Food allergy after liver transplantation in children: a prospective study

Abstract

Food allergy has been increasingly reported in children who had orthotopic liver transplantation (OLT). We aimed to conduct a prospective study to investigate the prevalence of sensitizations and food allergy in pediatric OLT recipients. We also aimed to identify potential risk factors. The study group consisted of 28 children (14 male, 14 female, mean age 4.96 +/- 0.76 yrs) who had OLT. Total eosinophil count (TEC), total IgE, and specific IgEs were studied before and 3, 6, 12 months after OLT. Six patients (21%) developed multiple food allergies. Mean age of six patients at OLT who developed food allergy was younger compared to the non-food allergy group (10.2 months vs. 68.9 months, p < 0.05). Food allergy has been developed within 1 yr in 5, and in 20 months in one patient after OLT. All six patients had cow's milk and egg allergy after OLT. Five children developed wheat, one children developed lentil and another one developed peach allergy in addition to cow's milk and egg allergy. Out of six food-allergic patients after OLT, four children developed Epstein-Barr virus (EBV) infection prior to food allergy. Before OLT, TECs and total IgE levels were not differed among food allergic and non-food allergic patients (p > 0.05). Mean of TECs were significantly higher in food allergic group compared to non-food allergic group at each time point after OLT (p < 0.05). Though statistically insignificant, mean of total IgE levels were also higher in the food allergic group (p > 0.05). These findings suggest that food allergy should be considered after OLT in patients who are younger than 1 yr of age, who developed hypereosinophilia, high total IgE levels or EBV viremia.

New-onset food allergy following cord blood transplantation in adult patients

“…Through this retrospective study, the incidence of new-onset food allergy in adult patients after CBT was estimated to be 6.6%. This incidence was lower than that reported in liver transplantation (10-21%) 3,4 and seemed higher than the estimated rate of 0.2-0.6% in common food allergies in the adult population, such as those against milk, egg, wheat and peanuts. 10 It is notable that food allergy associated with liver transplantation has been reported exclusively in pediatric patients.…”

“…10 It is notable that food allergy associated with liver transplantation has been reported exclusively in pediatric patients. [1][2][3][4] However, our study showed that adult patients can also develop food allergy after CBT. Indeed, two adult cases of food allergy after CBT have recently been reported.…”

“…This feature can be explained by the immature immune cells transferred from a cord blood donor under immunosuppression, which mimics the situation in pediatric patients undergoing liver transplantation. [1][2][3][4] Since the first report of food allergy after liver transplantation, the causative role of tacrolimus has been suggested and investigated. [1][2][3][4] Tacrolimus has been known to affect the intestinal mucosal barrier, increase permeability for allergenic proteins and induce a shift toward the Th2 profiles of cytokine and IgE production.…”

“…[1][2][3][4] One prospective study reported that 21% of pediatric patients receiving liver transplantation developed new-onset food allergy. 4 In contrast to the extensive investigation of food allergy after liver transplantation, food allergy after hematopoietic stem cell transplantation has not been fully evaluated. In bone marrow or peripheral blood stem cell transplantation, allergic disease can be transferred from donors.…”

“…[1][2][3][4] Since the first report of food allergy after liver transplantation, the causative role of tacrolimus has been suggested and investigated. [1][2][3][4] Tacrolimus has been known to affect the intestinal mucosal barrier, increase permeability for allergenic proteins and induce a shift toward the Th2 profiles of cytokine and IgE production. 11,12 On the basis of these effects, tacrolimus, unlike CsA, is considered to have an important role in the close relationship with the development of food allergy.…”