Nut Allergy Passed on from the Grave

Man gets life-threatening reaction from donated liver

TUESDAY, Jan. 28, 2003 (HealthDayNews) -- A 60-year-old man who received a liver transplant from a 15-year-old donor with undiagnosed allergies to nuts also got a life-threatening nut allergy, Australian researchers say.

Less than a month after the man got the liver from the teen boy, who had died after a fatal reaction to peanuts, the recipient had a serious but not fatal reaction to cashews although he had never had a problem before the transplant, the researchers report in the Jan. 27 issue of the Archives of Internal Medicine.

While the possibility of getting such an allergy from an organ donor is rare, Dr. Tri Giang Phan, an immunology expert at Royal Prince Alfred Hospital in Sydney, says the report should spark vigilance in the transplant community.

He thinks it is only the second such reported case of allergies passed via solid organ transplants, the first reported by French doctors six years ago. His team is evaluating the possibility in a third patient.

The two cases so far reported both involve livers, Phan says. Transfer of an allergy has also been reported for bone marrow transplants, he says, but the mechanism is probably different.

Exactly how the allergy was passed to the recipient, who had hepatitis B and cirrhosis of the liver, is not known, Phan says, but it's probable that the transplanted liver contained antibodies to allergens -- in this case nuts -- that sparked the reaction. When tests were done after the reaction, both donor and recipient had antibodies to the same three allergens -- peanut, cashew, and sesame seed.

When the researchers checked with the other recipients who got the teen's heart, kidney, and pancreas, they had reported no allergies to nuts after their procedures.

Organ donors should undergo allergy screening, and recipients should be advised to avoid certain allergens, if their donor was allergic, Phan says.

"Screening donors for allergies is simple and involves history-taking, examination of the medical records, and a blood test," Phan says. "It is inexpensive and cost-effective, partly as it will prevent potentially life-threatening reactions."

In the United States, an organ transplant procurement team already routinely asks the donor family questions about allergies, says Anne Paschke, a spokeswoman for the United Network for Organ Sharing, an organization that manages the transplant system under a contract with the federal government.

She puts the risk in some perspective. "There have been more than 55,000 liver transplants since we started keeping records in 1988, and this is the second case [of allergy transfer] that we are aware of."

Currently, if the donor family tells the procurement team about a history of allergy, Paschke says, that information is given to the transplant team caring for the recipient. "Based on all the information, they decide whether to accept the transplant."

An estimated 6 million Americans suffer from true food allergies, according to the Food Allergy & Anaphylaxis Network, with nuts among the top eight foods causing 90 percent of the allergies.

Another expert agrees that the Australian report should spark more awareness.

"While this still seems to be a relatively uncommon problem, it is certainly a potentially dangerous one that warrants consideration and investigation," says Dr. Scott H. Sicherer, assistant professor of pediatrics at the Jaffe Food Allergy Institute at the Mount Sinai School of Medicine in New York.

More information

For a history of organ transplantation, go to the United Network for Organ Sharing. For details on common food allergies, see the Food Allergy & Anaphylaxis Network.

SOURCES: Tri Giang Phan, M.B.B.S., F.R.A.C.P., R.R.C.P.A., department of clinical immunology, Royal Prince Alfred Hospital, Sydney, Australia; Scott H. Sicherer, M.D., assistant professor of pediatrics, Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York City; Anne Paschke, spokeswoman, United Network for Organ Sharing, Richmond, Va.; Food Allergy & Anaphylaxis Network; Jan. 27, 2003, Archives of Internal Medicine
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