Food allergen sensitization before and after liver transplantation: risk and evolution of IgE-mediated food allergies in 30 children cohort

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Children with liver transplantation (LT) treated with tacrolimus can develop IgE-mediated food allergies. LT children were addressed by hepatologist pediatricians to an allergist pediatrician for suspicion of food allergy reactions. A standardized questionnaire, including history of personal and familial atopy, was performed for each child. Skin prick test (SPT), specific IgE and recombinants for food allergens were realized for each child. SPT and biological tests realized before and after LT for each child were compared. Thirty children who underwent LT at age 2,8 years (2 months-10 years) were included. The main cause of LT was biliary atresia (n=20, 67% of cases). All children were treated with basiliximab and tacrolimus. Children under 5 years at LT (n=25) had a service protocol of food diet. Twenty-two children (73%) had confirmed IgE-mediated food allergy after LT and for eight children (27%), IgE-mediated food allergy after LT was not confirmed by allergist. History of allergic rhinitis in parents was most frequent in children who developed food allergies after LT (p=0.03). There were no statistical differences in terms of history of personal atopy. The delay of IgE-mediated food allergy reactions was on average of 25 months (1-96) after LT. The clinical severity of these reactions was grad I (n=21) and grad II (n=12) according to Astier classification. After LT, each allergic child used on average, three times oral treatment of the first-aid kit (steroids and anti-histamine agents). Three children used adrenaline pen and, among them, one boy used it 7 times after LT. Food allergens were principally, pea (n=7), fish (n=4), lentils (n=3), peanut (n=3), egg (n=3) and mustard (n=3). Two of the three children with positive SPT before LT, developed food allergies after LT. Eight of the twelve children with positive IgE specific before LT, developed allergy after LT. Ten children (33%) developed cutaneous sensitization after LT and among them, 82% developed IgE-mediated food allergy. Fourteen children (47%) developed biological sensitization after LT and among them 79% developed IgE-mediated food allergies after LT. Children after LT can develop cutaneous and biological sensitization and some of them will develop IgE-mediated food allergies. The pathophysiology of these reactions is not clear. Close monitoring of these children with regular clinical evaluation, SPT and biological tests before and after LT is essential to detect children at risk to develop IgE-mediated food allergies. Parental education with first-aid kit including adrenaline pen is also crucial.

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