Volume 10 Supplement 2

Canadian Society of Allergy and Clinical Immunology and AllerGen Abstracts 2014

Open Access

Anaphylaxis associated with folic acid: domestic case review

  • Pauline E Kerr1 and
  • David Cunningham1
Allergy, Asthma & Clinical Immunology201410(Suppl 2):A23

https://doi.org/10.1186/1710-1492-10-S2-A23

Published: 18 December 2014

Background

Synthetic folic acid has been shown to cause serious, potentially life-threatening IgE mediated anaphylaxis [13]. Synthetic folic acid does not occur naturally and is distinct from naturally occurring folic acid [1, 4, 5].

Methods

A search of the Canada Vigilance Database from April 1, 2008 to August 31, 2013 identified 15 cases of anaphylaxis and 16 reports of serious non-anaphylactic allergic reactions.

Results

All 15 cases of anaphylaxis involved multi ingredient products with NHP doses (up to and including 1 mg). Fourteen cases were female (93%). One case of anaphylaxis and 3 cases of serious allergic reaction involved women taking prenatal supplements, two of which reported spontaneous abortion. There was insufficient case information available to assess any causal association between the allergic reaction and the fetal loss. Three medically important cases involved pharmaceutical doses of folic acid (5 mg), one of which was a pediatric case involving a multi ingredient intravenous total parental nutrition product (Multi-12/K1 pediatric) containing folic acid.

Confirmatory allergy tests for folic acid were not available for any of the cases. None of the reports noted a known diagnosis of folic acid allergy.

Conclusions

Folic acid allergy appears to be rare and would not be expected to be well known among health providers or consumers. Increasing awareness amongst health providers regarding folic acid allergy may improve the identification and counselling of patients with this allergy.

Authors’ Affiliations

(1)
Marketed Health Products Directorate, Health Products and Food Branch, Health Canada

References

  1. Dykewicz MS, Orfan NA, Sun W: In vitro demonstration of IgE antibody to folate-albumin in anaphylaxis from folic acid. J Allergy Clin Immunol. 2000, 106: 386-89. 10.1067/mai.2000.108502.View ArticlePubMedGoogle Scholar
  2. Smith J, Empson M, Wall C: Recurrent anaphylaxis to synthetic folic acid. The Lancet. 2007, 370: 652-View ArticleGoogle Scholar
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  4. Stoevesandt J, Brocker E, Trautmann A: Folic acid allergy: no breakfast cereal hazard. EJD. 2011, 21: 280-1.PubMedGoogle Scholar
  5. HC: Health Canada: Monograph: Folate. 2009, Ottawa (ON): Health Canada, [http://webprod.hc-sc.gc.ca/nhpid-bdipsn/monoReq.do?id=90]Google Scholar

Copyright

© Kerr and Cunningham; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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