De novo food sensitization and eosinophilic gastrointestinal disease in children post‐liver transplantation

Abstract

Findings suggest that exposure to tacrolimus alone post-LT is insufficient to initiate de novo allergic disease in LT recipients; rather, younger age and underlying predisposition to atopic disease may play larger roles.

De novo food allergy in pediatric liver transplantation recipients

“…Several studies support our finding that LT at young age contributes to de novo FA. 11,16,27,29 The potential mechanism of young age and risk for de novo FA probably due to the immature immune tolerance mechanism in gastrointestinal and hepatic themselves. 2,9 Other reported potential risk factors included high PELD score prior to LT, underlying liver diseases, immunosuppressive regimens and donor's allergy.…”

“…EGIDs were found in 4 cases or 8.7% of survived LT which was relatively high when compared to the report of 4 in 10,000 in healthy children, however, this was similar to the previous reports of 3-26% in post-LT children. [16][17][18][19] The significant culprit foods were cow's milk, hen's egg, shellfish, fish, wheat, and soy. Reactions to these ''major allergens'' are similar to those occurring in Thai children population.…”

Immunosuppression in pediatric liver transplant recipients: Unique aspects

“…The reported incidence of PTLD is 4%‐15% in pediatric liver recipients versus 1%‐3% in adult recipients because children have a greater likelihood of being EBV‐naïve at the time of transplant. Observations in pediatric transplant recipients show that tacrolimus can lead to de novo development of food allergies and eosinophilic gastrointestinal disease and has not been identified in adult transplant recipients . Desired trough levels usually decrease over time, and values below the laboratory threshold may be sufficient to prevent rejection.…”

Development of Anaphylaxis to Cow's Milk as Early as the First Week of Orthotopic Liver Transplantation

“…In addition, severe food allergy as anaphylaxis was reported between 10% and 13% in 2 recent pediatric case series after liver transplantation. 4,18 Therefore significant food allergy is not a rare condition in post-transplant children. Therefore, we recommend evaluation of food allergy in all candidates and in their donors before organ transplantation as well as educating care givers to recognize a possible reaction after transplantation.…”