Lis Kinga
Department of Allergology, Clinical Immunology and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, ul. Ujejskiego 75, 85-168 Bydgoszcz, Poland.
Curr Issues Mol Biol. 2025 Aug 14;47(8):654. doi: 10.3390/cimb47080654.
Folic acid and its derivatives (e.g., folinic acid) are a group of water-soluble compounds collectively known as vitamin B9. Synthetic folic acid is a component of dietary supplements, medications and other pharmaceuticals and fortified foods. Folinic acid (5-formyltetrahydrofolic acid) is the active metabolite of folic acid. It is used to treat vitamin B9 deficiency and as an adjunct to various combination therapies. Hypersensitivity reactions to folic acid or folinic acid are rare and occur following exposure to synthetic folic acid or its derivatives but not on natural folates. In people allergic to folates, cross-reactions are possible following exposure to folic acid analogues (including antifolates, e.g., methotrexate). The mechanism of hypersensitivity to folic acid and/or folinic acid has not been clearly established. Both IgE-dependent and non-IgE-dependent hypersensitivity reactions are likely. It is possible that folic or folinic acid is either an immunogen or a hapten. Diagnosing hypersensitivity to folic/folinic acid is difficult. There are no validated in vitro or in vivo diagnostic tests. The basophil activation test (BAT) appears to be a promising tool for diagnosing folate allergy. The aims of the manuscript were to review published clinical cases of hypersensitivity reactions to folic or folinic acid, potential mechanisms of these reactions and possible cross-allergies, and current diagnostic possibilities of folate hypersensitivity.
叶酸及其衍生物（如亚叶酸）是一组水溶性化合物，统称为维生素B9。合成叶酸是膳食补充剂、药物及其他药品和强化食品的成分。亚叶酸（5-甲酰四氢叶酸）是叶酸的活性代谢产物。它用于治疗维生素B9缺乏症，并作为各种联合疗法的辅助药物。对叶酸或亚叶酸的过敏反应很少见，且发生在接触合成叶酸或其衍生物之后，而非天然叶酸。对叶酸过敏的人，接触叶酸类似物（包括抗叶酸药，如甲氨蝶呤）后可能会发生交叉反应。对叶酸和/或亚叶酸过敏的机制尚未明确。IgE依赖型和非IgE依赖型过敏反应都有可能。叶酸或亚叶酸可能既是免疫原又是半抗原。诊断对叶酸/亚叶酸的过敏反应很困难。目前尚无经过验证的体外或体内诊断试验。嗜碱性粒细胞活化试验（BAT）似乎是诊断叶酸过敏的一种有前景的工具。本文的目的是回顾已发表的对叶酸或亚叶酸过敏反应的临床病例、这些反应的潜在机制和可能的交叉过敏，以及目前叶酸过敏的诊断可能性。
