DEVELOPMENT OF PEANUT IGE-MEDIATED ALLERGY FOLLOWING ALLOGENIC BONE MARROW TRANSPLANT

Abstract

Introduction We describe an adult case of peanut-induced anaphylaxis following allogenic bone marrow transplantation. This case identifies a potential risk of conferring IgE-mediated food allergy with transplantation and the need for screening donors as well as monitoring recipients whose donors have known IgE-mediated food allergies. Case Description A 27-year-old female with a history of acute lymphoblastic leukemia underwent an allogenic bone marrow transplant. She had no history of atopic disease prior to transplantation. After transplantation, within 30 minutes of ingesting a peanut butter sandwich, she developed throat tightness and swelling followed by emesis. She avoided peanut ingestion until day 60 post-transplant when she ingested a Reese's® Peanut Butter Cup. Within minutes she developed throat tightness, emesis, and swelling. Her peanut serum specific IgE level to peanut was 27.70 kU/L, class IV. She declined skin testing to peanut. Her Hematologist was informed that the patient's donor indeed had a peanut allergy. Discussion There are published case reports of transferring food allergy between bone marrow transplant and solid organ donors and recipients. Additionally, there is a report of resolution of peanut allergy after a peanut allergic recipient receives a non-peanut allergic donor for bone marrow transplant. Several mechanisms have been proposed to explain this phenomenon including transfer of allergen-specific lymphocytes. In addition, medication therapy pre- and post-transplantation may correlate with increased risk. Given the increased prevalence of food allergies and the risk of severe reactions associated with transfer of IgE mediated food allergy, we concur with previous authors regarding evaluating transplant recipients for known donor allergies.