How to Determine Thresholds Clinically

Barbara K. Ballmer-Weber*, André C. Knulst, Jonathan O B Hourihane

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapterAcademicpeer-review


An individual threshold or a minimum eliciting dose (MED) is clinically determined by a titrated, double-blind, placebo-controlled, food challenge. A suitable challenge meal is usually of low fat content for minimal interference with allergen uptake and should be adequately blinded. Challenges are usually performed in a hospital setting. The medical staff in charge have to be specifically trained in early recognition of allergic symptoms, and more importantly in the treatment of a severe, even anaphylactic reaction that might occur under provocation. Challenges usually start with very low doses (μg range in terms of food protein) and the doses are steadily increased at intervals of 20-30. min up to a dose which equals a normal daily serving, carefully recording all subjective and objective symptoms that might occur under provocation. Since false negative challenges do occur, for instance, due to degradation of the responsible allergens, an open food challenge always has to follow a negative blinded challenge.

Original languageEnglish
Title of host publicationRisk Management for Food Allergy
Number of pages10
ISBN (Print)9780123819888
Publication statusPublished - Nov 2013


  • Diagnosis
  • Double-blind placebo-controlled food challenge
  • Lowest adverse effect level (LOAEL)
  • Matrix
  • Minimal eliciting dose
  • No observed adverse effect level (NOAEL)
  • Protocol
  • Requirements
  • Threshold dose


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