D1.21 - Three cases of Food induced Anaphylaxis - Role of Cofactors

Cofactors play an important role in food allergies. Cofactor dependent allergies can be missed or misdiagnosed without clear insight and detailed history taking. We present three cases of food allergies where cofactor played a crucial role.

Case1 - A patient reported two episodes of generalised itching, swelling of lips and throat, flushing and vomiting after 30 minutes of walk following consumption of chicken salad (chicken, cheese, lettuce, tomato and cucumber). No alcohol, NSAIDs, infection involved. Tolerated the similar salad in the absence of exercise. There were no issues with walking or exercise in the absence of salad. Investigations revealed negative Omega-5- gliadin and serum specific IgE to tomato, cucumber and lettuce and positive Pru p3 which is a ns LTP. The clinical history and investigation findings are consistent with LTP allergy and exercise act as a cofactor

Case2 - A patient reported an episode of symptoms consistent with anaphylaxis 30 minutes following consumption of pizza with pork sausages and a small amount of alcohol (Beer) while walking straight after the meal. He never had issues with wheat and exercise or wheat or pork with alcohol. Investigations revealed positive omega-5 gliadin and negative serum specific IgE to pork and  alpha-gal. Most probably alcohol acted as an additional cofactor. There is a possibility that the degree of exercise acted as a co-factor.

Case3- A patient experienced two episodes of anaphylaxis while walking following 30 minutes   of consumption of battered fish and potato chips. Never experienced symptoms of  type1 HSR with potatoes, fish and wheat in the absence of exercise. Serum specific IgE negative to Omega-5- gliadin and fish and positive to wheat and potatoes. Further test revealed strongly positive Pru p3. It's suggestive of LTP allergy and exercise acted as a co-factor.