INTRODUCTION:Peanuts are one of the most common food allergens and leading cause of food related anaphylaxis and death. Peanut allergy is an immediate-hypersensitivity reaction mediated by IgE. There are reported cases of transfer of allergen-specific IgE-mediated hypersensitivity in bone marrow and liver transplant recepients. We report this case of peanut allergy transfer in a lung transplant recepient.
CASE PRESENTATION:A 42 year old female with history of sarcoidosis underwent a successful bilateral lung transplant. The donor lungs were from a twelve year old who died from anaphylactic shock related to peanut allergy. Seven months later, the lung recipient ate a peanut butter cookie at a transplant support group. Immediately after, she became very short of breath with significant wheezing. She had lip swelling and a diffuse rash. On examination, she was in respiratory distress, hypoxic, and flushed. She was treated with oxygen, albuterol nebulization, IV methylprednisolone and diphenhydramine. During subsequent follow-up, she could recall three prior episodes of wheezing and mild difficulty breathing after eating peanut related foods. The first episode was four days after the transplant. Prior to her transplant, she never had any problem eating peanuts. She underwent skin testing with various nuts and foods and was positive for allergic reaction to peanuts only. The patient totally avoided peanuts and after about four years from the anaphylactic episode, she again underwent skin testing to peanuts which was negative along with a negative serum peanut IgE.
DISCUSSIONS:To our knowledge, this may be the first reported case of peanut allergy transfer after a lung transplant with only other case documented in a liver transplant recipient. The mechanism for sensitization is unclear. The transfer of IgE on sensitized mast cells from the donor lung is the most likely explanation, which from lack of re-exposure probably dissipated with time. Another potential mechanism is the transfer of peanut specific IgE-producing B cells or sensitized Th2 lymphocytes.
CONCLUSION:This case emphasizes the importance of testing for donor specific allergies when caring for lung transplant recipients in order to avoid a life threatening event.
DISCLOSURE:Imran Khalid, No Financial Disclosure Information; No Product/Research Disclosure Information