergens found are Pis-s 1 and Pis-s 2, members of the Vicilin and Covicilin families. However, in contrast to other allergens, pea-protein is not included on food labels as a potential food allergen in the EU, Canada, and the US, thus, making it a masked potential cause of allergic reactions. There is currently no data on dun-pea allergy in the US and little data regarding green-pea allergy. Thus, with the progressive increase in pea/pea proteins inclusion in foods, we report 6 children who presented to the Hospital-based Allergy clinic with allergic reactions to foods containing green peas or pea protein. <h3>Cases</h3> (Table 1) <h3>Discussion</h3> The prevalence of pea allergies is unknown; however, the sensitization rate was higher than soya beans, lupins, peanuts. Hence, identification of pea allergens should gain more attention by allergists, especially as they can be non-obvious ingredients in foods. Also, several publications reported the coexistence of legumes and pea allergies due to cross-reactive IgEs against peas.