Food Allergies and Food-induced Anaphylaxis: Role of Cofactors

Overview

Journal Clin Exp Pediatr

Specialty Pediatrics

Date 2020 Nov 12

PMID 33181008

Citations 8

Authors

Meeyong Shin

Affiliations

Soon will be listed here.

Abstract

Food allergies and food-induced anaphylaxis are important health problems. Several cofactors modulating the onset of anaphylaxis have been identified. In the presence of cofactors, allergic reactions may be induced at lower doses of food allergens and/or become severe. Exercise and concomitant infections are well-documented cofactors of anaphylaxis in children. Other factors such as consumption of nonsteroidal anti-inflammatory drugs, alcohol ingestion, and stress have been reported. Cofactors reportedly play a role in approximately 30% of anaphylactic reactions in adults and 14%-18.3% in children. Food-dependent exercise-induced anaphylaxis (FDEIA) is the best-studied model of cofactor-induced anaphylaxis. Wheat-dependent exercise-induced anaphylaxis, the most common FDEIA condition, has been studied the most. The mechanisms of action of cofactors have not yet been fully identified. This review aims to educate clinicians on recent developments in the role of cofactors and highlight the importance of recognizing cofactors in food allergies and food-induced anaphylaxis.

Citing Articles

Advances in Mechanisms of Anaphylaxis in Wheat Allergy: Utility of Rodent Models.

Arul Arasan T, Jorgensen R, Van Antwerp C, Ng P, Gangur V Foods. 2025; 14(5).

PMID: 40077585 PMC: 11899146. DOI: 10.3390/foods14050883.

Cofactor-enhanced food allergy to presumed soy storage proteins in a pediatric patient.

Pinto A, Carolino F Einstein (Sao Paulo). 2025; 23:eRC1044.

PMID: 39969026 PMC: 11869781. DOI: 10.31744/einstein_journal/2025RC1044.

Anaphylaxis.

Abrams E, Alqurashi W, Fischer D, Vander Leek T, Ellis A Allergy Asthma Clin Immunol. 2024; 20(Suppl 3):62.

PMID: 39654057 PMC: 11629490. DOI: 10.1186/s13223-024-00926-3.

Identifying patients at risk of anaphylaxis.

DuToit G, Smith P, Muraro A, Fox A, Roberts G, Ring J World Allergy Organ J. 2024; 17(6):100904.

PMID: 38966605 PMC: 11223123. DOI: 10.1016/j.waojou.2024.100904.

Blueberry () Induced Anaphylaxis in a Chinese Child with Lipid Transfer Protein Sensitization.

Jiang N, Xiang L, Guan H, Zhang X J Asthma Allergy. 2023; 16:1253-1258.

PMID: 38022748 PMC: 10664712. DOI: 10.2147/JAA.S436561.

References

Coyle E, Montain S . Benefits of fluid replacement with carbohydrate during exercise. Med Sci Sports Exerc. 1992; 24(9 Suppl):S324-30. View

Dave N, Xiang L, Rehm K, Marshall Jr G . Stress and allergic diseases. Immunol Allergy Clin North Am. 2010; 31(1):55-68. PMC: 3264048. DOI: 10.1016/j.iac.2010.09.009. View

van Nieuwenhoven M, Vriens B, Brummer R, Brouns F . Effect of dehydration on gastrointestinal function at rest and during exercise in humans. Eur J Appl Physiol. 2001; 83(6):578-84. DOI: 10.1007/s004210000305. View

Barg W, Wolanczyk-Medrala A, Obojski A, Wytrychowski K, Panaszek B, Medrala W . Food-dependent exercise-induced anaphylaxis: possible impact of increased basophil histamine releasability in hyperosmolar conditions. J Investig Allergol Clin Immunol. 2008; 18(4):312-5. View

Fernandes R, Regateiro F, Pereira C, Faria E, Pita J, Todo-Bom A . Anaphylaxis in a food allergy outpatient department: one-year review. Eur Ann Allergy Clin Immunol. 2018; 50(2):81-88. DOI: 10.23822/EurAnnACI.1764-1489.45. View

Kim K, Kwak Y . Dehydration affects exercise-induced asthma and anaphylaxis. J Exerc Rehabil. 2019; 15(5):647-650. PMC: 6834710. DOI: 10.12965/jer.1938470.235. View

Anderson S, Kippelen P . Airway injury as a mechanism for exercise-induced bronchoconstriction in elite athletes. J Allergy Clin Immunol. 2008; 122(2):225-35. DOI: 10.1016/j.jaci.2008.05.001. View

Agostini S, Goubern M, Tondereau V, Salvador-Cartier C, Bezirard V, Leveque M . A marketed fermented dairy product containing Bifidobacterium lactis CNCM I-2494 suppresses gut hypersensitivity and colonic barrier disruption induced by acute stress in rats. Neurogastroenterol Motil. 2012; 24(4):376-e172. DOI: 10.1111/j.1365-2982.2011.01865.x. View

Oropeza A, Bindslev-Jensen C, Broesby-Olsen S, Kristensen T, Moller M, Vestergaard H . Patterns of anaphylaxis after diagnostic workup: A follow-up study of 226 patients with suspected anaphylaxis. Allergy. 2017; 72(12):1944-1952. DOI: 10.1111/all.13207. View

10.

Larenas-Linnemann D, Costa-Dominguez M, Creticos P . Acute emotional stress proposed as a risk factor for anaphylaxis in patients receiving allergen immunotherapy. Ann Allergy Asthma Immunol. 2020; 124(4):314-317. DOI: 10.1016/j.anai.2020.01.006. View

11.

Cardona V, Luengo O, Garriga T, Labrador-Horrillo M, Sala-Cunill A, Izquierdo A . Co-factor-enhanced food allergy. Allergy. 2012; 67(10):1316-8. DOI: 10.1111/j.1398-9995.2012.02877.x.. View

12.

Christensen M, Eller E, Mortz C, Brockow K, Bindslev-Jensen C . Wheat-Dependent Cofactor-Augmented Anaphylaxis: A Prospective Study of Exercise, Aspirin, and Alcohol Efficacy as Cofactors. J Allergy Clin Immunol Pract. 2019; 7(1):114-121. DOI: 10.1016/j.jaip.2018.06.018. View

13.

Zong Y, Zhu S, Zhang S, Zheng G, Wiley J, Hong S . Chronic stress and intestinal permeability: Lubiprostone regulates glucocorticoid receptor-mediated changes in colon epithelial tight junction proteins, barrier function, and visceral pain in the rodent and human. Neurogastroenterol Motil. 2018; 31(2):e13477. PMC: 6347514. DOI: 10.1111/nmo.13477. View

14.

Christensen M, Eller E, Mortz C, Brockow K, Bindslev-Jensen C . Exercise Lowers Threshold and Increases Severity, but Wheat-Dependent, Exercise-Induced Anaphylaxis Can Be Elicited at Rest. J Allergy Clin Immunol Pract. 2018; 6(2):514-520. DOI: 10.1016/j.jaip.2017.12.023. View

15.

Uguz A, Lack G, Pumphrey R, Ewan P, Warner J, Dick J . Allergic reactions in the community: a questionnaire survey of members of the anaphylaxis campaign. Clin Exp Allergy. 2005; 35(6):746-50. DOI: 10.1111/j.1365-2222.2005.02257.x. View

16.

Versluis A, van Os-Medendorp H, Kruizinga A, Blom W, Houben G, Knulst A . Cofactors in allergic reactions to food: physical exercise and alcohol are the most important. Immun Inflamm Dis. 2016; 4(4):392-400. PMC: 5134724. DOI: 10.1002/iid3.120. View

17.

Scherf K, Lindenau A, Valentini L, Collado M, Garcia-Mantrana I, Christensen M . Cofactors of wheat-dependent exercise-induced anaphylaxis do not increase highly individual gliadin absorption in healthy volunteers. Clin Transl Allergy. 2019; 9:19. PMC: 6432753. DOI: 10.1186/s13601-019-0260-0. View

18.

Peng L, Li Z, Green R, Holzman I, Lin J . Butyrate enhances the intestinal barrier by facilitating tight junction assembly via activation of AMP-activated protein kinase in Caco-2 cell monolayers. J Nutr. 2009; 139(9):1619-25. PMC: 2728689. DOI: 10.3945/jn.109.104638. View

19.

Vanuytsel T, Van Wanrooy S, Vanheel H, Vanormelingen C, Verschueren S, Houben E . Psychological stress and corticotropin-releasing hormone increase intestinal permeability in humans by a mast cell-dependent mechanism. Gut. 2013; 63(8):1293-9. DOI: 10.1136/gutjnl-2013-305690. View

20.

Hompes S, Kohli A, Nemat K, Scherer K, Lange L, Rueff F . Provoking allergens and treatment of anaphylaxis in children and adolescents--data from the anaphylaxis registry of German-speaking countries. Pediatr Allergy Immunol. 2011; 22(6):568-74. DOI: 10.1111/j.1399-3038.2011.01154.x. View