title: Elicitors and co-factors in food-induced anaphylaxis in adults.
abstract: Food-induced anaphylaxis (FIA) in adults is often insufficiently diagnosed. One reason is related to the presence of co-factors like exercise, alcohol, additives and non-steroidal anti-inflammatory drugs. The objective of this analysis was to retrospectively investigate the role of co-factors in patients with FIA. 93 adult patients with suspected FIA underwent double-blind, placebo-controlled food challenges with suspected allergens and co-factors.The elicitors of anaphylaxis were identified in 44/93 patients. 27 patients reacted to food allergens upon challenge, 15 patients reacted only when a co-factor was co-exposed with the allergen. The most common identified allergens were celery (n = 7), soy, wheat (n = 4 each) and lupine (n = 3). Among the co-factors food additives (n = 8) and physical exercise (n = 6) were most frequent. In 10 patients more than one co-factor and/or more than one food allergen was necessary to elicit a positive reaction.The implementation of co-factors into the challenge protocol increases the identification rate of elicitors in adult food anaphylactic patients.
authors.affiliation: Department of Dermatology and Allergology, Allergy-Center-Charité, Charité - Universitätsmedizin Charitéplatz 1, 10117 Berlin, Germany. Margitta.worm@charite.de.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hompes
authors.forename: Sabine
authors.initials: S
authors.lastname: Dölle
authors.forename: Josefine
authors.initials: J
authors.lastname: Grünhagen
authors.forename: Linus
authors.initials: L
authors.lastname: Grabenhenrich
authors.forename: Margitta
authors.initials: M
authors.lastname: Worm