NON-TRANSFERENCE OF FOOD ALLERGY AND FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME (FPIES) AFTER BONE MARROW TRANSPLANT

Abstract

Introduction Transfer of food allergy after bone marrow and solid organ transplant are well described in literature. Here we report a case of non-transference of IgE mediated food allergy (peanut) and Food Protein-Induced Enterocolitis Syndrome (FPIES) (egg) following related donor bone marrow transplant. Case Description The donor is a 3 year-old female who initially presented with typical symptoms of egg related FPIES at 9 months of age. Subsequently was found to be sensitized to peanut (IgE 0.34 kUA/L). She initially passed peanut challenge, but peanut was never introduced. She lost tolerance and developed IgE mediated allergy to peanuts. Peanut allergy was confirmed upon challenge at 2 years of age. She has since avoided peanuts. She continues to have FPIES to egg. Her most recent FPIES reaction following accidental ingestion of egg and requiring fluid resuscitation was at 2 years of age. During this time, she served as a related bone marrow donor for her sibling. Even after withdrawal of the majority of immunosuppression and immune reconstitution with the donor bone marrow the sibling continues to tolerate both egg and peanut. Discussion Though transfer of food allergy has been reported following bone marrow transplant. This is the first case where transfer of FPIES has been a concern. This case is also unique because both FPIES and anaphylactic food allergy co-existed in the donor. Allergy in the donor was documented before and after transplant and likewise tolerance was documented in the recipient pre and post-transplant.