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1
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Lee EY, Sohng K, Singer LG, Tarlo SM, Phillips EJ. The risk of donor-acquired allergy in solid-organ transplant recipients: A systematic review. Ann Allergy Asthma Immunol 2025; 134:474-483.e7. [PMID: 39863119 DOI: 10.1016/j.anai.2025.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 12/24/2024] [Accepted: 01/07/2025] [Indexed: 01/27/2025]
Abstract
BACKGROUND Donor-acquired allergy (DAA) occurs when donors transfer their allergies to recipients through solid-organ transplant (SOT). However, the risk of DAA in recipients of organs from allergic donors has not been systematically characterized. OBJECTIVE To synthesize the available evidence on the risk of DAA in SOT recipients. METHODS We searched Embase and MEDLINE databases for original and peer-reviewed articles related to transplant allergy since database inception to February 11, 2024. Two reviewers independently screened records, extracted data, and assessed risk of bias. RESULTS The review included 24 studies with 747 SOT recipients and their 135 allergic donors in the category of food, drug, or venom. Only 40 recipients (5.4%) underwent allergy testing to donor allergens, and 23 of them had the testing done before an exposure to donor allergens. Among the 30 recipients (4.0%) who were diagnosed with having DAA based on a clinical reaction or positive allergy testing result, 19 (2.5%) had anaphylaxis to donor allergens. Only the type of SOT (lung or liver) was associated with an increased risk of DAA (odds ratio 88.0, 95% CI 22.5-481.3), with no association found for other organs. CONCLUSION Despite the uncommon occurrence, recipients of organs from allergic donors could be at risk of severe allergic reactions to donor allergens. Although infrequently performed, allergy testing to donor allergens can effectively assess the risk of developing DAA. These findings highlight the risk of DAA and underscore the importance of proactive allergy assessment to prevent unnecessary anaphylaxis in this vulnerable population.
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Affiliation(s)
- Erika Yue Lee
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Ajmera Transplant Centre, Toronto General Hospital, Toronto, Ontario, Canada.
| | - Kaylee Sohng
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lianne G Singer
- Ajmera Transplant Centre, Toronto General Hospital, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, University of Toronto, Ontario, Canada; Division of Respirology, University Health Network, Toronto, Ontario, Canada
| | - Susan M Tarlo
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, University of Toronto, Ontario, Canada; Division of Respirology, University Health Network, Toronto, Ontario, Canada
| | - Elizabeth J Phillips
- Center for Drug Safety and Immunology, Vanderbilt University Medical Centre, Nashville, Tennessee; Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
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2
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Stojanovic S, Chatelier J, Bosco J, O'Hehir RE, Snell G. Transient acquired donor peanut allergy presenting as life-threatening anaphylaxis following lung transplantation. Ann Allergy Asthma Immunol 2022; 129:517-519. [PMID: 35830945 DOI: 10.1016/j.anai.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Stephanie Stojanovic
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Victoria, Australia.
| | - Josh Chatelier
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Victoria, Australia
| | - Julian Bosco
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Victoria, Australia; Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash University, Victoria, Australia
| | - Robyn E O'Hehir
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Victoria, Australia; Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash University, Victoria, Australia
| | - Greg Snell
- Lung Transplant Service, The Alfred Hospital, Victoria, Australia
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3
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Debiasi M, Pichler H, Klinglmüller F, Boztug H, Schmidthaler K, Rech J, Scherer D, Lupinek C, Valenta R, Kacinska‐Pfaller E, Geyeregger R, Fritsch G, Haas OA, Peters C, Lion T, Akdis M, Matthes S, Akdis CA, Szépfalusi Z, Eiwegger T. Transfer and loss of allergen-specific responses via stem cell transplantation: A prospective observational study. Allergy 2020; 75:2243-2253. [PMID: 32181893 DOI: 10.1111/all.14278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/31/2020] [Accepted: 02/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Currently, no estimates can be made on the impact of hematopoietic stem cell transplantation on allergy transfer or cure of the disease. By using component-resolved diagnosis, we prospectively investigated 50 donor-recipient pairs undergoing allogeneic stem cell transplantation. This allowed calculating the rate of transfer or maintenance of allergen-specific responses in the context of stem cell transplantation. METHODS Allergen-specific IgE and IgG to 156 allergens was measured pretransplantation in 50 donors and recipients and at 6, 12 and 24 months in recipients post-transplantation by allergen microarray. Based on a mixed effects model, we determined risks of transfer of allergen-specific IgE or IgG responses 24 months post-transplantation. RESULTS After undergoing stem cell transplantation, 94% of allergen-specific IgE responses were lost. Two years post-transplantation, recipients' allergen-specific IgE was significantly linked to the pretransplantation donor or recipient status. The estimated risk to transfer and maintain individual IgE responses to allergens by stem cell transplantation was 1.7% and 2.3%, respectively. Allergen-specific IgG, which served as a surrogate marker of maintaining protective IgG responses, was highly associated with the donor's (31.6%) or the recipient's (28%) pretransplantation response. CONCLUSION Hematopoietic stem cell transplantation profoundly reduces allergen-specific IgE responses but also comes with a considerable risk to transfer allergen-specific immune responses. These findings facilitate clinical decision-making regarding allergic diseases in the context of hematopoietic stem cell transplantation. In addition, it provides prospective data to estimate the risk of transmitting allergen-specific responses via hematopoietic stem cell transplantation.
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Affiliation(s)
- Markus Debiasi
- Department of Pediatrics and Adolescent Medicine Medical University of Vienna Vienna Austria
| | - Herbert Pichler
- Department of Pediatrics and Adolescent Medicine St. Anna Children's Hospital Medical University of Vienna Vienna Austria
| | - Florian Klinglmüller
- Center for Medical Statistics Informatics and Intelligent Systems Medical University of Vienna Vienna Austria
| | - Heidrun Boztug
- Department of Pediatrics and Adolescent Medicine St. Anna Children's Hospital Medical University of Vienna Vienna Austria
| | - Klara Schmidthaler
- Department of Pediatrics and Adolescent Medicine Medical University of Vienna Vienna Austria
| | - Jonas Rech
- Department of Pediatrics and Adolescent Medicine Medical University of Vienna Vienna Austria
| | - David Scherer
- Department of Pediatrics and Adolescent Medicine Medical University of Vienna Vienna Austria
| | - Christian Lupinek
- Division of Immunopathology Department of Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - Rudolf Valenta
- Division of Immunopathology Department of Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
- NRC Institute of Immunology FMBA of Russia Moscow Russia
| | - Ewa Kacinska‐Pfaller
- Department of Pediatrics and Adolescent Medicine St. Anna Children's Hospital Medical University of Vienna Vienna Austria
| | | | | | - Oskar A. Haas
- Department of Pediatrics and Adolescent Medicine St. Anna Children's Hospital Medical University of Vienna Vienna Austria
- Children's Cancer Research Institute (CCRI) Vienna Austria
| | - Christina Peters
- Department of Pediatrics and Adolescent Medicine St. Anna Children's Hospital Medical University of Vienna Vienna Austria
| | - Thomas Lion
- Department of Pediatrics and Adolescent Medicine St. Anna Children's Hospital Medical University of Vienna Vienna Austria
- Children's Cancer Research Institute (CCRI) Vienna Austria
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
| | - Susanne Matthes
- Department of Pediatrics and Adolescent Medicine St. Anna Children's Hospital Medical University of Vienna Vienna Austria
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
| | - Zsolt Szépfalusi
- Department of Pediatrics and Adolescent Medicine Medical University of Vienna Vienna Austria
| | - Thomas Eiwegger
- Department of Pediatrics and Adolescent Medicine Medical University of Vienna Vienna Austria
- Division of Immunology and Allergy Food allergy and Anaphylaxis Program Department of Pediatrics The Hospital for Sick Children Toronto Canada
- Research Institute The Hospital for Sick Children Translational Medicine program Toronto Canada
- Department of Immunology University of Toronto Toronto Ontario Canada
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4
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Muller YD, Vionnet J, Beyeler F, Eigenmann P, Caubet J, Villard J, Berney T, Scherer K, Spertini F, Fricker MP, Lang C, Schmid‐Grendelmeier P, Benden C, Roux Lombard P, Aubert V, Immer F, Pascual M, Harr T, the Swiss Transplant Cohort Study AmicoPatriziaAubertJohn‐DavidBanzVanessaBeldiGuidoBendenChristianBergerChristophBinetIsabelleBochudPierre‐YvesBrancaSandaBucherHeinerCarellThierryCatanaEmmanuelleChalandonYvesde GeestSabinade RougemontOlivierDickenmannMichaelDuchosalMichelElkriefLaureFehrThomasFerrari‐LacrazSylvieGarzoniChristianGasche SoccalPaolaGaudetChristopheGiostraEmilianoGolshayanDélaHadayaKarineHalterJörgHauriDimitriHeimDominikHessChristophHillingerSvenHirschHans H.HofbauerGüntherHuynh‐DoUyenImmerFranzKlaghoferRichardKollerMichaelLaesserBettinaLaubeGuidoLehmannRogerLovisChristianMajnoPietroManuelOriolMartiHans‐PeterYves MartinPierreMartinelliMicheleMeylanPascalMorelPhilippeMuellerNicolas J.MüllerAntoniaMüllerThomasMüllhauptBeatPascualManuelPasswegJakobPosfay‐BarbeKlaraRickJulianeRoosnekEddyRosseletAnneRothlinSilviaRuschitzkaFrankSchanzUrsSchaubStefanSchnyderAureliaSeilerChristianSprachtaJanStampfSusanneSteigerJürgStirnimannGuidoTosoChristianVan DeldenChristianVenetzJean‐PierreVillardJeanWickMadeleineWilhelmMarkusYerlyPatrick. Management of allergy transfer upon solid organ transplantation. Am J Transplant 2020; 20:834-843. [PMID: 31535461 PMCID: PMC7065229 DOI: 10.1111/ajt.15601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/03/2019] [Accepted: 09/07/2019] [Indexed: 01/25/2023]
Abstract
Allergy transfer upon solid organ transplantation has been reported in the literature, although only few data are available as to the frequency, significance, and management of these cases. Based on a review of 577 consecutive deceased donors from the Swisstransplant Donor-Registry, 3 cases (0.5%) of fatal anaphylaxis were identified, 2 because of peanut and 1 of wasp allergy. The sera of all 3 donors and their 10 paired recipients, prospectively collected before and after transplantation for the Swiss Transplant Cohort Study, were retrospectively processed using a commercial protein microarray fluorescent test. As early as 5 days posttransplantation, newly acquired peanut-specific IgE were transiently detected from 1 donor to 3 recipients, of whom 1 liver and lung recipients developed grade III anaphylaxis. Yet, to define how allergy testing should be performed in transplant recipients and to better understand the impact of immunosuppressive therapy on IgE sensitization, we prospectively studied 5 atopic living-donor kidney recipients. All pollen-specific IgE and >90% of skin prick tests remained positive 7 days and 3 months after transplantation, indicating that early diagnosis of donor-derived IgE sensitization is possible. Importantly, we propose recommendations with respect to safety for recipients undergoing solid-organ transplantation from donors with a history of fatal anaphylaxis.
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Affiliation(s)
- Yannick D. Muller
- Division of Immunology and AllergyDepartment of MedicineUniversity Hospitals and University of GenevaGenevaSwitzerland,Transplantation CenterLausanne University Hospital and University of LausanneLausanneSwitzerland,Department of SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Julien Vionnet
- Transplantation CenterLausanne University Hospital and University of LausanneLausanneSwitzerland,Department of Inflammation Biology, School of Immunology and Microbial SciencesKing's College LondonLondonUK
| | | | - Philippe Eigenmann
- Pediatric Allergy UnitDepartment of Women-Children-TeenagersPediatric Allergy UnitUniversity Hospitals of Geneva and University of GenevaGenevaSwitzerland
| | - Jean‐Christoph Caubet
- Pediatric Allergy UnitDepartment of Women-Children-TeenagersPediatric Allergy UnitUniversity Hospitals of Geneva and University of GenevaGenevaSwitzerland
| | - Jean Villard
- Department of Genetic, Laboratory and Pathology MedicineGeneva University HospitalsGenevaSwitzerland
| | - Thierry Berney
- Division of TransplantationDepartment of SurgeryGeneva University HospitalsGenevaSwitzerland
| | - Kathrin Scherer
- Division of Allergy and DermatologyUniversity Hospital BaselBaselSwitzerland
| | - Francois Spertini
- Service of Immunology and AllergyLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Michael P. Fricker
- Division of Rheumatology, Immunology and AllergyInselspitalBernSwitzerland
| | - Claudia Lang
- Allergy UnitDepartment of DermatologyUniversity Hospital of ZürichZürichSwitzerland
| | | | - Christian Benden
- Division of Pulmonary MedicineUniversity Hospital of ZürichZürichSwitzerland
| | - Pascale Roux Lombard
- Division of Immunology and AllergyDepartment of MedicineUniversity Hospitals and University of GenevaGenevaSwitzerland
| | - Vincent Aubert
- Service of Immunology and AllergyLausanne University Hospital and University of LausanneLausanneSwitzerland
| | | | - Manuel Pascual
- Transplantation CenterLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Thomas Harr
- Division of Immunology and AllergyDepartment of MedicineUniversity Hospitals and University of GenevaGenevaSwitzerland
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5
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Caruso C, Pinter E, Poli E, Ferri F, Merli M, Colantuono S, Mennini G, Melandro F, Rumi G, Galandrini R, Ginanni Corradini S. Acquired cow's milk sensitization after liver transplant in an adult: "clinical implications" and future strategies. Allergy Asthma Clin Immunol 2019; 15:11. [PMID: 30828351 PMCID: PMC6385433 DOI: 10.1186/s13223-019-0326-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background Identifying the mechanisms responsible for the development of food allergy in liver transplant recipients is more complex as there are several different clinical scenarios related to the immunological function of the liver. Case presentation We describe the first case of Transplant Acquired Food Allergy (TAFA) to cow milk in an adult following LT from a donor dead because of anaphylactic shock. A 67-year-old woman with primary biliary cirrhosis was referred to the Transplant Center of our hospital because of an acute-on-chronic liver failure. The donor was a 15-year-old girl deceased for anoxic encephalopathy due to food induced anaphylaxis after eating a biscuit. In the donor's history food allergies to cow milk and eggs were present. Conclusion This case emphasizes the need for a standardized assessment of both solid-organ donors and recipients including donor allergy history in order to detect recipients at risk for anaphylaxis due to passive IgE transfer. Despite several reports of TAFA after solid organ, especially liver, an appropriate protocol to avoid risk for the recipient doesn't exist at the moment. The SPT (skin prick test) or specific IgE level are not enough to ensure a correct management in these cases and a correct education of the patients and the medical staff involved is absolutely necessary. It is the first case of milk allergy sensitization after solid organ transplant by passive transfer of IgE.
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Affiliation(s)
- C Caruso
- Allergy Unit, Presidio Columbus, Fondazione Policlinico A. Gemelli, IRCSS, Rome, Italy
| | - E Pinter
- 3Clinical Immunology, Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - E Poli
- 5Gastroenterology Unit, Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - F Ferri
- 5Gastroenterology Unit, Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - M Merli
- 5Gastroenterology Unit, Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - S Colantuono
- Allergy Unit, Presidio Columbus, Fondazione Policlinico A. Gemelli, IRCSS, Rome, Italy.,3Clinical Immunology, Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - G Mennini
- 2Dipartimento di Chirurgia Generale e Trapianti d'Organo, "Sapienza" Università di Roma, Policlinico Umberto I, Rome, Italy
| | - F Melandro
- 2Dipartimento di Chirurgia Generale e Trapianti d'Organo, "Sapienza" Università di Roma, Policlinico Umberto I, Rome, Italy
| | - G Rumi
- Allergy Unit, Presidio Columbus, Fondazione Policlinico A. Gemelli, IRCSS, Rome, Italy
| | - R Galandrini
- 4Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Ginanni Corradini
- 5Gastroenterology Unit, Department of Clinical Medicine, Sapienza University, Rome, Italy
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6
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Odish M, Chen M, Kim A, Floreth T. Acquired Donor Peanut Allergy From Lung Transplantation Resulting in Respiratory Failure: A Case Report. Transplant Proc 2018; 50:4085-4086. [PMID: 30447764 DOI: 10.1016/j.transproceed.2018.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
This case report describes a patient who acquired a donor peanut allergy after lung transplantation. A 53-year-old woman with alpha-1 antitrypsin deficiency underwent left-sided lung transplant from a donor with a history of anaphylaxis to peanut. Two weeks after the transplant, the patient developed acute respiratory failure immediately after consuming a peanut butter and jelly sandwich. The donor's serum confirmed high titers of peanut-specific immunoglobulin E (IgE). The recipient patient had never had allergies to peanuts or other nuts before her transplant. After the transplant, she had negative serology but positive skin testing to peanuts. This case illustrates the importance of considering donor food allergies when caring for solid organ transplant recipients.
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Affiliation(s)
- M Odish
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California-San Diego, San Diego, California.
| | - M Chen
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California-San Diego, San Diego, California
| | - A Kim
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California-San Diego, San Diego, California
| | - T Floreth
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California-San Diego, San Diego, California
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7
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Donor-derived infections in solid organ transplant patients: toward a holistic approach. Curr Opin Infect Dis 2018; 30:329-339. [PMID: 28538045 DOI: 10.1097/qco.0000000000000377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Solid organ demand far exceeds organ supply. Strategies to increase the donor pool include the liberalization of selection criteria without increasing the risk of unexpected donor-derived infection (DDI), a rare complication of transplantation carrying high morbidity and mortality. We review the challenging aspects in the prevention of DDI, focusing on the complexities of data sharing and efficient communication and the role infectious diseases specialists play in the process. RECENT FINDINGS Advances in donor screening, transmission recognition and reporting allow for a better estimation of the risk of DDI. However, there is great variability in the frequency and methods with which organ procurement organizations report transmission events.Moreover, the Scientific Registry of Transplant Recipients provides limited donor and recipient outcome infectious diseases related data. Infectious disease contribution to the allocation process has been found to improve organ donation efficiency and communication between involved parties. Although communication gaps are strongly associated with infection transmission (relative risk 2.36%, confidence interval 1.48-3.78), effective communication minimizes or prevents infection in transplant recipients (X(1) 13.13, P = 0.0003). SUMMARY Prospective research is still required to define optimal screening protocols and further prevent transmission of infection. A holistic approach is likely to result in enhanced transplantation safety. Toward this goal, development of standards of investigation; improvement in reporting and data sharing; and strategies ensuring coordinated and rapid communication among parties involved in the allocation process need to be pursued.
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8
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Abstract
Mechanisms that regulate the tolerance to dietary proteins or the loss of this and subsequent development of disease are poorly understood. In food allergy, there is growing awareness of the urgency in understanding these events to aid in the development of next-generation therapies and interventions. This review focuses on the accumulating evidence related to food allergy that develops after transplantation. This intriguing immunological phenomenon has been described in several different types of transplant settings and to variety of different foods. We outline these studies and the evidence from them that support transplant-acquired food allergy being a process regulated by both the donor allergic status and the recipient genetics and treatments. A number of key risk factors seem prevalent throughout transplant-acquired food allergy and include type of transplant, age and general health of the recipient, modality of immunosuppression and potentially the genetics of both donor and recipient. Importantly, these studies provide a window into better general understanding of food allergy, and facilitate clearer understanding of the critical immunological and epidemiological factors needed to allow the adoptive transfer of a food-specific allergic disease from one individual to another.
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Affiliation(s)
- Shweta S Hosakoppal
- Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul J Bryce
- Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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9
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Roberts G, Boyle R, Crane J, Hogan SP, Saglani S, Wickman M, Woodfolk JA. Developments in the field of allergy in 2016 through the eyes of Clinical and Experimental Allergy. Clin Exp Allergy 2017; 47:1512-1525. [PMID: 29068551 DOI: 10.1111/cea.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In this article, we described the development in the field of allergy as described by Clinical and Experimental Allergy in 2016. Experimental models of allergic disease, basic mechanisms, clinical mechanisms, allergens, asthma and rhinitis, and clinical allergy are all covered.
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Affiliation(s)
- G Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - R Boyle
- Department of Paediatrics, Imperial College London, London, UK
| | - J Crane
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - S P Hogan
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - S Saglani
- National Heart & Lung Institute, Imperial College London, London, UK
| | - M Wickman
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - J A Woodfolk
- Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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10
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Moutsoglou DM, Dreskin SC. B cells establish, but do not maintain, long-lived murine anti-peanut IgE(a). Clin Exp Allergy 2016; 46:640-53. [PMID: 27021119 DOI: 10.1111/cea.12715] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 10/25/2015] [Accepted: 01/05/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Peanut allergy (PNA) has been reported to be transferred to tolerant recipients through organ and bone marrow (BM) transplantation. The roles T and B cells play in establishing, and the roles B cell subsets play in maintaining lifelong anti-peanut IgE levels are unknown. OBJECTIVES To determine the cellular requirements for the transfer of murine PNA and to determine the role CD20(+) cells play in maintaining long-lived anti-peanut IgE levels. METHODS We developed a novel adoptive transfer model to investigate the cellular requirements for transferring murine PNA. We also treated peanut-allergic (PA) mice with anti-CD20 antibody and measured IgE levels throughout treatment. RESULTS Purified B220(+) cells from PA splenocytes and purified CD4(+) cells from naïve (NA) splenocytes are the minimal requirements for the adoptive transfer of PNA. Prolonged treatment of allergic mice with anti-CD20 antibody results in significant depletion of B cell subsets but does not affect anti-peanut IgE levels, symptoms, or numbers of IgE antibody secreting cells (ASCs) in the BM. Adoptive transfer of BM and spleen cells from allergic donors treated with anti-CD20 antibody does not result in the transfer of PNA in NA recipients, demonstrating that anti-CD20 antibody treatment depletes B cells capable of differentiating into peanut-specific IgE ASCs. CONCLUSIONS AND CLINICAL RELEVANCE Peanut allergy can be established in a NA hosts with B220(+) cells from PA donors and CD4(+) cells from peanut-NA donors. However, long-term depletion of B220(+) cells with anti-CD20 antibody does not affect anti-peanut IgE levels. These results highlight a novel role for B cells in the development of PNA and provide evidence that long-lived anti-peanut IgE levels may be maintained by long-lived ASCs.
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Affiliation(s)
- D M Moutsoglou
- Division of Allergy and Clinical Immunology, Departments of Medicine and Immunology, University of Colorado Denver, Aurora, CO, USA
| | - S C Dreskin
- Division of Allergy and Clinical Immunology, Departments of Medicine and Immunology, University of Colorado Denver, Aurora, CO, USA
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11
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Niedzwiecki M, Yamada Y, Inci I, Weder W, Jungraithmayr W. Decrease of Airway Allergies After Lung Transplantation Is Associated With Reduced Basophils and Eosinophils. Transplant Proc 2016; 48:2140-6. [PMID: 27569960 DOI: 10.1016/j.transproceed.2016.02.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/14/2016] [Accepted: 02/24/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Allergies are hypersensitive reactions of the immune system on antigen exposure similar to immune reactions after transplantation (Tx). Their activity can change after Tx. The lung as a transplantable organ is challenged two-fold, by antigens from the blood and the air environment. Herein we analyzed if airway allergies change after lung Tx. METHODS We systematically reviewed patients' airway allergies before and after lung Tx between 1992 and 2014. The course of lymphocytes, thrombocytes, and leukocytes, among them neutrophils, eosinophils, and basophils, was analyzed in patients in whom airway allergies have changed and in whom they did not change. RESULTS From 362 lung transplanted patients, 44 patients had suffered from allergies before Tx (12.2%). In 20 of these patients (45.5%), airway allergies disappeared completely within 1 year after lung Tx and were persistently absent thereafter. In these patients, basophils and eosinophils decreased significantly (P < .0012); in contrast, cells did not decrease in patients whose allergies did not disappear. Leukocytes overall, and in particular, neutrophils, decreased significantly in patients whose allergy disappeared (P < .014, P < .012, respectively). CONCLUSIONS Airway allergies disappeared in almost half of cases after lung Tx. Along with this reduction, basophils and eosinophils decreased as potentially responsible cells for this phenomenon. These findings may stimulate intensified research on basophils and eosinophils as major drivers of airway allergies.
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Affiliation(s)
- M Niedzwiecki
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Y Yamada
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - I Inci
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - W Weder
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - W Jungraithmayr
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
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Word C, Klaffky E, Ortiz C, Palacios T, Pelletier S, Oliveira W, Greb B, Workman L, Platts-Mills T, Wisniewski J. Management of acquired peanut allergy following solid-organ transplant. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:612-4. [PMID: 25912655 DOI: 10.1016/j.jaip.2015.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Carolyn Word
- University of Virginia Health Care System, Charlottesville, Va
| | - Erin Klaffky
- University of Virginia Health Care System, Charlottesville, Va
| | - Christina Ortiz
- University of Virginia Health Care System, Charlottesville, Va
| | | | - Shawn Pelletier
- University of Virginia Health Care System, Charlottesville, Va
| | - Walter Oliveira
- University of Virginia Health Care System, Charlottesville, Va
| | - Barbara Greb
- University of Virginia Health Care System, Charlottesville, Va
| | - Lisa Workman
- University of Virginia Health Care System, Charlottesville, Va
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Berry A, Campsen J, Shihab F, Firszt R. Transfer of peanut IgE sensitisation after combined pancreas-kidney transplant. Clin Exp Allergy 2015; 44:1020-2. [PMID: 24919754 DOI: 10.1111/cea.12355] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 06/03/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The transfer of peanut allergy has been reported following solid organ transplantation. OBJECTIVE Present a case of peanut sensitization following combined pancreas-and-kidney transplantation. METHODS Circulating specific IgE against peanut were measured in serum samples collected from the transplant recipient 1 month before transplantation, and 1, 3 and 6 months after transplantation. Skin tests were performed 1, 3 and 6 months following transplant. RESULTS The organ recipient's pre-transplant peanut IgE levels were negative. At 1 month post-transplant, the patient had a 6 mm skin test to peanut and had serum IgE to peanut Arah1 of 0.79 kU/L. At 3 months, skin test size and IgE to peanut Arah1 decreased to 4 mm, and 0.69 kU/L respectively. At 6 months, the patient's skin test and IgE to peanuts were negative. At that time, the patient underwent a peanut food challenge without a clinical reaction to suggest allergy. CONCLUSION AND CLINICAL RELEVANCE We report the development of IgE peanut sensitization in a recipient of a combined pancreas and kidney transplantation. Increasing awareness of this allergen sensitization following transplantation may help prevent serious allergic reactions in transplant recipients.
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Affiliation(s)
- A Berry
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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Brough HA, Cousins DJ, Munteanu A, Wong YF, Sudra A, Makinson K, Stephens AC, Arno M, Ciortuz L, Lack G, Turcanu V. IL-9 is a key component of memory TH cell peanut-specific responses from children with peanut allergy. J Allergy Clin Immunol 2014; 134:1329-1338.e10. [PMID: 25112699 DOI: 10.1016/j.jaci.2014.06.032] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 06/15/2014] [Accepted: 06/26/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Differentiation between patients with peanut allergy (PA) and those with peanut sensitization (PS) who tolerate peanut but have peanut-specific IgE, positive skin prick test responses, or both represents a significant diagnostic difficulty. Previously, gene expression microarrays were successfully used to identify biomarkers and explore immune responses during PA immunotherapy. OBJECTIVE We aimed to characterize peanut-specific responses from patients with PA, subjects with PS, and atopic children without peanut allergy (NA children). METHODS A preliminary exploratory microarray investigation of gene expression in peanut-activated memory TH subsets from 3 children with PA and 3 NA children identified potential PA diagnostic biomarkers. Microarray findings were confirmed by using real-time quantitative PCR in 30 subjects (12 children with PA, 12 children with PS, and 6 NA children). Flow cytometry was used to identify the TH subsets involved. RESULTS Among 12,257 differentially expressed genes, IL9 showed the greatest difference between children with PA and NA children (45.59-fold change, P < .001), followed by IL5 and then IL13. Notably, IL9 allowed the most accurate classification of children with PA and NA children by using a machine-learning approach with recursive feature elimination and the random forest algorithm. Skin- and gut-homing TH cells from donors with PA expressed similar TH2- and TH9-associated genes. Real-time quantitative PCR confirmed that IL9 was the highest differentially expressed gene between children with PA and NA children (23.3-fold change, P < .01) and children with PS (18.5-fold change, P < .05). Intracellular cytokine staining showed that IL-9 and the TH2-specific cytokine IL-5 are produced by distinct TH populations. CONCLUSION In this study IL9 best differentiated between children with PA and children with PS (and atopic NA children). Mutually exclusive production of IL-9 and the TH2-specific cytokine IL-5 suggests that the IL-9-producing cells belong to the recently described TH9 subset.
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Affiliation(s)
- Helen A Brough
- Division of Asthma, Allergy and Lung Biology, King's College London, and Guys' Hospital, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and Guys' Hospital, London, United Kingdom
| | - David J Cousins
- Division of Asthma, Allergy and Lung Biology, King's College London, and Guys' Hospital, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and Guys' Hospital, London, United Kingdom; Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Alina Munteanu
- Faculty of Computer Science, University of Iasi, Iasi, Romania
| | - Yuen Fei Wong
- Genomics Centre, King's College London, London, United Kingdom
| | - Asha Sudra
- Division of Asthma, Allergy and Lung Biology, King's College London, and Guys' Hospital, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and Guys' Hospital, London, United Kingdom
| | - Kerry Makinson
- Division of Asthma, Allergy and Lung Biology, King's College London, and Guys' Hospital, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and Guys' Hospital, London, United Kingdom
| | - Alick C Stephens
- Division of Asthma, Allergy and Lung Biology, King's College London, and Guys' Hospital, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and Guys' Hospital, London, United Kingdom
| | - Matthew Arno
- Genomics Centre, King's College London, London, United Kingdom
| | - Liviu Ciortuz
- Faculty of Computer Science, University of Iasi, Iasi, Romania
| | - Gideon Lack
- Division of Asthma, Allergy and Lung Biology, King's College London, and Guys' Hospital, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and Guys' Hospital, London, United Kingdom
| | - Victor Turcanu
- Division of Asthma, Allergy and Lung Biology, King's College London, and Guys' Hospital, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and Guys' Hospital, London, United Kingdom.
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Özdemir &O. New developments in transplant-acquired allergies. World J Transplant 2013; 3:30-35. [PMID: 24255880 PMCID: PMC3832858 DOI: 10.5500/wjt.v3.i3.30] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 05/19/2013] [Accepted: 06/04/2013] [Indexed: 02/05/2023] Open
Abstract
Transplant-acquired allergy (TAA) was firstly described as transplant-acquired food allergy (TAFA) after bone marrow transplantations and mostly observed in a transient form. The picture is complicated by numerous case reports of TAFA after the receipt of liver grafts from donors with no documented history of food allergy. The estimated prevalence of TAFA among young children in the literature has been documented in various studies ranging from 6% to 57%. Although TAA is mostly found to be associated with liver transplantation; it has been recently reported to be related with heart, intestinal, lung and even renal transplantations in adults. Previous reviews of published cases of liver TAA misleadingly emphasized the predominance of children and the absence of TAA in cardiac, pulmonary, and renal transplant recipients. In different studies, the male/female ratio is equal. Literature data suggest that children with TAFA typically present within the first year after surgery and are typically allergic to multiple foods. The pathogenesis of TAA is not still completely understood. Most of the studies support the concept that the functioning liver itself, and not only tacrolimus immunosuppression, is one of the main contributors to TAA in these patients. In the light of recent findings, other possible mechanisms can be summarized as following: (1) the recovery of delayed type hypersensitivity; (2) late manifestation of food allergy; (3) intestinal injury as well as inhibition of cellular energy production by tacrolimus; and (4) transfer of food-specific IgE or lymphocytes. Thus, interplay between hematopoietic cells from the transplanted organ and recipient specific factors (e.g., younger age and atopic background) seem to underlie the development of TAA. Most patients will have symptomatic improvement following reduced immunosuppression and an appropriately restricted diet. Nevertheless, some studies suggest that atopic diseases occur in some of pediatric liver transplant recipients, with manifestations including food allergy, eczema, allergic rhinitis, and asthma. More studies would be needed including greater number of patients to determine whether TAA is transient or not in pediatric/adult solid organ recipients.
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Shroff P, Mehta RS, Chinen J, Karpen SJ, Davis CM. Presentation of atopic disease in a large cohort of pediatric liver transplant recipients. Pediatr Transplant 2012; 16:379-84. [PMID: 22489822 DOI: 10.1111/j.1399-3046.2012.01684.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Atopic disease occurs in solid organ transplant recipients with an increasingly recognized frequency. The time course for the development of these atopic diseases in liver transplantation has not been described. The objective was to characterize the atopic manifestations of children receiving chronic immunosuppression after orthotopic liver transplantation (OLT). Chart review and follow-up questionnaire were utilized for 176 OLT pediatric recipients at a single institution for manifestations of allergic disease. Atopic disease was present in 25 (14.2%) patients. Median age at transplant was 16 months with a median follow-up of 63 months. Food allergy and non-food related atopic symptoms presented at a median of 11.5 (IQR, 6-28) and 19 (IQR, 5-41) months post-transplantation, respectively. The median age at transplant of the non-atopic children was 72 months, higher than patients with atopy (p < 0.001). Food allergy and atopic skin disease symptoms were present in 40% and 56% of cases, respectively. Asthma, allergic rhinitis, or both were found in 66% of cases. The onset of symptoms of food allergy and eczema (median, 12 months post-transplantation) preceded symptoms of allergic rhinitis and asthma. (median of 27 and 30 months post-transplantation, respectively). Atopy occurs in ∼14% of pediatric liver transplant recipients, with manifestations including food allergy, eczema, allergic rhinitis, and asthma.
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Affiliation(s)
- P Shroff
- Section of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
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