Management of tacrolimus‐associated food allergy after liver transplantation

Obayashi, Naho; Suzuki, Mitsuyoshi; Yokokura, Tomoaki; Naritaka, Nakayuki; Nakano, Satoshi; Ohtsuka, Yoshikazu; Sugo, Hiroyuki; Kawasaki, Seiji; Shimizu, Toshiaki

doi:10.1111/ped.12721

Cited by 7 publications

(8 citation statements)

References 11 publications

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“…With this in mind, it is interesting to notice the change in the cytokine profile of two allergic patients in the transplantation group who were converted from tacrolimus. There are previous reports that change in the immunosuppression from tacrolimus to cyclosporine decrease IgE and reduce the symptoms of allergy in liver transplanted patients . Our two patients who had their immunosuppression changed because of food allergy also experienced a marked clinical improvement of food allergy and reduction in total and specific IgE after conversion.…”

Section: Discussionsupporting

confidence: 54%

Cytokine profile in children with food allergy following liver transplantation

Hafliðadóttir

Matthews

Almaas

2020

Pediatric Transplantation

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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.

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Section: Discussionsupporting

confidence: 54%

Cytokine profile in children with food allergy following liver transplantation

Hafliðadóttir

Matthews

Almaas

2020

Pediatric Transplantation

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“…Thereby, the odds of developing FA were higher among children treated with tacrolimus, compared with those receiving cyclosporine (OR 7.21, 95% CI 2.62–19.89, P = 0.0001). The role of tacrolimus in the pathogenesis of FA is further supported by the resolution or improvement of post-transplant allergies described after switch from tacrolimus to cyclosporine or sirolimus ( 19 , 21 , 35 , 51 , 54 ).…”

Section: Resultsmentioning

confidence: 95%

“…Many authors have investigated the causal link between the onset of de novo FA and immunosuppression. Tacrolimus has been strongly implicated in the development of FA by a large number of studies ( 9 , 15 , 19 , 25 , 27 , 41 , 42 , 46 , 54 ). Consistently, 96.6% (283/293) of the pediatric LT recipients included in our analysis, for whom details on immunosuppression were provided, developed FA while on treatment with tacrolimus.…”

Section: Resultsmentioning

confidence: 99%

“…The data obtained from our systematic review demonstrate that tacrolimus is significantly more associated than cyclosporine with the onset of de novo FA after pediatric LT. Although calcineurin inhibitors share the same mechanism of action, tacrolimus is 10–100 times more active than cyclosporine in suppressing T- and B-cell responses and in reducing IL-2 production, and this may favor a stronger immunological imbalance toward Th2 responses ( 27 , 54 ). Furthermore, tacrolimus, but not cyclosporine, increases intestinal permeability and is thus responsible for an amplified immunological exposure to food allergens ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

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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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“…Moreover, these IgE-mediated food allergies may present as life-threatening conditions, for example, urticaria and/or angioedema and hypersensitivity [70]. However, the pathogenesis behind food allergies after liver transplant is not well understood; tacrolimus is believed to contribute in the development of food allergies [71].…”

Section: Dermatological Complications After Ltmentioning

confidence: 99%

Dermatological Disorders following Liver Transplantation: An Update

Yadav

Bai

Liang

2019

Canadian Journal of Gastroenterology and Hepatology

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Patients undergoing liver transplantation (LT) are at a high risk of dermatological complications compared to the general population as a result of long-term use of immunosuppressant. However, the risk is not as high as other solid organ transplantations (SOT), particularly for skin cancer. The liver is considered as an immune privileged organ since it has a low prevalence of humoral rejection in contrast to other SOT, and thus, LT requires a minimal amount of immunosuppressants compared to other SOT recipients. However, because of the large volume of the liver, patients with LT have higher donor lymphocytes that sometimes may trigger graft-versus-host-disease, yet it is rare. On the other hand, the vast majority of the nonspecific dermatological lesions linked with cirrhosis improve after removal of diseased liver or due to the immunosuppressant used after LT. Nevertheless, dermatological infections related to bacteria, viruses, and fungus after LT are not uncommon. Additionally, the incidence of IgE-mediated food allergies develops in 12.2% of LT patients and may present as life-threatening conditions such as urticaria and/or angioedema and hypersensitivity. Moreover, skin malignancies after LT are a matter of concern. Thus, posttransplant dermatological care should be provided to all LT patients for any suspicious dermatological lesions. Our goal is to give an outline of the dermatological manifestation associated with LT for the clinicians by collecting the published data from all archived case reports.

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Management of tacrolimus‐associated food allergy after liver transplantation

Cited by 7 publications

References 11 publications

Cytokine profile in children with food allergy following liver transplantation

Cytokine profile in children with food allergy following liver transplantation

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

Dermatological Disorders following Liver Transplantation: An Update

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