New developments in transplant-acquired allergies

Area of Science:

• Immunology
• Transplantation Medicine
• Allergy Research

Background:

• Transplant-acquired allergy (TAA), initially termed transplant-acquired food allergy (TAFA), is increasingly recognized following various organ transplantations.
• TAA has been observed after bone marrow, liver, heart, intestinal, lung, and renal transplantations, affecting both children and adults.
• Previous literature may have underestimated TAA prevalence and its occurrence in non-liver transplant recipients.

Purpose of the Study:

• To review and synthesize current knowledge on transplant-acquired allergy (TAA).
• To explore the prevalence, clinical presentation, and potential pathogenesis of TAA.
• To discuss management strategies and identify gaps in understanding TAA's transient nature.

Main Methods:

• Review of existing literature and case reports on transplant-acquired allergy.
• Analysis of reported prevalence, patient demographics, and clinical manifestations.
• Exploration of proposed pathogenetic mechanisms, including immune responses and immunosuppressive effects.

Main Results:

• TAA, particularly TAFA, is reported across various solid organ transplants, with prevalence estimates in children ranging widely (6%–57%).
• Children with TAFA typically develop symptoms within a year post-transplant and often exhibit allergies to multiple foods.
• The functioning transplanted organ, alongside recipient factors like age and atopy, is implicated in TAA development, not solely immunosuppression.

Conclusions:

• The pathogenesis of TAA is multifactorial, involving immune system interactions between the graft and recipient.
• Symptomatic improvement in TAA is often achieved by reducing immunosuppression and dietary modifications.
• Further research with larger patient cohorts is necessary to definitively determine if TAA is transient in solid organ transplant recipients.