Transfer of Peanut Allergy Following Lung Transplantation: A Case Report

Schüller, Arthur; Barnig, C.; Matau, C.; Geny, S.; Gosselin, Marc V.; Moal, Marie-Christine; Champion, G.; Atal, L.; Blay, F. De; Massard, Gilbert; Kessler, Romain

doi:10.1016/j.transproceed.2011.08.088

Cited by 17 publications

(15 citation statements)

References 20 publications

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“…In this case, and 3 others (2,3,4), recurrent adverse clinical reactivity with peanut ingestion was prevented by patient education and delaying peanut re-entry into the transplant recipient’s diet until both serum IgE and skin prick reactivity to peanut were negative. While testing for serum IgE to nut components provides clinical utility to guide food challenges in certain patient situations (8,9), we propose that its main value in acquired peanut allergy is to evaluate if the serum sensitization profile in the organ recipient reflects organ donor sensitization.…”

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confidence: 71%

“…Examination of affected patients’ peanut IgE component profile relative to donor serum can help to support the diagnosis of a transient food allergy (2,3,4). IgE profiling in donor and recipient serum combined with skin prick testing has also helped to safely guide the re-introduction of dietary peanut for organ recipients presenting with peanut anaphylaxis after transplant (2, 3, 4). …”

mentioning

confidence: 99%

“…Though the average half-life of serum IgE ab is 3 days, the kinetics of passive IgE catabolism in recipient serum are influenced by the titer of IgE in donor serum, recipient IgE, as well as IgE bound to mast cells and basophils (5, 6). There are undetermined variables that affect IgE catabolism after transplant; previous reports have detected elevated IgE to peanut components up to 10 months following some organ transplants suggesting that solid organs serve as a reservoir of IgE entering circulation over time (2). Given the unknown kinetics of free peanut IgE transfer from different solid organs, affected organ recipients should be followed closely with the recommendation of peanut avoidance until testing is complete.…”

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confidence: 99%

“…In current practice, prospective screening for acquired peanut allergy based on donor history is rare (4), leading to periodic case reports of anaphylaxis (2,3,7). In this case, and 3 others (2,3,4), recurrent adverse clinical reactivity with peanut ingestion was prevented by patient education and delaying peanut re-entry into the transplant recipient’s diet until both serum IgE and skin prick reactivity to peanut were negative.…”

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confidence: 99%

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Management of acquired peanut allergy following solid-organ transplant

Word

Klaffky

Ortiz

et al. 2015

The Journal of Allergy and Clinical Immunology: In Practice

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confidence: 71%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Management of acquired peanut allergy following solid-organ transplant

Word

Klaffky

Ortiz

et al. 2015

The Journal of Allergy and Clinical Immunology: In Practice

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“…1,2 Here we report likely transfer of peanut allergy following leukocyte-replete BMT from a HLA-matched sibling donor.…”

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confidence: 83%

Peanut allergy transferred by BMT

Ip¹,

Cale

Veys

et al. 2014

Bone Marrow Transplant

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Suspected transfer of peanut allergy has been sporadically reported after solid organ transplantation of cadaveric lung or liver grafts collected from donors with documented allergy histories. 1,2 Here we report likely transfer of peanut allergy following leukocyte-replete BMT from a HLA-matched sibling donor.A 1-month-old South Asian male infant with homozygous RMRP gene mutation (35 C>A) and family history of severe combined immunodeficiency underwent an unconditioned cord blood transplant from an older sibling. The donor was known to have significant peanut allergy since the age of 2 years and maintained dietary exclusion. The transplant was complicated by retarded kinetics of cellular immune reconstitution resulting in adenovirus reactivation and widespread molluscum contagiosum. Donor chimerism was initially restricted to the T-cell lineage and a second transplant with BM stem cells from the original donor was performed at 20 months of age with conditioning comprising fludarabine 30 mg/m 2 (days − 7 to − 3) and melphalan 140 mg/m 2 (day − 2), and prophylaxis against GVHD with CYA and mycophenolate mofetil. The donor was 4 years 6 months old at the time of the second transplant. Serotherapy was not administered, both grafts were infused without manipulation and were leukocyte replete. High-level T-cell (70%) and mixed, myeloid (18%) and B-cell (25%) chimerism was achieved after the second transplant, and was associated with clearance of viral infections, including molluscum. EBV reactivation at 5 months post transplant was treated with a single dose of rituximab (375 mg/m 2 ). Grade I stage 1 skin GVHD developed after 3 months and was controlled with topical steroids. CYA was discontinued 8 months after the transplant. Approximately 12 months later (aged 2 years 8 months), the subject presented with facial rash and angioedema shortly after ingestion of a peanut-containing breakfast cereal, suggestive of acute allergic reaction. After his first transplant he had regularly tolerated nuts and peanuts, including this specific cereal without adverse reactions. On first resuming intake of the same cereal after his second transplant, the subject developed allergic symptoms. The subject's skin prick test showed positive wheal responses to peanut (10 mm) and cashew nut (8 mm) (positive control 3 mm, negative control 0 mm; almond, hazelnut and walnut 0 mm). Total serum IgE was not elevated (44 kU/L) but specific IgE for peanut was high at 24.6 kUA/L. Elevated levels of specific IgE to peanut storage protein Ara h1 and Ara h6 were detected. Further investigations found that the sibling BM donor also had elevated specific IgEs for peanut Ara h1 and Ara h6, as well as against Ara h2 and h3; cashew Ana o2, walnut Jug R1, r2 and soybean Glym6. There have been several reports of transfer of aeroallergen-specific IgE and asthma/rhinitis following haematopoietic SCT from atopic donors (both related and unrelated donors) and non-atopic donors; 1,3 however, this is the first report using allergen component-resolved diagnostics ...

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Lung Transplantation: Marginal Donors and Risk Assessment

Donahoe,

Keshavjee

2023

Textbook of Transplantation and Mechanical Support for End‐Stage Heart and Lung Disease

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Transfer of Peanut Allergy Following Lung Transplantation: A Case Report

Cited by 17 publications

References 20 publications

Management of acquired peanut allergy following solid-organ transplant

Management of acquired peanut allergy following solid-organ transplant

Peanut allergy transferred by BMT

Lung Transplantation: Marginal Donors and Risk Assessment

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