New‐onset post‐transplantation food allergy in children – Is it attributable only to the immunosuppressive protocol?

Abstract

New-onset post-transplantation food allergy has been described mainly after liver transplantation, and its pathogenesis was attributed to the immunomodulatory effects of tacrolimus therapy. The aim of the present study was to evaluate the association of food allergy with solid organ transplantation in our center. The medical records of children who underwent kidney transplantation and children who underwent liver or liver and kidney transplantation from 1986 to 2005 were reviewed. A total of 189 children (124 after kidney transplantation, 65 after liver or liver and kidney transplantation) received tacrolimus as part of the immunosuppressive regimen. New-onset post-transplantation food allergy was documented in four of them: two with liver transplants and two with combined kidney and liver transplants. The absence of new-onset food allergy in the children with isolated kidney transplants is compatible with other reports in the literature. This study supports the concept that the functioning liver itself, and not only tacrolimus immunosuppression, is a main contributor to food allergy in this patient population.

De novo food allergy in pediatric liver transplantation recipients

“…4,5 Our study demonstrated the same prevalence as the several worldwide reports of FA after LT which range from 6% to 57%. 9 The prevalence rate of de novo FA in this study was high compared to other reports, possibly due to the selective criteria of FA that we included all types of food allergic reactions; IgE-, non IgE-, and mixed types.…”

“…6,[8][9][10][11] While the incidence of this condition was increasing, several risk factors such as tacrolimus use, EBV viremia and younger age at transplantation have been reported but these remain inconclusive. 8,9,12,13 Furthermore, the natural history is also unclear leading to the reluctance of health care providers and child caregivers for dietary management. Therefore, this study aimed to 1) determine the prevalence of de novo FA, 2) identify risk factors of de novo FA, and 3) demonstrate the natural history of de novo FA in post LT children.…”

“…Potential mechanism related to chronic tacrolimus use and imbalance immunological function in liver themselves, have been hypothesized base on the reports in LT children both in retrospective, prospective, case-controlled, and in vitro studies. 6,9,11,12,26,27 Chronic exposure to oral tacrolimus, the calcineurin inhibitor, might skew the Th2 response and alter gastrointestinal barrier, and eventually increases a risk of FA development due to the improper allergen exposure. 28 However, the present study showed that outgrowing of de novo FA patients did not related to a change in immunosuppressive protocol.…”

“…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. 20,27,29 However, we could not demonstrate the association of these factors with de novo FA.…”

“…Reactions to these ''major allergens'' are similar to those occurring in Thai children population. 4,5 In addition, these are not different from previous reports of de novo FA or food sensitization in children after LT. 9 Considering the common food allergens among Asian countries, cow's milk protein was the most common in our study…”