Development of cofactor-dependent anaphylaxis in a patient with cross-reactive food allergy

Anaphylaxis is a severe life-threatening systemic IgE-dependent hypersensitivity reaction that develops rapidly and can be fatal. As a rule, an anaphylactic reaction develops in response to food, insect stings, and medicine drugs. Sometimes, cofactors can modulate anaphylaxis and significantly reduce the required allergen dose for the development of an anaphylactic reaction. In such cases, anaphylaxis is considered cofactor-dependent. Alcohol consumption is a leading factor in cofactor-dependent anaphylaxis. This article presents a clinical case of cofactor-dependent anaphylaxis. Skin testing with extracts of inhalation allergens and molecular allergy diagnostics using the ImmunoCAP ISAC allergochip (112 allergy components) performed at the Institute of Immunology (Moscow) showed positive results with pollen allergens of deciduous trees and meadow grasses and an increase in the level of specific immunoglobulin E (sIgE) to the main inhalation allergens — birch, hazel, alder, Timothy, pigweed, and wormwood pollen, and to cross-reacting components of allergens from the PR-10 protein group, such as soya bean, kiwi, apple, peach, celery, peanut, and hazelnut. Based on the results of molecular allergy diagnostics, a personalized elimination diet was prepared and recommendations were made to the patient.