{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T02:50:16Z","timestamp":1767840616392,"version":"3.49.0"},"reference-count":38,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,10,23]],"date-time":"2018-10-23T00:00:00Z","timestamp":1540252800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Netherlands Food and Consumer Product Safety Authority"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cofactors, such as physical exercise and alcohol intake, might be associated with the severity or occurrence of food allergic reactions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To gain insight into the frequency of presence of potential cofactors in accidental food allergic reactions in adults and to what extent these factors influence the severity and occurrence of allergic reactions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective cohort study was conducted, with a 1\u2010year follow\u2010up in adult patients with a physician\u2010diagnosed food allergy. Patients were required to fill in a questionnaire after every accidental allergic reactions to food over a 1\u2010year period. The primary outcome measure was the frequency that potential cofactors were present in these allergic reactions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 157 patients were included, of which 46% reported a total of 153 reactions during a 1\u2010year follow\u2010up period. In 74% of the reactions, \u22651 potential cofactor was reported to be present: tiredness (38%), alcohol intake (16%), stress (14%), symptoms of pollinosis (16%), symptoms of asthma (9%), sickness\/flu (3%), physical exercise (3%) and use of analgesics (2%). More than one potential cofactor was reported in almost half of all reactions (47%). There was no significant difference in the presence of these factors between mild, moderate and severe reactions (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.522). In the total study population, 9% of the patients used medication that might act as cofactor (antacids, angiotensin receptor blockers [ARBs], beta blockers and angiotensin\u2010converting enzyme inhibitors [ACEIs]) on a daily basis, which however did not influence the occurrence of reactions. Furthermore, 38% daily used allergy\u2010suppressing medication.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although factors suggested to be cofactors were frequently present during accidental food allergic reactions, we found no evidence for an association between the potential cofactors examined and reaction severity, in a population where most reactions were of mild to moderate severity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cea.13282","type":"journal-article","created":{"date-parts":[[2018,9,23]],"date-time":"2018-09-23T08:19:40Z","timestamp":1537690780000},"page":"207-215","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Potential cofactors in accidental food allergic reactions are frequently present but may not influence severity and occurrence"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3235-7648","authenticated-orcid":false,"given":"Astrid","family":"Versluis","sequence":"first","affiliation":[{"name":"Department of Dermatology\/Allergology University Medical Center Utrecht Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harmieke","family":"van Os\u2010Medendorp","sequence":"additional","affiliation":[{"name":"Department of Dermatology\/Allergology University Medical Center Utrecht Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W. Marty","family":"Blom","sequence":"additional","affiliation":[{"name":"TNO, Netherlands Organization for Applied Scientific Research Zeist The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anouska D.","family":"Michelsen\u2010Huisman","sequence":"additional","affiliation":[{"name":"Department of Dermatology\/Allergology University Medical Center Utrecht Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline J. M.","family":"Castenmiller","sequence":"additional","affiliation":[{"name":"Netherlands Food and Consumer Product Safety Authority Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hubert P. J. 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