Passive Transfer of Nut Allergy After Liver Transplantation

An anaphylactic reaction to cashew nut developed in a nonatopic 60-year-old man 25 days after receiving a liver allograft from a 15-year-old atopic boy who died of anaphylaxis after peanut ingestion. The liver recipient had no history of nut allergy. Posttransplantation skin prick test results were positive for peanut, cashew nut, and sesame seed, and the donor had allergen-specific IgE antibodies to the same 3 allergens. Contact tracing of the recipients of other solid organs from the same donor disclosed no other development of allergic symptoms after ingestion of peanut or cashew nut. Results of molecular HLA typing did not detect any donor-origin leukocytes in the recipient after transplantation, which excluded peripheral microchimerism. The patient inadvertently ingested peanut-contaminated food and suffered a second anaphylactic reaction 32 weeks after the transplantation. This case illustrates that transfer of IgE-mediated hypersensitivity can occur after liver transplantation and have potentially serious consequences. We therefore recommend that organ donors undergo screening for allergies, and that recipients be advised regarding allergen avoidance. Copyright 2003 by the American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use. American Medical Association, 515 N. State St, Chicago, IL 60610.; References: 1. Sampson HA. Managing peanut allergy. BMJ. 1996;312:1050-1051. 2. Saarinen UM. Transfer of latent atopy by bone marrow transplantation? a case report. J Allergy Clin Immunol. 1984;74:196-200. 3. Tucker J, Barnetson RS, Eden OB. Atopy after bone marrow transplantation. BMJ (Clin Res Ed). 1985;290:116-117. 4. Walker SA, Riches PG, Wild G, et al. Total and allergen-specific IgE in relation to allergic response pattern following bone marrow transplantation. Clin Exp Immunol. 1986;66:633-639. 5. Agosti JM, Sprenger JD, Lum LG, et al. Transfer of allergen-specific IgE-mediated hypersensitivity with allogeneic bone marrow transplantation. N Engl J Med. 1988;319:1623-1628. 6. Legendre C, Caillat-Zucman S, Samuel D, et al. Transfer of symptomatic peanut allergy to the recipient of a combined liver-and-kidney transplant. N Engl J Med. 1997;337:822-824. 7. Dreskin SC, Goldsmith PK, Strober W, Zech LA, Gallin JI. Metabolism of immunoglobulin E in patients with markedly elevated serum immunoglobulin E levels. J Clin Invest. 1987;79:1764-1772. 8. Castells MC, Boyce J. Transfer of peanut allergy by a liver allograft [letter]. N Engl J Med. 1998;338:202-203. 9. Loveless MH. Immunological studies of pollinosis, II: passive sensitization of man through transfusion. J Immunol. 1941;41:1534. 10. Castells MC, Pasual C, Esteban M, Ojeda JA. Allergy to white potato. J Allergy Clin Immunol. 1986;78:1110-1114.