Asthma, Eczema, and Food Allergy in Children Following Liver Transplantation

Almaas, Runar; Hafliðadóttir, Svanhildur; Kaldestad, Runa Helen; Matthews, Iren Lindbak

doi:10.1016/j.jpeds.2018.08.050

Cited by 9 publications

(15 citation statements)

References 35 publications

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“…Additionally, it has also been suggested that tacrolimus may cause an increase in cytokines such as interleukin-4, 5, 13 and T-helper 2, which are the main mediators of atopic diseases. 13,14 In our study, two patients were detected with eczematous lesions. Urticaria was observed in three patients and one of them had angioedema secondary to hazelnut allergy.…”

Section: Demographic and Clinical Findings Of The Patientsmentioning

confidence: 65%

“…Dermatologic complications associated with immunosuppressive regimen included; xerosis (n=5), acne vulgaris (n=3), fissured tongue (n=3), alopecia areata Children are affected more often than adults and the average time from transplant to onset of atopic eczema is first 12 months. 13 Tacrolimus has been shown to increase intestinal permeability and to cause food allergens to pass the intestinal barrier more easily. Additionally, it has also been suggested that tacrolimus may cause an increase in cytokines such as interleukin-4, 5, 13 and T-helper 2, which are the main mediators of atopic diseases.…”

Section: Demographic and Clinical Findings Of The Patientsmentioning

confidence: 99%

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Mucocutaneous complications in pediatric patients with liver transplantation

Issi

Güven

Çakır

2020

Mucosa

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Background Liver transplant recipients can develop mucocutaneous lesions and the severity of these lesions can vary from benign to life-threatening conditions. The aim of this study was to investigate the frequency and clinical features of mucocutaneous complications after liver transplantation (LT) in pediatric patients. Methods Retrospectively, children who underwent LT and were detected with skin and mucosa lesions while being followed up in our Pediatric Gastroenterology outpatient clinic between June 2005 and July 2020 were evaluated. Age, gender, primary diagnosis, graft type, immunosuppression history and post-transplantation mucocutaneous complications were recorded from the patients’ file. Results Mucocutaneous lesions were observed in 16 (9 girls, 7 boys) of 37 patients after LT. Mean transplantation age ± SD was 1.96 ± 2.03 years and a mean follow-up period was 7.31 ± 2.69 years. The lesions due to viral infections were the most common dermatologic findings (n=7, 20.5%), followed by soft tissue infection (n=6), xerosis (n=5), urticaria (n=3), eczema (n=2), fissured tongue (n=3), acne vulgaris (n=3), tinea (n=2), alopecia areata (n=1), oral aphthae (n=1) and leukocytoclastic vasculitis (n=1). No premalignant or malignant lesion was detected in any patient. Conclusion Studies about mucocutaneous complications are limited in children after LT and these lesions are often caused by infections associated with the side effects of immunosuppressive treatment. Accordingly, a carefully dermatological examination should be performed during the follow-up of patients undergoing LT.

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Section: Demographic and Clinical Findings Of The Patientsmentioning

confidence: 65%

Section: Demographic and Clinical Findings Of The Patientsmentioning

confidence: 99%

Mucocutaneous complications in pediatric patients with liver transplantation

Issi

Güven

Çakır

2020

Mucosa

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“…Rejection, re-transplantation, and metabolic disease are independent risk factors associated with shorter stature. The use of steroids post-transplant for autoimmune (e.g., de novo autoimmune hepatitis) or allergic complications also contributes [ 123 , 124 ]. However, underlying genetic conditions (e.g., Alagille syndrome) may contribute to permanent low stature.…”

Section: Pre- and Post-transplant Nutritional Status Of Children With End-stage Cholestatic Liver Diseasementioning

confidence: 99%

Malnutrition in Pediatric Chronic Cholestatic Disease: An Up-to-Date Overview

et al. 2021

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Despite recent advances, the causes of and effective therapies for pediatric chronic cholestatic diseases remain elusive, and many patients progress to liver failure and need liver transplantation. Malnutrition is a common complication in these patients and is a well-recognized, tremendous challenge for the clinician. We undertook a narrative review of both recent and relevant older literature, published during the last 20 years, for studies linking nutrition to pediatric chronic cholestasis. The collected data confirm that malnutrition and failure to thrive are associated with increased risks of morbidity and mortality, and they also affect the outcomes of liver transplantation, including long-term survival. Malnutrition in children with chronic liver disease is multifactorial and with multiple potential nutritional deficiencies. To improve life expectancy and the quality of life, patients require careful assessments and appropriate management of their nutritional statuses by multidisciplinary teams, which can identify and/or prevent specific deficiencies and initiate appropriate interventions. Solutions available for the clinical management of these children in general, as well as those directed to specific etiologies, are summarized. We particularly focus on fat-soluble vitamin deficiency and malnutrition due to fat malabsorption. Supplemental feeding, including medium-chain triglycerides, essential fatty acids, branched-chain amino acids, and the extra calories needed to overcome the consequences of anorexia and high energy requirements, is reviewed. Future studies should address the need for further improving commercially available and nutritionally complete infant milk formulae for the dietary management of this fragile category of patients. The aid of a specialist dietitian, educational training regarding nutritional guidelines for stakeholders, and improving family nutritional health literacy appear essential.

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“…As a consequence of the increase in the rate of organ transplantation, previously non-allergic transplant recipients have been increasingly recognized as being at higher risk for developing de novo FA in comparison to the general population ( 3 – 6 ). Moreover, children undergoing liver transplantation (LT) have resulted to be far more affected by FA when compared to all the other transplant groups ( 5 , 7 – 10 ).…”

Section: Introductionmentioning

confidence: 99%

De novo Food Allergy After Pediatric Liver Transplantation: A Systematic Review

et al. 2022

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Background:Liver transplant (LT) recipients, particularly children, have an increased risk of developing de novo food allergies (FAs) after transplantation both compared to all the other transplant groups and to the general population. Little is known about the pathogenesis underlying this phenomenon and comprehensive recommendations or clinical practice guidelines are still lacking, mainly due to the scarcity of high-quality evidence.AimWe aimed to prepare a systematic review on de novo FA in pediatric LT recipients to assess epidemiology and risk factors, evaluate the correlation to specific food groups, describe clinical manifestations, investigate the rate of tolerance acquisition over time and report available therapeutic strategies.MethodsWe conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). MEDLINE, Scopus, Web of Science, Wiley online library, Cochrane Library, and ClinicalTrials.gov databases were systematically searched for studies published from January 1980 to September 2021. All the articles were checked independently by two reviewers in two steps. A total of 323 articles were screened, and 40 were included for data extraction.Results and ConclusionsWe found that de novo FAs develop in the 15% of pediatric LT recipients, especially in the first 2 years after surgery, with higher risk related to younger age at transplantation (especially <2 years of age) and tacrolimus immunosuppression. Subjects are often allergic to multiple foods, and 15% of them suffer from anaphylaxis. The majority of patients do not spontaneously outgrow their symptoms during follow-up. The discontinuation of tacrolimus in favor of cyclosporine or the association of tacrolimus with mycophenolate have been associated with the resolution or the improvement of FA in small retrospective case series and could be considered in case of severe or multiple, difficult to manage FAs. Prospective multicenter studies are needed to confirm these findings, guide the risk-based stratification of pediatric LT recipients, and provide for high-evidence therapeutic strategies for children with de novo FA.

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Asthma, Eczema, and Food Allergy in Children Following Liver Transplantation

Cited by 9 publications

References 35 publications

Mucocutaneous complications in pediatric patients with liver transplantation

Mucocutaneous complications in pediatric patients with liver transplantation

Malnutrition in Pediatric Chronic Cholestatic Disease: An Up-to-Date Overview

De novo Food Allergy After Pediatric Liver Transplantation: A Systematic Review

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