Drug allergy to folic acid - myth or reality?
- Authors: Klimanova Y.М.1, Latysheva E.A.1, Myasnikova T.N.1
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Affiliations:
- National Research Center — Institute of Immunology Federal Medical-Biological Agency of Russia
- Section: Case reports
- Submitted: 16.12.2025
- Accepted: 27.02.2026
- URL: https://rusalljournal.ru/raj/article/view/17103
- DOI: https://doi.org/10.36691/RJA17103
- ID: 17103
Cite item
Abstract
Drug allergy is one of the most interesting and complex issues that a doctor of any speciality may encounter in their practice. Accordingly, the study of drug allergies remains a pressing concern in modern medicine, including allergology, taking into account the increase in the number of pharmacological drugs available on the market, the duration of drug use in global practice, and the development of pharmacotherapy for various nosologies. The main causative drugs of drug hypersensitivity are antibiotics and NSAIDs. Folic acid is a rare trigger of drug allergy. Currently, there are only a few reported cases of drug allergy to folic acid. This article presents a clinical case of immediate-type drug allergy to folic acid, confirmed by in vivo testing.
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About the authors
Yulia М. Klimanova
National Research Center — Institute of Immunology Federal Medical-Biological Agency of Russia
Author for correspondence.
Email: ulklim5@gmail.com
ORCID iD: 0009-0009-1349-7187
SPIN-code: 8867-9448
Russian Federation, Москва
Elena A. Latysheva
National Research Center — Institute of Immunology Federal Medical-Biological Agency of Russia
Email: ealat@mail.ru
ORCID iD: 0000-0002-1606-205X
SPIN-code: 2063-7973
Dr. Sci. (Medicine)
Russian Federation, MoscowTatiana N. Myasnikova
National Research Center — Institute of Immunology Federal Medical-Biological Agency of Russia
Email: t_miasnikova@mail.ru
ORCID iD: 0000-0001-8491-195X
SPIN-code: 4684-3112
MD, Cand. Sci. (Med.)
Russian Federation, MoscowReferences
- Khaitov R.M., Ilina N.I., eds. Allergology. Clinical Guidelines. Moscow: GEOTAR-Media; 2009:256
- Siatka T., Mát’uš M., Moravcová M., et al. Biological, dietetic and pharmacological properties of vitamin B9. NPJ Sci Food. 2025;9:30. doi: 10.1038/s41538-025-00396-w.
- EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies) Scientific Opinionon the substantiation of a health claim related to increasing maternal folate status by supplemental folate intake and reduced risk of neural tube defects pursuant to Article 14 of Regulation (EC) No 1924/2006. EFSA J. 2013;11:3328. doi: 10.2903/j.efsa.2013.3328.
- Shulpekova Y., Nechaev V., Kardasheva S., et al. The Concept of Folic Acid in Health and Disease. Molecules.2021;26(12):3731. doi: 10.3390/molecules26123731.
- Zheng Y., Cantley L.C. Toward a better understanding of folate metabolism in health and disease. J Exp Med.2019;216:253-266. doi: 10.1084/jem.20181965.
- Vayner A.S., Zhechev D.A., Kechin A.A., et al. Folate metabolism and congenital developmental anomalies. Mother and Child in Kuzbass. 2011;2(45):3-10. doi: 10.1134/S001667581103008X.
- Mitchell D.C., Vilter R.W., Vilter C.F. Hypersensitivity to folic acid. Ann Intern Med. 1949;31:1102-1105. doi: 10.7326/0003-4819-31-6-1102.
- Lis K. Hypersensitivity to Folic Acid and/or Folinic Acid: A review of clinical cases, potential mechanism, possible cross-allergies and current diagnostic options. Curr Issues Mol Biol. 2025;47(8):654. doi: 10.3390/cimb47080654.
- Nucera E., Aruanno A., Mezzacappa S., Pascolini L., Buonomo A., Schiavino D. Hypersensitivity reactions to folic acid: Three case reports and a review of the literature. Int J Immunopathol Pharmacol. 2018;32:2058738418817704. doi: 10.1177/2058738418817704.
- Dykewicz M.S., Orfan N.A., Sun W. In vitro demonstration of IgE antibody to folate-albumin in anaphylaxis from folic acid. J Allergy Clin Immunol. 2000;106:386-389. doi: 10.1067/mai.2000.108502.
- Sanders G.M., Fritz S.B. Allergy to natural and supplemental folic acid as a cause of chronic, intermittent urticaria and angioedema. Ann Allergy Asthma Immunol. 2004;93:S51-S52. doi: 10.1016/S1081-1206(10)61736-X.
- Smith J., Empson M., Wall C. Recurrent anaphylaxis to synthetic folic acid. Lancet. 2007;370:652. doi: 10.1016/S0140-6736(07)61330-0.
- Pfab F., Willi R., Albert A., Huss-Marp J., Athanasiadis G.I., Jakob T., Ollert M., Ring J., Darsow U. Anaphylactic reaction to folic acid verified by provocational testing. Allergy.2007;62:823-824. doi: 10.1111/j.1398-9995.2007.01371.x.
- Valdivieso R., Cevallos F., Caballero M.T., Quirce S. Chronic urticaria caused by folic acid. Ann Allergy Asthma Immunol.2009;103:81-82. doi: 10.1016/S1081-1206(10)60149-4.
- Nishitani N., Adachi A., Fukumoto T., Ueno M., Fujiwara N., Ogura K., Horikawa T. Folic acid-induced anaphylaxis showing cross-reactivity with methotrexate: A case report and review of the literature. Int J Dermatol. 2009;48:522-524. doi: 10.1111/j.1365-4632.2009.03926.x.
- Schrijvers R., Chiriac A.M., Demoly P. Allergy workup for suspected folic acid hypersensitivity. J Investig Allergol Clin Immunol. 2015;25:233-236. doi: 10.1186/s13223-022-00752-5.
- Gaeta F., Romano A., Guéant-Rodriguez R.M., Guéant J.L. IgE-mediated anaphylactic reaction against free synthetic folic acid and methyl folate. J Allergy Clin Immunol Pract. 2020;8:809-811. doi: 10.1016/j.jaip.2019.08.026.
- Schnebert B., Saïd B.B., Dupire G. IgE-mediated allergy to folic acid: A case report. Eur J Dermatol. 2023;33:41-42. doi: 10.1684/ejd.2023.4408.
- Nonhoff J., Jafari R., Tronnier M. Folate malady—Anaphylaxis after folic acid substitution. J Dtsch Dermatol Ges.2023;21(Suppl 2):13-14. doi: 10.1111/ddg.15096_g.
- Riaz A., Tabbah K. Folic acid allergy in pregnancy: a case report. J Pak Med Assoc. 2025;75(1):119-121. doi: 10.47391/JPMA.10691.
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