Risk Factors in Food‐induced Anaphylactic Shock: Which Matters Most, Food or Cofactor?: 445

Abstract

Rosa Munoz-Cano, MD, PhD, Rocio Casas, MD, Mariona Pascal, PhD, Giovanna Araujo, MD, Silvia Quarta, MD, Silvia A. Riggioni Viquez, MD, Clara San Bartolome, and Joan Bartra, MD, PhD; Hospital Clinic, Barcelona, Spain, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. RATIONALE: Food allergy (FA) symptoms have a broad spectrum of severity but anaphylactic shock (AnS) is a rare manifestation. Lipid Transfer Protein (LTP) is one of the most frequent FA elicitors in adults in our area (Barcelona, Spain). Our objectivewas to describe the characteristics of anaphylaxis and AnS in LTP allergic patients. METHODS: Adult patients with a clinical diagnosis of anaphylaxis and AnS due to LTP allergy were recruited between 2009-2018. Anaphylaxis was defined by the EAACI criteria; AnS was defined as that anaphylaxis that occurred with presyncope/loss of consciousness due to cardiovascular and/or respiratory collapse. RESULTS: 103 reactions were identified in 63 patients; 85 anaphylaxis (1.9/patient) and 18 AnS (1/patient). In both groups the most common triggers were prunoidae fruits, apple, walnut and tomato. Peanut was involved in anaphylaxis but not in AnS. Cofactor was required in 29(34.1%) anaphylaxis and 10(55.6%) AnS; exercise was the most frequent cofactor in anaphylaxis and NSAIDs in AnS. Most peach and peanut related reactions (regardless of severity) did not required cofactor. Conversely, tomato needed a cofactor in 9/10 anaphylaxis and 1/1 AnS. In the AnS group, 11(61.1%) had skin symptoms and only 7(38.8%) respiratory symptom. CONCLUSIONS: Reaction severity seems to be related with both the presence of cofactors and certain foods. Peanut and peach were associated with more severe reactions in the absence of cofactors, whereas other foods as tomatoes necessarily required a cofactor to induce a similar reaction. NSAIDs may be considered as a risk factor for severe reactions (anaphylactic shock).