{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T04:37:58Z","timestamp":1792816678341,"version":"4.5.0"},"reference-count":41,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:00:00Z","timestamp":1792713600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:00:00Z","timestamp":1792713600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["409525714"],"award-info":[{"award-number":["409525714"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Experimental Allergy"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The role of cofactors contributing to anaphylaxis severity remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed data from the European Anaphylaxis Registry (2007\u20132024) to determine the impact of suspected cofactors on reaction severity. Adjusted odds ratios (aOR) were calculated for the number of organ systems affected, but also two severity classification systems (Ring\/Messmer and Brown).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At least one suspected cofactor was reported in 8310 cases (49%) out of 16,915. Cofactors were less frequently suspected among younger patients (&lt;\u200918\u2009years: 26% and \u2265\u200918\u2009years: 59%). Medication was the most common suspected cofactor in adults (41%), followed by exercise (27%), which was in parallel the most frequent suspected cofactor in children (19%). Emotional burden (children 3%\/adults 8%), alcohol (0.4%\/8%), sleep deprivation (0.5%\/2%) and menstruation (2%\/4%) were less commonly reported. We observed a trend between reaction severity and an increasing number of suspected cofactors. Among suspected cofactors, we observed consistent effects on anaphylaxis reaction severity for acute infections among children and alcohol consumption among adults in food\u2010induced reactions. Moreover, we identified an association between the presence of a suspected cofactor(s) and an increased time interval between exposure and onset of symptoms across all age groups in food\u2010induced anaphylaxis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our data suggest an age\u2010dependent role of suspected cofactors in anaphylaxis severity. Clinicians should explore the presence of cofactors in patients who experienced anaphylaxis, in particular in those with prolonged time intervals between exposure and reaction onset.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cea.70457","type":"journal-article","created":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T04:17:36Z","timestamp":1792815456000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cofactors in Anaphylaxis: Insights From the European Anaphylaxis Registry"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3449-1245","authenticated-orcid":false,"given":"Margitta","family":"Worm","sequence":"first","affiliation":[{"name":"Division of Allergy and Immunology, Department of Dermatology, Venereology and Allergy Charit\u00e9\u2014University Medical Center Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t Zu Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3339-0709","authenticated-orcid":false,"given":"Sabine","family":"D\u00f6lle\u2010Bierke","sequence":"additional","affiliation":[{"name":"Division of Allergy and Immunology, Department of Dermatology, Venereology and Allergy Charit\u00e9\u2014University Medical Center Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t Zu Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4118-6385","authenticated-orcid":false,"given":"Guillaume","family":"Pouessel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children's Hospital, CH Roubaix  Roubaix France"},{"name":"CHU Lille, Pediatric Pulmonology and Allergy Department, P\u00f4le Enfant H\u00f4pital Jeanne de Flandre  Lille France"},{"name":"Universit\u00e9 de Lille ULR 2694: METRICS  Lille 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Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0384-114X","authenticated-orcid":false,"given":"Claudia","family":"Pf\u00f6hler","sequence":"additional","affiliation":[{"name":"Department of Dermatology Saarland University Medical Center  Homburg\/Saar Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9324-6039","authenticated-orcid":false,"given":"Maria Beatrice","family":"Bil\u00f2","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Sciences Universit\u00e0 Politecnica delle Marche  Ancona Italy"},{"name":"Department of Internal Medicine\/Allergy Unit University Hospital Ospedali Riuniti  Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6040-9305","authenticated-orcid":false,"given":"Nicola","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Uniklinikum Erlangen University of Erlangen\u2010Nuremberg (FAU)  Erlangen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4448-3468","authenticated-orcid":false,"given":"Nikolaos G.","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"Allergy Department, 2nd Paediatric Clinic University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1104-5848","authenticated-orcid":false,"given":"Lars","family":"Lange","sequence":"additional","affiliation":[{"name":"Department of Paediatrics GFO\u2010Kliniken Bonn, St. Marien\u2010Hospital  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4411-3088","authenticated-orcid":false,"given":"Andrea","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Dermatology University Allergy Center (UAC), University Hospital Carl Gustav Carus Technical University  Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0418-7381","authenticated-orcid":false,"given":"Johannes","family":"Tr\u00fcck","sequence":"additional","affiliation":[{"name":"Division of Allergy and Children's Research Center University Children's Hospital, University of Zurich (UZH)  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9862-5161","authenticated-orcid":false,"given":"Paul J.","family":"Turner","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8538-3439","authenticated-orcid":false,"given":"Veronika","family":"H\u00f6fer","sequence":"additional","affiliation":[{"name":"Division of Allergy and Immunology, Department of Dermatology, Venereology and Allergy Charit\u00e9\u2014University Medical Center Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t Zu Berlin  Berlin Germany"},{"name":"Division of Allergy and Children's Research Center University Children's Hospital, University of Zurich (UZH)  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,23]]},"reference":[{"issue":"2","key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.jaci.2025.01.021","article-title":"Anaphylaxis Definition, Overview, and Clinical Support Tool: 2024 Consensus Report\u2014A GA(2)LEN Project","volume":"156","author":"Dribin T. 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