Incidence, Clinical Features and Prognosis of Food Allergy in Children who Underwent Liver Transplantation

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IntroductionChildren suffer from food allergy after liver transplant (LT). We evaluated our 16 years of experience in pediatric patients who developed food allergy after LTMaterials and MethodsThe clinical and laboratory data and clinical outcome of food allergy was evaluated. Total eosinophil count, total IgE and specific IgE levels were measured and skin prick tests were performed.ResultsA total of 236 pediatric patients received LT at Başkent University from 2001-2017. Food allergy incidence was 8% (19/236) among all patients with LT. All of the patients with food allergy were younger than 3 years of age and food allergy incidence at this group of age was 19.2% (19/99). Twelve patients were male (63.2%). The mean age at the time of LT was 7.92±2.64 months. All of the patients were started on tacrolimus in the posttransplant period. The mean period of time from LT to food allergy was 14.5±13.6 months. Four patients had single food allergy, while 15 patients had multiple food allergies. The allergen was milk in 3 patients and nut in 1 patient with single food allergy. The allergens in patients with multiple food allergy were egg (13 patients, 86.7%), milk (11 patients, 73.3%), nuts (6 patients, 40%), wheat (5 patients, 33.3%), lentil (4 patients, 26.7%), chickpea (4 patients, 26.7%), tropical fruits (3 patients, 20%), red meat (2 patients, 13.3%), soybean (2 patients, 13.3%), sesame (2 patients, 13.3%) and fish (1 patient, 6.7%). The presenting symptoms included diarrhea (13 patients, 68.4%), flushing (12 patients, 63.2%), angioedema attacks (9 patients, 47.4%), bronchiolitis/chronic cough (7 patients, 36.8%) and vomiting (6 patients, 31.6%). One patient with multiple food allergies also had anaphylaxis with lentil ingestion. The total eosinophil count and eosinophil percentage in blood at the time of diagnosis for food allergy were 1853±2876/mm3 and 12.7±10.91%, respectively. Twelve patients had eosinofilia. Total IgE count was 350±411 IU/ml. Nine patients had an increase in total IgE. Milk, egg and wheat specific IgEs were positive in 14 (73.7%), 10 (52.6%) and 7 (36.8%) patients, respectively. Skin prick test was positive for specific allergens in 13 (68,4%) patients. The patients were followed up for a mean period of 4.76±3.97 years. All of the incriminated foods were successfully reintroduced in 7 (36.8%) patients, while only some of the foods were successfully introduced in 8 patients with multiple food allergies. Out of 7 patients who have complete resolution of food allergy, 3 had single food allergy (3/4 patients, 75%) and 4 patients (4/15 patients, 26.7%) had multiple food allergy.ConclusionThe development of food allergy after LT is common especially in patients who were transplanted under 3 years of age. Multiple food allergies are more common and they are mostly IgE-mediated. Prognosis is better in single food allergies. Also, milk, egg and wheat were more commonly reintroduced than other foods in multiple food allergies.

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