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De novo food allergy in pediatric liver transplantation recipients

Ratchaneewan Sinitkul1, Wiparat Manuyakorn1, Wasu Kamchaisatian1

  • 1Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Asian Pacific Journal of Allergy and Immunology
|November 22, 2017
PubMed

Insights

Food allergy (FA) is common after pediatric liver transplants (LT), affecting over half of recipients. Younger age at transplant, family history of atopy, and Epstein-Barr virus (EBV) viremia increase FA risk.

Area of Science:

  • Pediatric Gastroenterology
  • Transplant Immunology
  • Allergy and Immunology

Background:

  • The prevalence of food allergy (FA) is rising in children who have undergone liver transplantation (LT).
  • Limited data exists on the clinical course and outcomes of de novo FA post-LT.

Purpose of the Study:

  • To determine the prevalence of de novo food allergy in pediatric liver transplant recipients.
  • To identify risk factors associated with developing de novo FA post-LT.
  • To describe the natural history of de novo FA in this population.

Main Methods:

  • Retrospective cohort study of pediatric LT recipients (Jan 2001 - Dec 2014).
  • De novo FA diagnosed by post-LT symptoms, improvement with elimination diets, and confirmed by re-challenge, sensitization, or eosinophilia.
  • Analysis of medical records to identify risk factors and clinical characteristics.

Main Results:

  • Over half (54.3%) of 46 pediatric LT recipients developed de novo FA at a median of 12.2 months post-transplant.
  • Confirmed FA occurred in 39.1%, with gastrointestinal symptoms being most common, followed by skin reactions and anaphylaxis.
  • Risk factors included age <2 years at LT (HR 2.62), family history of atopy (HR 5.67), and Epstein-Barr virus (EBV) viremia (HR 2.39).

Conclusions:

  • De novo food allergy is a significant concern in pediatric liver transplant recipients.
  • Early age at transplant (<2 years), family history of atopy, and EBV viremia are key risk factors for developing FA.
  • Tolerance development over 3 years appears similar to the general population.
Abstract

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