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Post-transplant food anaphylaxis in an adult cord blood transplant recipient (Ms. No. IJHM-D-20-01037R1)

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Abstract

Transplant acquired food allergy (TAFA) is a well-known complication following pediatric liver transplantation, but post-cord blood transplantation (post-CBT) TAFA has rarely been reported. Here, we describe a case of new-onset food anaphylaxis after CBT in an adult patient that demonstrates that post-CBT allergen-challenge is not a risk for long-term allergic sensitization even in adult recipients. The patient was a 39-year-old Japanese man with aggressive NK cell leukemia. He had no previous history of allergies. After receiving CBT, the patient had an unbalanced diet with high preference for bread, bananas, miso-soup, cow’s milk, cheese, egg, sesame and buckwheat soba noodles, and experienced repeated diarrhea. Six months later, he developed symptoms such as vomiting, epigastric pain, diarrhea, high fever and hypotension. The condition was initially diagnosed as enterocolitis, but symptoms recurred after consumption of buckwheat. Anaphylaxis induced by buckwheat was confirmed with serum radioallergosorbent tests (RAST), showing allergen-specific IgE for buckwheat (greater than 100 U/mL, Class 6) and egg ovomucoid (Class 4). Nineteen months after a buckwheat and egg-free diet, serum RAST for buckwheat and egg significantly improved. As a result, the patient acquired a tolerance and was able to consume buckwheat and egg without allergic symptoms.

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References

  1. Legendre C, Caillat-Zucman S, Samuel D, Morelon S, Bismuth H, Bach JF, et al. Transfer of symptomatic peanut allergy to the recipient of a combined liver-and-kidney transplant. N Engl J Med. 1997;337(12):822–4.

    Article  CAS  Google Scholar 

  2. Lykavieris P, Frauger E, Habes D, Bernard O, Debray D. Angioedema in pediatric liver transplant recipients under tacrolimus immunosuppression. Transplantation. 2003;75(1):152–5.

    Article  CAS  Google Scholar 

  3. Levy Y, Davidovits M, Cleper R, Shapiro R. New-onset post-transplantation food allergy in children–is it attributable only to the immunosuppressive protocol? Pediatr Transplant. 2009;13(1):63–9. https://doi.org/10.1111/j.1399-3046.2007.00883.x.

    Article  CAS  PubMed  Google Scholar 

  4. Hosakoppal SS, Bryce PJ. Transplant-acquired food allergy: current perspectives. J Asthma Allergy. 2017;10:307–15. https://doi.org/10.2147/JAA.S136319.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Watanabe T, Katsukura H, Shirai Y, Yamori M, Chiba T, Kita T, et al. Helper CD4+ T cells for IgE response to a dietary antigen develop in the liver. J Allergy Clin Immunol. 2003;111(6):1375–85. https://doi.org/10.1067/mai.2003.1466.

    Article  CAS  PubMed  Google Scholar 

  6. Tucker J, Barnetson RS, Eden OB. Atopy after bone marrow transplantation. Br Med J (Clin Res Ed). 1985;290(6462):116–7.

    Article  CAS  Google Scholar 

  7. Yong PF, Grosse-Kreul D, Devereux S, Pagliuca A, Maher J, Ibrahim MA. Increase in allergy following donor lymphocyte infusions. Bone Marrow Transplant. 2006;37(10):983–4. https://doi.org/10.1038/sj.bmt.1705363.

    Article  CAS  PubMed  Google Scholar 

  8. Khan F, Hallstrand TS, Geddes MN, Henderson WR Jr, Storek J. Is allergic disease curable or transferable with allogeneic hematopoietic cell transplantation? Blood. 2009;113(2):279–90. https://doi.org/10.1182/blood-2008-01-128686.

    Article  CAS  PubMed  Google Scholar 

  9. Debiasi M, Pichler H, Klinglmuller F, Boztug H, Schmidthaler K, Rech J, et al. Transfer and loss of allergen-specific responses via stem cell transplantation: a prospective observational study. Allergy. 2020;75(9):2243–53. https://doi.org/10.1111/all.14278.

    Article  CAS  PubMed  Google Scholar 

  10. Agosti JM, Sprenger JD, Lum LG, Witherspoon RP, Fisher LD, Storb R, et al. Transfer of allergen-specific IgE-mediated hypersensitivity with allogeneic bone marrow transplantation. N Engl J Med. 1988;319(25):1623–8.

    Article  CAS  Google Scholar 

  11. Hallstrand TS, Sprenger JD, Agosti JM, Longton GM, Witherspoon RP, Henderson WR Jr. Long-term acquisition of allergen-specific IgE and asthma following allogeneic bone marrow transplantation from allergic donors. Blood. 2004;104(10):3086–90. https://doi.org/10.1182/blood-2004-05-1775.

    Article  CAS  PubMed  Google Scholar 

  12. Prescott SL, Macaubas C, Smallacombe T, Holt BJ, Sly PD, Holt PG. Development of allergen-specific T-cell memory in atopic and normal children. Lancet. 1999;353(9148):196–200. https://doi.org/10.1016/s0140-6736(98)05104-6.

    Article  CAS  PubMed  Google Scholar 

  13. Warner JA, Miles EA, Jones AC, Quint DJ, Colwell BM, Warner JO. Is deficiency of interferon gamma production by allergen triggered cord blood cells a predictor of atopic eczema? Clin Exp Allergy. 1994;24(5):423–30.

    Article  CAS  Google Scholar 

  14. Holt PG, O’Keeffe P, Holt BJ, Upham JW, Baron-Hay MJ, Suphioglu C, et al. T-cell “priming” against environmental allergens in human neonates: sequential deletion of food antigen reactivity during infancy with concomitant expansion of responses to ubiquitous inhalant allergens. Pediatr Allergy Immunol. 1995;6(2):85–90.

    Article  CAS  Google Scholar 

  15. Prescott SL, Macaubas C, Holt BJ, Smallacombe TB, Loh R, Sly PD, et al. Transplacental priming of the human immune system to environmental allergens: universal skewing of initial T cell responses toward the Th2 cytokine profile. J Immunol. 1998;160(10):4730–7.

    CAS  PubMed  Google Scholar 

  16. Inoue Y, Ochiai H, Hishiki T, Shimojo N, Yoshida H, Kohno Y. Food allergy after cord blood stem cell transplantation with tacrolimus therapy in two patients who developed veno-occlusive disease. Allergol Int. 2012;61(3):497–9.

    Article  Google Scholar 

  17. Sakashita K, Nakazawa Y, Yanagisawa R, Tanaka M, Saito S, Yoshikawa K, et al. Food allergy after cord blood transplantation in children. Br J Haematol. 2012;158(5):672–6.

    Article  Google Scholar 

  18. Hernandez-Ojeda A, Rojas N, Barriga F, Wietstruck MA, Morales PS, Borzutzky A. Incidence and risk factors of food allergy after umbilical cord blood transplantation in children. J Allergy Clin Immunol Pract. 2017;5(6):1789–91. https://doi.org/10.1016/j.jaip.2017.04.034.

    Article  PubMed  Google Scholar 

  19. Feliu J, Clay J, Raj K, Barber L, Devlia V, Shaw B, et al. Transplant-acquired food allergy (TAFA) following cord blood stem cell transplantation in two adult patients with haematological malignancies. Br J Haematol. 2014;167(3):426–8.

    Article  Google Scholar 

  20. Mori T, Kato J, Sakurai M, Hashimoto N, Kohashi S, Hashida R, et al. New-onset food allergy following cord blood transplantation in adult patients. Bone Marrow Transplant. 2016;51(2):295–6. https://doi.org/10.1038/bmt.2015.243.

    Article  CAS  PubMed  Google Scholar 

  21. Lacaille F, Laurent J, Bousquet J. Life-threatening food allergy in a child treated with FK506. J Pediatr Gastroenterol Nutr. 1997;25(2):228–9.

    Article  CAS  Google Scholar 

  22. Gabe SM, Bjarnason I, Tolou-Ghamari Z, Tredger JM, Johnson PG, Barclay GR, et al. The effect of tacrolimus (FK506) on intestinal barrier function and cellular energy production in humans. Gastroenterology. 1998;115(1):67–74.

    Article  CAS  Google Scholar 

  23. Rentenaar RJ, van Diepen FN, Meijer RT, Surachno S, Wilmink JM, Schellekens PT, et al. Immune responsiveness in renal transplant recipients: mycophenolic acid severely depresses humoral immunity in vivo. Kidney Int. 2002;62(1):319–28. https://doi.org/10.1046/j.1523-1755.2002.00425.x.

    Article  CAS  PubMed  Google Scholar 

  24. Cardet JC, Boyce JA. Addition of mycophenolate mofetil to tacrolimus is associated with decreases in food-specific IgE levels in a pediatric patient with liver transplantation-associated food allergy. J Allergy Clin Immunol Pract. 2013;1(1):104–6. https://doi.org/10.1016/j.jaip.2012.08.001.

    Article  PubMed  Google Scholar 

  25. Haflidadottir S, Matthews IL, Almaas R. Cytokine profile in children with food allergy following liver transplantation. Pediatr Transplant. 2020;24(2):e13657. https://doi.org/10.1111/petr.13657.

    Article  CAS  PubMed  Google Scholar 

  26. Hourihane JO, Rhodes HL, Jones AM, Veys P, Connett GJ. Resolution of peanut allergy following bone marrow transplantation for primary immunodeficiency. Allergy. 2005;60(4):536–7. https://doi.org/10.1111/j.1398-9995.2005.00752.x.

    Article  PubMed  Google Scholar 

  27. Wahn V, Laws HJ, Bode CP, Burdach SE. Cure of latex allergy by bone marrow transplantation. Eur J Pediatr. 1999;158(1):88.

    Article  CAS  Google Scholar 

  28. Mavroudi A, Xinias I, Deligiannidis A, Parapanissiou E, Imvrios G. Long term outcome of acquired food allergy in pediatric liver recipients: a single center experience. Pediatr Rep. 2012;4(1):e6. https://doi.org/10.4081/pr.2012.e6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Frischmeyer-Guerrerio PA, Wisniewski J, Wood RA, Nowak-Wegrzyn A. Manifestations and long-term outcome of food allergy in children after solid organ transplantation. J Allergy Clin Immunol. 2008;122(5):1031–3.

    Article  Google Scholar 

  30. Khalid I, Zoratti E, Stagner L, Betensley AD, Nemeh H, Allenspach L. Transfer of peanut allergy from the donor to a lung transplant recipient. J Heart Lung Transplant. 2008;27(10):1162–4.

    Article  Google Scholar 

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Acknowledgments

The authors would like to thank the patient and the members of Hematology of University of Occupational and Environmental Health for their cooperation.

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Authors and Affiliations

  1. University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8556, Japan

    Ai Kawahara, Tsukasa Nakanishi, Midori Goto, Kenichi Akao, Takefumi Katsuragi & Junichi Tsukada

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  1. Ai Kawahara
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  2. Tsukasa Nakanishi
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  3. Midori Goto
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  4. Kenichi Akao
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  5. Takefumi Katsuragi
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  6. Junichi Tsukada
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Contributions

AK: designed the study, collected and analyzed the data, and was the first writer of the paper. TN, KA, MG and TK: collected, analyzed the data and helped AK to write the paper. JT: designed the study, collected and analyzed the data, wrote the paper, and supervised all the process. All authors have reviewed and approved the manuscript.

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Correspondence to Junichi Tsukada.

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The authors have no conflicts of interest to declare. This study received no funding from public, private, or not‐for‐profit sectors.

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Written informed consent was obtained from the patient for the publication of this case report.

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Kawahara, A., Nakanishi, T., Goto, M. et al. Post-transplant food anaphylaxis in an adult cord blood transplant recipient (Ms. No. IJHM-D-20-01037R1). Int J Hematol 114, 292–296 (2021). https://doi.org/10.1007/s12185-021-03140-8

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  • DOI: https://doi.org/10.1007/s12185-021-03140-8

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