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Cofactors in food anaphylaxis in adults

Bartra, Joan, Turner, Paul J., Muñoz-Cano, Rosa M.·2023·Annals of Allergy, Asthma & Immunology
DOI 10.1016/j.anai.2023.03.017
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Abstract

Around 25% to 50% of food-induced allergic reactions in adults cause anaphylaxis, and epidemiologic evidence suggests that food is the most common cause of anaphylaxis. Reaction severity is unpredictable, and patients will often experience reactions of variable severity, even to an identical exposure (both dose and allergen). A common explanation for this phenomenon has been the impact of "cofactors"-factors that might contribute to reaction severity independent of the allergen exposure. Cofactors can influence reaction severity in 2 ways: either by reducing the reaction threshold (ie, the dose needed to trigger any symptoms) so that patients have no symptoms in the absence of the cofactor and only react with the cofactor present, or by increasing reaction severity such that individuals have only mild symptoms in the absence of the cofactor, but a more severe reaction when the cofactor is present. Indeed, the same patient may have reactions with different cofactors or even need more than one cofactor to develop a severe reaction. Cofactors reportedly play a role in approximately 30% of anaphylaxis reactions in adults. Exercise, nonsteroidal, anti-inflammatory drugs, alcohol, and sleep deprivation are the most frequent cofactors reported. Routine evaluation of the possible involvement of cofactors is essential in managing patients with food anaphylaxis: in patients with a suggestive history but a negative oral food challenge, cofactors should be taken into account to provide a…

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Metadata

Authors
Bartra, J., Turner, P. J., & Muñoz-Cano, R. M.
ORCID
Turner, Paul J.
Venue
Annals of Allergy, Asthma & Immunology
Publisher
Elsevier BV
Published
2023-06
Volume
130
Issue
6
Pages
733-740
ISSN
1081-1206
DOI
10.1016/j.anai.2023.03.017
Cited by
30
References
4
Language
en
Licence
Funders
  • National Institute for Health and Care Research
  • NIHR Imperial Biomedical Research Centre

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