Sep 5, 2025
Dr. Alpana Mohta is a co-author on a new narrative review titled “Pediatric cofactor-enhanced food anaphylaxis: A narrative review of epidemiology, pathophysiology, and clinical phenotypes.”
The article appears in the September 2025 issue of Pediatric Allergy and Immunology and provides a timely overview of how “cofactors” can intensify food-allergic reactions in children.
What the paper is about
Cofactors are external influences that lower the threshold for allergic reactions and can amplify severity, turning otherwise mild or moderate reactions into anaphylaxis. Common cofactors include exercise, nonsteroidal anti-inflammatory drugs (NSAIDs), infections, alcohol, and menstruation. The review synthesizes current knowledge on epidemiology, mechanisms, and clinical phenotypes specific to children.
Why this matters
Underrecognized but important: Cofactors are documented in ~14–18.3% of pediatric food-anaphylaxis cases, yet the true burden is likely higher due to variable and unpredictable presentations.
Clinical vigilance: The review highlights frequent misdiagnosis (e.g., as idiopathic anaphylaxis, exercise-induced anaphylaxis, or asthma) when subtle or delayed food triggers go undetected.
Practical implications: Recognizing and managing cofactors (e.g., advising temporary avoidance of intense exercise or NSAIDs around exposure windows) may help reduce risk in susceptible children.
Notable insights from the review
Terminology: The authors use cofactor-enhanced food allergy (CEFA) as an umbrella concept that includes entities such as food-dependent exercise-induced anaphylaxis (FDEIA), wheat-dependent exercise-induced anaphylaxis (WDEIA), and food-dependent NSAID-induced anaphylaxis (FDNIA).
Common cofactors & allergens: In pediatric cases, exercise and infections are most often implicated; ω-5 gliadin emerges as a predominant allergen in wheat-related presentations.
Research needs: The field is still developing, with most evidence drawn from adults. The authors call for prospective pediatric studies to refine diagnosis, risk prediction, and management.