Non-atopic IgE and eosinophil cationic protein after allogeneic hematopoietic stem cell transplantation in children

Abstract

Allogeneic hematopoietic stem cell transplantation (HSCT) in childhood is associated with severe pulmonary complications, but the pathophysiologic mechanisms remain unclear. Our aim was to evaluate the association of total and specific IgE, eosinophil cationic protein (ECP) and eosinophilia in HSCT recipients with pulmonary complications. We prospectively measured total and specific serum IgE, eosinophils, and ECP before and 28, 100, and 180 days after HSCT. We included 30 children (age 2-17 years) undergoing HSCT. Nine patients had a history of previous atopy without being associated with pulmonary complications after HSCT until day +360. Specific IgE levels showed a decline after HSCT, associated with the absence of allergy symptoms, suggesting a reduction of atopy. Elevated total serum IgE levels occurred in seven patients on day +28 after HSCT. This elevation did not coincide with allergy symptoms. ECP showed no correlation with total allergy symptoms, eosinophilia, IgE levels, or pulmonary complications. There was a significant correlation (p = 0.0367) between ECP levels on day +28 and concurrent acute graft-versus-host disease (GvHD). Non-atopic serum ECP and IgE levels are elevated on day +28 after HSCT in children, with ECP showing a potential relation to acute GvHD.

The emergence of eosinophilic disorders in pediatric transplant recipients

“…Transplant‐acquired food allergy was first described in 1997 when a non‐allergic recipient developed de novo peanut allergy three months after receiving a combined liver/kidney transplant from a 22‐yr‐old man who had died of anaphylaxis following accidental dietary exposure to peanut . Transplant‐acquired food allergy was attributed to the passive transfer of donor‐derived stem cells present in the donor liver, as bone marrow transplantation has resulted in similar reports of transfer of food allergy . Subsequently, numerous case reports and single‐center retrospective studies of food allergy following liver transplantation, particularly in the pediatric population, have not been able to find the same relationship between a donor's allergy status and transplant‐acquired food allergy .…”