De Novo Food Allergy in Pediatric Recipients of Liver Transplant

Abstract

Allergic and atopic conditions, including food allergy, asthma, eczema and eosinophilic disease of the gastrointestinal tract after liver transplant in previously non-allergic children have been increasingly described. After a liver transplant, children can present mild to severe reactions to food allergens (ie, from urticaria-angioedema to life-threatening anaphylactic reactions). De novo post-transplant food allergy may become clinically evident in children who undergo liver transplant between a few months and a few years of transplant. The present narrative review aims to describe the spectrum of de novo post-transplant food allergy development, the current theories of pathogenesis, risk factors and to suggest possible clinical management strategies.

Late airway complications following pediatric liver transplantation: A case series

“…Several mechanisms underlie this difference. These include the immunological role of the liver in promotion of food tolerance, disruption of intestinal mucosal integrity due to intestinal surgery in liver transplant recipients and differing immunosuppression strategies used in liver versus kidney transplant recipients 10 …”

“…Immunosuppression with calcineurin inhibitors (e.g., cyclosporine, tacrolimus) plays a key role in the development of de novo atopy 10,11 . Tacrolimus, in particular, is associated with a greater degree of de novo compared to cyclosporin 12 .…”

“…These include the immunological role of the liver in promotion of food tolerance, disruption of intestinal mucosal integrity due to intestinal surgery in liver transplant recipients and differing immunosuppression strategies used in liver versus kidney transplant recipients. 10 Immunosuppression with calcineurin inhibitors (e.g., cyclosporine, tacrolimus) plays a key role in the development of de novo atopy. 10,11 Tacrolimus, in particular, is associated with a greater degree of de novo compared to cyclosporin.…”

“…10 Immunosuppression with calcineurin inhibitors (e.g., cyclosporine, tacrolimus) plays a key role in the development of de novo atopy. 10,11 Tacrolimus, in particular, is associated with a greater degree of de novo compared to cyclosporin. 12 This is hypothesized to be due to tacrolimus' more potent, selective suppression of Th1 lymphocytes, which promotes Th2 lymphocytes and an allergenic immune response.…”

Eosinophilic Esophagitis After Pediatric Hematopoietic Stem Cell Transplantation

“…De Novo Food Allergy in Pediatric Recipients of Liver Transplant by Mori et al (1), delineates allergic conditions in children post‐liver transplant. While the transfer of allergic diseases and rare eosinophilic gastrointestinal disorders (EGID) after adult hematopoietic stem cell transplant (HSCT) has been reported, at the time of this review, there are no reports of EGID post‐pediatric allogeneic HSCT.…”