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These include exercise, nonsteroidal anti\u2010inflammatory drugs (NSAIDs), alcohol, menstruation, and infections. Initially described in relation to food allergens and physical activity or NSAIDs, these reactions have been labeled under various terms, such as food\u2010dependent exercise\u2010induced anaphylaxis (FDEIA), wheat\u2010dependent exercise\u2010induced anaphylaxis (WDEIA), and food\u2010dependent NSAID\u2010induced anaphylaxis (FDNIA). However, cofactor\u2010enhanced food allergy (CEFA), a recently proposed concept, serves as an umbrella term to encompass these conditions and is applied in this text for consistency. Pediatric cofactor\u2010enhanced food anaphylaxis (PCEFA) is a rare but severe condition in which a food allergy becomes significantly more severe in the presence of one or more cofactors. Cofactors are documented in 14%\u201318.3% of pediatric food anaphylactic reactions; however, the true burden is likely higher due to frequent underdiagnosis from variable and unpredictable presentations. Exercise and infections are the most common cofactors in PCEFA, while \u03c9\u20105 gliadin is the predominant allergen. PCEFA is frequently misdiagnosed as idiopathic anaphylaxis, exercise\u2010induced anaphylaxis (EIA), or asthma when subtle or delayed food triggers go undetected. Some cases may represent high\u2010threshold food allergies rather than true cofactor\u2010dependent anaphylaxis, challenging conventional definitions. Research on cofactors in anaphylaxis is still in its early stages, with most studies focusing on adults. More research is needed to improve diagnostic accuracy and treatment strategies for pediatric cases.<\/jats:p>\n                  <jats:p>\n                    <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                      <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/pai70194-gra-0001-m.png\">\n                        <jats:alt-text>image<\/jats:alt-text>\n                      <\/jats:graphic>\n                    <\/jats:boxed-text>\n                  <\/jats:p>","DOI":"10.1111\/pai.70194","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T10:01:52Z","timestamp":1757066512000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pediatric cofactor\u2010enhanced food anaphylaxis: A narrative review of epidemiology, pathophysiology, and clinical phenotypes"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7526-2089","authenticated-orcid":false,"given":"Alpana","family":"Mohta","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venerology and Leprosy Sharda Multispeciality Clinic  Bikaner India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8159-3394","authenticated-orcid":false,"given":"Emilio","family":"Narvaez","sequence":"additional","affiliation":[{"name":"Allergy Department, Hospital Clinic University of Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9339-777X","authenticated-orcid":false,"given":"Patricia","family":"Mir\u2010Ihara","sequence":"additional","affiliation":[{"name":"Allergy Department, Hospital Clinic University of Barcelona  Barcelona Spain"},{"name":"METRI2A\/IRCE \u2013 Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS)  Barcelona Spain"},{"name":"RICORS \u2013 REI, Instituto de Salud Carlos III  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7767-4730","authenticated-orcid":false,"given":"Joan","family":"Bartra","sequence":"additional","affiliation":[{"name":"Allergy Department, Hospital Clinic University of Barcelona  Barcelona Spain"},{"name":"METRI2A\/IRCE \u2013 Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS)  Barcelona Spain"},{"name":"RICORS \u2013 REI, Instituto de Salud Carlos III  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Mu\u00f1oz\u2010Cano","sequence":"additional","affiliation":[{"name":"Allergy Department, Hospital Clinic University of Barcelona  Barcelona Spain"},{"name":"METRI2A\/IRCE \u2013 Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS)  Barcelona Spain"},{"name":"RICORS \u2013 REI, Instituto de Salud Carlos III  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-0-387-75845-9_29"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.5409\/wjcp.v11.i3.253"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2020.02.010"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.16345"},{"key":"e_1_2_14_6_1","unstructured":"Food Allergy Allies \u2013 Food Allergies Around the World. 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