Epidemiology

Babies may have higher risk for new food allergy after liver transplant

Last Updated: 2012-03-09 16:55:30 -0400 (Reuters Health)

By Fran Lowry

NEW YORK (Reuters Health) - A substantial proportion of babies who underwent liver transplantation developed food allergies, most commonly to egg, in a new study from Japan presented March 3rd at the annual meeting of the American Academy of Allergy, Asthma and Immunology, held this year in Orlando.

"Children undergoing liver transplantation have been increasingly recognized to develop food allergy after the transplant surgery, however specific risk factors related to liver transplantation other than tacrolimus have been difficult to identify," Dr. Tetsuo Shoda from the National Center for Child Health and Development in Tokyo told Reuters Health.

To analyze the phenomenon, Dr. Shoda and his team reviewed data on 106 children who underwent liver transplantation between 2005 and 2010.

Fifteen patients (10 female and 5 male; 14.2%) developed new-onset food allergy. In those 15, the average age at transplantation was 10 months, and food allergy developed with two years. All had received tacrolimus-based immunosuppression.

The most common allergic manifestations were urticaria and angioedema, which occurred in 80%. Fifty percent presented with gastrointestinal symptoms. Non-IgE-mediated gastrointestinal allergy was suspected in two patients.

Egg was the most common newly acquired allergy, found in 50% of the children.

Last year, Noble et al. from Brisbane reported that 12 of 60 pediatric liver transplant survivors had developed de novo food allergies, including nine who were infants at the time of transplant. They also said that since only half of the 60 children were being followed at their hospital, that 20% figure could well be an underestimate.

In the experience of Ozbek et al. in Turkey, published in 2009, six of 28 pediatric liver recipients developed de novo food allergies. They too were relatively young at transplant (mean 10 months, vs. 70 months for children without new-onset food allergy).

"Another important clinical finding from our analysis was that the cumulative incidence of food allergy developing after pediatric liver transplantation differed according to the primary liver disease," Dr. Shoda told Reuters Health.

In particular, 11 of the 15 children with de novo food allergies had biliary atresia.

A history of previous intestinal surgery was also a significant risk factor for the development of food allergy after liver transplantation, according to the presentation.

"Based on the results of this study, there appears to be a susceptible subgroup requiring special attention," Dr. Shoda said. "We believe that a more precise further clarification of these associations in future studies would allow us to determine whether new interventions could decrease the rate of food allergy development in this population."