Cytokine profile in children with food allergy following liver transplantation

Abstract

Background LTX in children is associated with increased risk of food allergy, and the mechanisms underlying this are unknown. We wanted to study whether plasma cytokine profile differed in liver transplanted children, with and without food allergy, and whether it differed from untransplanted children with CLD. Methods Plasma cytokines, total and specific IgE in nine patients with food allergy were compared with 13 patients without food allergy following LTX, and also with seven untransplanted patients with CLD. Results No difference was found in the cytokine profile between liver transplanted patients with and without food allergy. Transplanted patients with food allergy having received a prescription of epinephrine had a significantly higher total IgE (2033 [234‐2831] vs 10 [5‐41] IU/L, P = .002) and MIP‐1b (52 [37‐96] vs 36 [32‐39], P = .035) compared with transplanted patients without food allergy. Two patients with severe food allergy responded favorably to conversion from tacrolimus‐based immunosuppression to MMF and corticosteroids with reduction in clinical symptoms, total IgE, specific IgE, IL‐1ra, IL‐4, RANTES, PDGF, MIP‐1a, and TNFα. The transplantation group had higher levels of IL‐1b, IL‐5, IL‐7, IL‐13, GCSF, IFNγ, and MIP‐1a compared with the CLD group. Conclusions No overall difference was found in plasma cytokine profile between patients with and without food allergy. Patients with severe food allergy had significant elevation of MIP‐1b. Discontinuation of tacrolimus reduced total and specific IgE and changed plasma cytokine profile. The plasma cytokine profile in liver transplanted children was different compared with children with CLD.

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

“…A switch from tacrolimus to cyclosporine was reported by 8 studies and led to successful reintroduction of food allergens in 71.4% of patients (15/21, excluding duplicates). Similarly, the switch from tacrolimus to mycophenolate or the addition of mycophenolate to tacrolimus led to the reduction of the biomarkers of Th2 activation (including total and specific IgEs), along with the improvement or the resolution of FA in 3 out of 3 children ( 38 , 48 ). The introduction of the mTOR inhibitor sirolimus was reported as effective in the treatment of post-transplant immune mediated disorders, such as autoimmune cytopenia, but had mixed results as regards the improvement of FA, reported in 3 out of 5 patients ( 14 , 33 , 51 ).…”

Mycophenolate Mofetil Use Is Associated With Reduced Incidence of Food Allergy in Liver Transplanted Children

“…A previous case report presents a single pediatric liver transplant patient with food allergy that experienced reduction in specific IgE levels after the addition of MMF and reduction in tacrolimus dosage (17). Stopping tacrolimus improves food allergies (6,8,18). Whether this single patient responded to reduction of tacrolimus or to addition of MMF is unknown.…”

“…Several studies have indicated that there is an association between the use of tacrolimus and the development of de novo food allergies in children after liver transplantation (4,6,13,14). A possible causative relationship is further supported by studies where a change in the immunosuppression from tacrolimus to other agents reduces allergic symptoms (6,8) and alters the cytokine profile (8). Tacrolimus may lead to a shift in the T helper cell 1/T helper cell 2 (T H 1/T H 2) balance (8,13) and increase gut permeability which may in turn lead to an increased exposure…”

“…A possible causative relationship is further supported by studies where a change in the immunosuppression from tacrolimus to other agents reduces allergic symptoms (6,8) and alters the cytokine profile (8). Tacrolimus may lead to a shift in the T helper cell 1/T helper cell 2 (T H 1/T H 2) balance (8,13) and increase gut permeability which may in turn lead to an increased exposure…”

“…Food allergies influence the life of many transplanted children with elimination of one or several foods from the diet. Some transplanted children experience anaphylaxis (6,7), many are prescribed epinephrine (5,8), and some children have to change their immunosuppression because of new-onset food allergies (6)(7)(8). Furthermore, food allergies in liver transplant children are accompanied by increased rates of eczema and asthma (5).…”