Transference of Food Allergy After Adult Liver Transplantation

Food Allergy: Transfused and Transplanted

“…The reactions in this case were attributed to the passive transfer of donor food-specific IgE residing in the liver sinusoids and extravascular space because microchimerism was not identified, the donor was on immunosuppression that would have inhibited antibody production at the time of the first reaction, and his skin test responses were decreased at 48 weeks. The most recent similar case was reported by Vagefi et al [24] and involved a 54-yearold man transplanted with the liver of a 24-year-old woman who died of anaphylaxis to an unknown allergen. On the eighth postoperative day, he experienced anaphylaxis after eating a nut-containing ice cream.…”

“…The transfer of allergy only to the patient who received the donor liver was speculated as resulting from the migration and engraftment of pluripotential hematopoietic stem cells and dendritic cells present in the donor's liver, but not his other organs. Other cases of the transfer of food allergy accompanying liver transplantation from a food allergic donor include the reports by Phan et al [23] and Vagefi et al [24]. In 2003, Phan et al [23] described the case of a 60-year-old man transplanted with the liver of a 15-year-old boy who died of peanut anaphylaxis.…”

“…Several cases have been described in which an adult organ recipient became food allergic after receiving a liver from a donor allergic to the culprit food [22][23][24]. The first case of the transfer of symptomatic peanut allergy by organ transplantation was described by Legendre et al [22] in 1997.…”

“…The possibility of persistent production of IgE confined to the transplanted organ is suggested by the case involving the recipient of a lung transplant from a peanut allergic donor [36] and the case of the adult who reacted to walnut after receiving a liver transplant from a nut allergic donor [24]. The reactions occurring in these patients in the absence of positive skin tests or the ability to identify serum food allergen-specific IgE near the time of the reaction reinforce the need for caution in the evaluation of these patients.…”

Esophageal Eosinophilic Disease After Intestinal Transplantation in Children

“…Passive transfer of food-sensitized donor cells and IgE in donated blood has been reported as giving rise to de novo food allergy (7). Direct transfer of immunologic components with the liver graft is proposed to have a role in food allergy and would account for the preponderance of reports in livertransplanted children (8). Factors that have been reported to correlate with allergic disease after transplantation included prematurity, a young age transplantation, a history of acute rejection, weaning of steroids, and a family history of atopy (1).…”