Folic acid‐induced anaphylaxis showing cross‐reactivity with methotrexate: a case report and review of the literature

Nishitani, Nao; Adachi, Atsuko; Fukumoto, Takeshi; Ueno, Mitsuhiko; Fujiwara, Norihiro; Ogura, K.; Horikawa, Tsuyoshi

doi:10.1111/j.1365-4632.2009.03926.x

Cited by 11 publications

(12 citation statements)

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“…62 Idiopathic anaphylaxis is diagnosed when no triggers can be identified based on history, skin tests are negative, and serum specific IgE levels are absent or undetectable. Before this diagnosis is made, however, the possibility of a hidden or previously unrecognized trigger should be ruled out, 24,[28][29][30]32,33,[37][38][39][40]57 and the patients should be evaluated for mastocytosis and clonal mast cell disorders. [63][64][65][66][67] Mechanisms…”

Section: Pathogenesis Triggers Of Anaphylaxismentioning

confidence: 99%

“…Antibiotics, especially b-lactam antibiotics, and nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen, and other agents, are often implicated, as are chemotherapeutic agents. 24,25,[34][35][36][37][38][39][40] Newly recognized medication triggers include loperamide 37 ; contaminants in medications, such as oversulfated chondroitin sulfate (OSCS)-contaminated heparin 38 ; seemingly innocuous substances, such as vitamins and supplements containing folic acid 39 ; and herbal treatments. 40 Perioperative medications, 41 iodinated contrast media 42 and medical dyes are becoming increasingly relevant triggers in community settings.…”

Section: Pathogenesis Triggers Of Anaphylaxismentioning

confidence: 99%

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Anaphylaxis

Simons

2010

Journal of Allergy and Clinical Immunology

397

380

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Anaphylaxis occurs commonly in community settings. The rate of occurrence is increasing, especially in young people. Understanding potential triggers, mechanisms, and patient-specific risk factors for severity and fatality is the key to performing appropriate risk assessment in those who have previously experienced an acute anaphylactic episode. The diagnosis of anaphylaxis is based primarily on clinical criteria and is valid even if the results of laboratory tests, such as serum total tryptase levels, are within normal limits. Positive skin test results or increased serum specific IgE levels to potential triggering allergens confirm sensitization but do not confirm the diagnosis of anaphylaxis because asymptomatic sensitization is common in the general population. Important patient-related risk factors for severity and fatality include age, concomitant diseases, and concurrent medications, as well as other less well-defined factors, such as defects in mediator degradation pathways, fever, acute infection, menses, emotional stress, and disruption of routine. Prevention of anaphylaxis depends primarily on optimal management of patient-related risk factors, strict avoidance of confirmed relevant allergen or other triggers, and, where indicated, immunomodulation (eg, subcutaneous venom immunotherapy to prevent Hymenoptera sting-triggered anaphylaxis, an underused, potentially curative treatment). The benefits and risks of immunomodulation to prevent food-triggered anaphylaxis are still being defined. Epinephrine (adrenaline) is the medication of first choice in the treatment of anaphylaxis. All patients at risk for recurrence in the community should be equipped with 1 or more epinephrine autoinjectors; a written, personalized anaphylaxis emergency action plan; and up-to-date medical identification. Improvements in the design of epinephrine autoinjectors will help to optimize ease of use and safety. Randomized controlled trials of pharmacologic agents, such as antihistamines and glucocorticoids, are needed to strengthen the evidence base for treatment of acute anaphylactic episodes.

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Section: Pathogenesis Triggers Of Anaphylaxismentioning

confidence: 99%

Section: Pathogenesis Triggers Of Anaphylaxismentioning

confidence: 99%

Anaphylaxis

Simons

2010

Journal of Allergy and Clinical Immunology

397

380

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“…The anaphylaxis cases are assumed to be forms of immediate-type allergy because IgE antibodies to folic acid are detected in the patient’s serum. 2,9 Folic acid is thought to be able to act as a hapten in immunogenic reactions, corresponding with its low molecular weight (441 D), well below the 1000 D threshold usually required for an agent to be recognized as a complete antigen or allergen. The ability of folic acid solutions to elicit positive immediate skin test reactions suggests that folic acid must be capable of rapidly combining with self-proteins or polypeptides in the skin to form a complete allergen.…”

Section: Discussionmentioning

confidence: 99%

“…Adverse reactions to folic acid are an extremely uncommon condition, but in literature, 13 cases (all female subjects, but 1) of hypersensitivity are described from 1949. 1–11…”

Section: Introductionmentioning

confidence: 99%

Hypersensitivity reactions to folic acid: Three case reports and a review of the literature

Nucera

Aruanno

Mezzacappa

et al. 2018

Int J Immunopathol Pharmacol

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“…[17][18][19] Medication triggers include b-lactam and other antibiotics; aspirin, ibuprofen, and other analgesics 20 ; and newly recognized agents such as oversulfated chondroitin sulfate (OSCS)-contaminated heparin, 21 as well as seemingly innocuous substances such as folic acid contained in vitamins and supplements. 22 Biologic agents that trigger anaphylaxis include mAbs such as cetuximab, 23 infliximab, 24 and omalizumab 25 ; allergens used in immunotherapy 26 ; and, rarely, vaccines to prevent infectious diseases. 27 Venom from a stinging insect (order Hymenoptera) 28 or, less commonly, saliva from a biting insect (eg, order Diptera [flies and mosquitoes] or Hemiptera [kissing bugs]) can induce anaphylaxis.…”

Section: Epidemiologymentioning

confidence: 99%