Tag Archives: allergy

Food Allergy in Liver Transplant Recipients

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F Mori et al. JPGN 2022; 74: 175-179. De Novo Food Allergy in Pediatric Recipients of Liver Transplant

This interesting review has several key points:

  • Reported prevalence of food allergy after liver transplant ranges from 5% to 40%
  • Younger age at transplantation is a risk factor for developing de novo post-transplant food allergy (dnPTFA)
  • Tacrolimus has been implicated as a risk factor for dnPTFA
  • Common dnPTFA are the same as in the general population: milk, egg, wheat, peanouts/nuts, fish, and soy

Management recommendations:

  • If the donor has a food allergy, the recipient should be tested within the first months of transplant for food-specific IgE and “it is advisable to introduce the suspected food in a controlled setting”
  • Elimination diet is mainstay of treatment. Some individuals may need modification of their immunosuppressive medications
  • Provide self-injectable epinephrine in those with food allergy
  • Monitoring of specific IgE/skin prick tests is advised

My take: There are increased allergy issues in kids who have had liver transplantation.

Related blog post: Lots of Allergy & Autoimmunity Issues Following Solid Organ Transplantation

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Is Propofol Safe in Pediatric Patients with Food Allergy and Eosinophilic Esophagitis?

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According to a recent study (P Mehta et al. JPGN 2017; 64: 546-49), propofol was safe in pediatric patients with eosinophilic esophagitis (EoE) and food allergy.

This finding was based on a retrospective study of 1365 upper endoscopies (2013-2014).  Though, propofol was used less frequently, “there was no difference in complication rates relative to propofol use.”

Specifically, egg or soy allergy patients had 38 procedures; 114 children had EoE (without known egg or soy allergy) and 27 and EoE and egg or soy allergy.

This study is important because propofol is used frequently in patients with egg and soy allergies despite a contraindication warning on the package insert. Nevertheless, this study does not provide a definitive answer due to the very low rates of allergic reactions to propofol (~1:10,000 to 1:20,000).  In addition, the diagnosis of food allergy in this study relied on review of the medical record.

My take: This study is limited in scope but did not identify any significant safety concerns with propofol in patients who had EoE and/or egg/soy allergies.

Palace of Versailles

Peanut Allergy Prevention Guidelines

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From USA Today: Peanut allergy: Everything they told you was wrong

LINK::

An excerpt:

Research suggests the method to stopping a lifelong peanut allergy is to, well, feed your baby peanut foods.

The National Institute of Allergy and Infectious Diseases, part of the federal government’s National Institute of Health, issued new guidelines to health care providers and parents Thursday…

The guidelines are based on whether a child has eczema or an egg allergy, good indicators of peanut allergies. Fauci suggests parents check with their doctor before moving forward with peanut foods.

The guidelines are as follows:

– For infants deemed a high risk for developing a peanut allergy, based on eczema or egg allergies, experts suggest feeding them food with peanuts as early as four to six months old.

– Infants with mild to moderate eczema should be introduced to peanuts at six months old.

– For babies without eczema or egg allergies, researchers say parents can start giving them peanut foods when they see fit.

 

From NBC News: Peanut Allergy Prevention (includes video)

High-risk infants

Babies with with severe eczema or an egg allergy should be tested at a specialist’s office when they’re 4 to 6 months old and have started taking solid food.

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