Karaciğer transplantasyonu sonrası de nova çoklu besin alerjisi gelişen olgu

Year 2022, Volume: 13 Issue: 47, 450 - 452, 15.12.2022

Gül Şeker , Sinem Kahveci Çelik , Yeşim Öztürk

https://doi.org/10.17944/mkutfd.1057902

Abstract

Gıda alerjisi, gıdaya karşı bağışıklık aracılı bir yanıt olarak tanımlanır. Katı organ nakli sonrası gıda alerjisi ilk kez 1997 yılında karaciğer ve böbrek naklinden sonra tanımlanmıştır. Burada 10 aylıkken biliyer atrezi nedeniyle anneden karaciğer transplantasyonu yapılan ve 3 yaşında çoklu gıda alerjisi saptanan olgu sunulmuştur. 3 yaş 5 aylık erkek olgu, gıda alımı sonrası gelişen dudakta şişlik yakınması nedeniyle başvurdu. 10 aylıkken biliyer atrezi nedeniyle anneden karaciğer transplantasyonu olan olgu takrolimus ve mikofenolat mofetil tedavilerini düzenli olarak kullanmaktaydı. 20 aylıkken yumurta yedikten 5 dakika sonra gelişen dudakta şişlik yakınması ile acil servise başvurmuş. Daha önce yumurtayı sorunsuz olarak tüketebiliyormuş. Bu sırada solunum, deri veya gastrointestinal sisteme ait bulgular eşlik etmemiş. Daha sonra farklı zamanlarda bal tahin karışımı, mayonez soslu mısır tükettikten sonra da dudak ve gözlerinde şişlik gelişmiş. Testlere göre yumurta, fıstık ve fındık hastanın diyetinden çıkarıldı. Olgu 2 yıl diyet tedavisi ile sorunsuz takip edildi. Organ alıcılarının nakil sonrası yeni gıda alerjileri riskini tahmin etmek için organ bağışçıları gıda alerjileri açısından taranmalıdır. Donörde herhangi bir besin alerjisine dair kanıt bulunmamakla birlikte solid organ nakli yapılan hastalarda yeni besin allerjisi gelişebileceği akılda tutulmalı ve hastaların bu konuda takip edilmesi gerekmektedir.

Keywords

takrolimus, çoklu gıda alerjisi, çocuk, karaciğer nakli

Supporting Institution

yok

De novo multiple food allergy after liver transplantation: A case report

Abstract

Food allergy is defined as an immune-mediated response to food. Food allergy after solid organ transplantation was first described in 1997 after liver and kidney transplantation. Three years- five-month-old male was admitted with lip swelling after food intake. He had received a liver transplant from a living donor at ten months of age due to biliary atresia. Treatment with tacrolimus and mycophenolate mofetil was monitored. He was admitted to the emergency department with complaints of lip swelling that developed immediately after eating eggs in our department at 20 months of age. No associated respiratory, skin or gastrointestinal findings were noted in the case, who had previously eaten eggs without any problems. Later, after eating honey and tahini mixture and corn with mayonnaise sauce at different times, swelling developed on his lips and eyes. According to the tests, eggs, peanuts, and hazelnuts were excluded from the patient’s diet. The case was followed with diet therapy for two years with no problems. Organ donors should be screened for food allergies to predict organ recipients’ risk for new food allergies after transplantation. Although there is no evidence of food allergy in the donor, it should be kept in mind that new food allergies may develop in patients who have undergone solid organ transplantation, and patients should be monitored in this regard.

Keywords

Liver transplantation;, tacrolimus, multiple food allergy, child

References

• Legendre, C., Caillat-Zucman, S., Samuel, D., Morelon, S., Bismuth, H., Bach, J. F., & Kreis, H. Transfer of symptomatic peanut allergy to the recipient of a combined liver-and-kidney transplant. The New England journal of medicine, 1997;337(12), 822–824. https://doi.org/10.1056/NEJM19970918337120.
• Lacaille F, Laurent J, Bousquet J. Life-threatening food allergy in a child treated with FK506. J Pediatr Gastroenterol Nutr. 1997;25(2):228-229. doi:10.1097/00005176-199708000-00019.
• Boyle RJ, Hardikar W, Tang ML. The development of food allergy after liver transplantation. Liver Transpl. 2005;11(3):326-330. https://doi.org/10.1002/lt.20368.
• Frischmeyer-Guerrerio PA, Wisniewski J, Wood RA, Nowak-Wegrzyn A. Manifestations and long-term outcome of food allergy in children after solid organ transplantation. J Allergy Clin Immunol. 2008;122(5):1031-1033.e1. https://doi. org/10.1016/j.jaci.2008.08.032.
• Noble C, Peake J, Lewindon PJ. Increase in de novo allergies after pediatric liver transplantation: the Brisbane experience. Pediatr Transplant. 2011;15(5):451-454. https://doi. org/10.1111/j.1399-3046.2011.01486.x.
• Asante-Korang A, Boyle GJ, Webber SA, Miller SA, Fricker FJ. Experience of FK506 immune suppression in pediatric heart transplantation: a study of long-term adverse effects. J Heart Lung Transplant. 1996;15(4):415-422.
• Levy Y, Davidovits M, Cleper R, Shapiro R. New-onset post-transplantation food allergy in children--is it attributable only to the immunosuppressive protocol?. Pediatr Transplant. 2009;13(1):63-69. https://doi.org/10.1111/j.1399-3046.2007.00883.x.
• 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(4):379-384. https://doi.org/10.1111/j.1399-3046.2012.01684.x.
• Wisniewski J, Lieberman J, Nowak-Węgrzyn A, et al. De novo food sensitization and eosinophilic gastrointestinal disease in children post-liver transplantation. Clin Transplant. 2012;26(4):365-371. https://doi.org/10.1111 /j.1399-0012.2012.01670.
• Ozbek OY, Ozcay F, Avci Z, Haberal A, Haberal M. Food allergy after liver transplantation in children: a prospective study. Pediatr Allergy Immunol. 2009;20(8):741-747. https://doi. org/10.1111/j.1399-3038.2009.00867.x.
• Mavroudi A, Xinias I, Deligiannidis A, Parapanissiou E, Imvrios G. Long term outcome of acquired food allergy in pediatric liver recipients: a single center experience. Pediatr Rep. 2012;4(1):6. https://doi.org/10.4081/pr.2012.e6.