Transfer of Allergen-Specific IgE-Mediated Hypersensitivity with Allogeneic Bone Marrow Transplantation

Abstract

We investigated whether allergen-specific IgE-mediated hypersensitivity is transferred by bone marrow transplantation. Twelve patients, 14 to 47 years of age, undergoing allogeneic bone marrow transplantation for the treatment of hematologic cancer were selected, along with their donors, by a screening questionnaire for a history of atopy in the donor. We evaluated these donor-recipient pairs before transplantation and at several points afterward for immediate skin-test reactivity to 17 allergens. For allergens for which pretransplantation skin tests had been positive in the donors and negative in the recipients, 20 of 46 post-transplantation skin tests were positive in 8 of the 11 recipients who survived for more than one year after transplantation. For allergens for which both donors and recipients had had negative skin tests before transplantation, only 6 of 256 tests (2.3 percent) were positive in the recipients after transplantation. Long-term transfer of donor-derived mite-specific IgE was demonstrated by radioallergosorbent testing in two recipients. Seven recipients either acquired or had an exacerbation of allergic rhinitis, and two recipients without a history of asthma had asthma one year after transplantation. We conclude that allergen-specific IgE-mediated hypersensitivity is adoptively transferred by bone marrow transplantation from donor to recipient by B cells with allergen-specific memory.

The role of the bone marrow in allergy and asthma

“…There is only one study of the contribution of human bone marrow to the allergic diathesis: in nine of 12 patients receiving bone marrow from atopic donors, there was a change in skin test responses to standard allergens and/or airway hyperresponsiveness ( 109). An hypothesis derived from these observations is that hemopoietic stem cells are involved in the transfer of IgE and possibly other responses (basophilia, mastocytosis, eosinophilia) in allergic reactions.…”

Resolution of atopic dermatitis following allogeneic bone marrow transplantation for chronic myelogenous leukemia

“…By contrast, transfer of atopy following BMT has been observed in several case reports. 8,9 It is of particular note that allergenspecific IgE-mediated hypersensitivity may be adoptively transferred by BMT from an atopic donor to the recipient. 8 Additionally, experimental studies in animal models have demonstrated that various autoimmune diseases can be transferred to healthy animals by BMT.…”

“…8,9 It is of particular note that allergenspecific IgE-mediated hypersensitivity may be adoptively transferred by BMT from an atopic donor to the recipient. 8 Additionally, experimental studies in animal models have demonstrated that various autoimmune diseases can be transferred to healthy animals by BMT. 10 Taking these findings together, ablation of the host hematopoietic system and reconstitution with the donor immune system resolved the atopic dermatitis in this patient.…”

Late-onset unilateral renal dysfunction combined with non-insulin-dependent diabetes mellitus and bronchial asthma following allogeneic bone marrow transplantation for acute lymphoblastic leukemia in a child

“…It seems that the bronchial asthma and allergic predisposition were transferred by BMT. Agosti et al 17 reported that IgE-mediated reactivity is frequently transferred during bone marrow transplantation. Finally, these successive complications after BMT appeared independently but all of them seemed related to BMT, particularly TBI and/or splenic irradiation.…”