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Canadian Respiratory Journal
Volume 18, Issue 3, Pages 154-156
http://dx.doi.org/10.1155/2011/768750
Case Report

Development of Transient Peanut Allergy Following Lung Transplantation: A Case Report

Sacha Bhinder, Matthew J Heffer, Jason K Lee, Cecilia Chaparro, and Susan M Tarlo

Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

Copyright © 2011 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 47-year-old woman underwent bilateral lung transplantation for nonspecific interstitial pneumonitis and received donor lungs from a 12-year-old patient with a known peanut allergy. Post-transplant, the patient experienced four anaphylaxis-like reactions. A skin prick test to peanut was initially positive; however, it steadily declined over serial assessments and reverted to negative one year post-transplant. The patient subsequently had a negative oral peanut challenge. Transfer of food allergy post-transplantation is theorized to occur via transfer of donor B lymphocytes producing peanut-specific immunoglobulin E into the circulation of the recipient. An alternate mechanism proposes passive transfer of immunoglobulin E-sensitized mast cells and/or basophils within the transplanted tissue that subsequently migrate into recipient tissues. The gradual decline in the magnitude of the peanut skin prick test and its return to negative over the course of one year supports the gradual depletion of sensitized cells in the recipient (B lymphocytes and, possibly, mast cells), and supports the initial passive transfer of sensitized cells from donor tissue during transplantation. This should be considered when donor organs are obtained from allergic individuals.