Article

Passive transfer of nut allergy after liver transplantation

Department of Clinical Immunology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney 2050, New South Wales, Australia.
Archives of Internal Medicine (Impact Factor: 13.25). 02/2003; 163(2):237-9. DOI: 10.1001/archinte.163.2.237
Source: PubMed

ABSTRACT An anaphylactic reaction to cashew nut developed in a nonatopic 60-year-old man 25 days after receiving a liver allograft from a 15-year-old atopic boy who died of anaphylaxis after peanut ingestion. The liver recipient had no history of nut allergy. Posttransplantation skin prick test results were positive for peanut, cashew nut, and sesame seed, and the donor had allergen-specific IgE antibodies to the same 3 allergens. Contact tracing of the recipients of other solid organs from the same donor disclosed no other development of allergic symptoms after ingestion of peanut or cashew nut. Results of molecular HLA typing did not detect any donor-origin leukocytes in the recipient after transplantation, which excluded peripheral microchimerism. The patient inadvertently ingested peanut-contaminated food and suffered a second anaphylactic reaction 32 weeks after the transplantation. This case illustrates that transfer of IgE-mediated hypersensitivity can occur after liver transplantation and have potentially serious consequences. We therefore recommend that organ donors undergo screening for allergies, and that recipients be advised regarding allergen avoidance.

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    • "Although the individual effect of intrauterine or early-in-life exposure to a particular food has not been elucidated, high maternal consumption of peanuts in pregnancy, and early introduction during infancy, have been correlated with a higher frequency of sensitisation. Peanut allergy can be transferred with a liver transplantation from an allergic donor (Legendre et al. 1997; Phan et al. 2003). Food allergy, particularly peanut, has also been documented in organ recipients receiving immunosuppressive treatment with Tacrolimus. "
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    British Journal Of Nutrition 12/2006; 96 Suppl 2:S95-102.
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    • "Although the individual effect of intrauterine or early-in-life exposure to a particular food has not been elucidated, high maternal consumption of peanuts in pregnancy, and early introduction during infancy, have been correlated with a higher frequency of sensitisation. Peanut allergy can be transferred with a liver transplantation from an allergic donor (Legendre et al. 1997; Phan et al. 2003). Food allergy, particularly peanut, has also been documented in organ recipients receiving immunosuppressive treatment with Tacrolimus. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Nuts are a well-defined cause of food allergy, which affect approximately 1 % of the general population in the UK and the USA. There do appear to be differences in the frequency of nut allergy between different countries because of different dietary habits and cooking procedures. For example, in the USA and France, peanuts are one of the most frequent causes of food allergy, but in other countries, it seems to be less common. Genetic factors, in particular, appear to play a role in the development of peanut allergy. While the majority of nut allergens are seed storage proteins, other nut allergens are profilins and pathogenesis-related protein homologues, considered as panallergens because of their widespread distribution in plants. The presence of specific IgE antibodies to several nuts is a common clinical finding, but the clinical relevance of this cross-reactivity is usually limited. Allergic reactions to nuts appear to be particularly severe, sometimes even life-threatening, and fatal reactions following their ingestion have been documented. Food allergy is diagnosed by identifying an underlying immunological mechanism (i.e. allergic testing), and establishing a causal relationship between food ingestion and symptoms (i.e. oral challenges). In natural history investigations carried out in peanut-allergic children, approximately 20 % of the cases outgrew their allergy or developed oral tolerance. The treatment of nut allergies should include patient and family education about avoiding all presentations of the food and the potential for a severe reaction caused by accidental ingestion. Patients and families should be instructed how to recognise early symptoms of an allergic reaction and how to treat severe anaphylaxis promptly.
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    ABSTRACT: A 47-year-old woman underwent bilateral lung transplantation for nonspecific interstitial pneumonitis and received donor lungs from a 12-year-old patient with a known peanut allergy. Post-transplant, the patient experienced four anaphylaxis-like reactions. A skin prick test to peanut was initially positive; however, it steadily declined over serial assessments and reverted to negative one year post-transplant. The patient subsequently had a negative oral peanut challenge. Transfer of food allergy post-transplantation is theorized to occur via transfer of donor B lymphocytes producing peanut-specific immunoglobulin E into the circulation of the recipient. An alternate mechanism proposes passive transfer of immunoglobulin E-sensitized mast cells and⁄or basophils within the transplanted tissue that subsequently migrate into recipient tissues. The gradual decline in the magnitude of the peanut skin prick test and its return to negative over the course of one year supports the gradual depletion of sensitized cells in the recipient (B lymphocytes and, possibly, mast cells), and supports the initial passive transfer of sensitized cells from donor tissue during transplantation. This should be considered when donor organs are obtained from allergic individuals.
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