• J. Allergy Clin. Immunol. · Aug 2000

    Case Reports

    In vitro demonstration of IgE antibody to folate-albumin in anaphylaxis from folic acid.

    • M S Dykewicz, N A Orfan, and W Sun.
    • Division of Allergy and Immunology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
    • J. Allergy Clin. Immunol. 2000 Aug 1; 106 (2): 386-9.

    BackgroundFolic acid (the synthetic form of folate B vitamins in foods) is widely used in vitamin supplements. Anaphylaxis from ingestion or injection of folic acid suggests IgE antibody-mediated mechanisms, but this has not been demonstrated previously in vitro.ObjectiveThis study was conducted to better define the mechanism of folic acid hypersensitivity and cross-reactivity among folic acid congeners.MethodsSkin testing was performed with folic acid congeners in a woman who developed anaphylaxis after ingestion of 2 different multivitamin preparations containing folic acid. In vitro immunologic serum studies were conducted using a folate-human serum albumin (HSA) conjugate prepared by a novel application of carbodiimide condensation.ResultsThe patient had positive immediate-type skin test reactions to folic acid and several folate analogues including leucovorin (folinic acid). Urticaria developed during graded oral test dosing with leucovorin. Using a dot immunoblot assay or an ELISA for IgE antibody to folate-HSA, results of the patient's serum testing were positive, whereas results of sera from normal control subjects were negative, the first in vitro demonstration of IgE to a folic acid-protein conjugate. By ELISA, the positive result of the patient's serum was inhibited significantly by serum coincubation with folate-HSA, but not HSA or folic acid.ConclusionsImmediate hypersensitivity to folic acid and possibly other vitamins can be mediated by IgE antibody to conjugates formed between vitamins and self-proteins or polypeptides. Leucovorin can have clinically important immunologic cross-reactivity with folic acid. A diet rich in natural folates (pteroylpolyglutamates) appears useful as a management strategy for providing adequate nutrition to patients with folic acid hypersensitivity.

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