Elicitors of
anaphylactic reactions are any sources of
protein with allergenic capacity. However, not all
allergic reactions end up in the most severe form of
anaphylaxis. Augmenting factors may explain why certain conditions lead to
anaphylaxis. Augmenting factors may exhibit three effects: lowering the threshold, increasing the severity, and reversing acquired clinical tolerance. Common augmenting factors are physical exercise, menstruation,
NSAIDs, alcohol, body temperature, acute
infections, and
antacids. Therapeutic options may address causative, preventive, pragmatic, or symptomatic considerations: avoid the eliciting food, take an
antihistamine before any situation with a possible risk of augmentation, separate food and sport (at least for 2 h), and carry an
adrenaline autoinjector at all times. Individual patterns include summation effects and specific patterns. In conclusion, in the case of a suggestive history but a negative oral challenge, one should consider the possible involvement of augmenting factors; after
anaphylactic reactions, always ask for possible augmentation and other risk factors during the recent past; if augmentation is suspected, oral food challenges should be performed in combination with augmenting factors; and in the future, standardized challenge protocols including augmenting factors should be established.