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New-onset food allergy following cord blood transplantation in adult patients

Bone Marrow Transplantation volume 51, pages 295–296 (2016)Cite this article

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New-onset food allergy has been recognized as one of the complications after liver transplantation, especially in pediatric patients, which was closely associated with tacrolimus administration in several studies.1, 2, 3, 4 One prospective study reported that 21% of pediatric patients receiving liver transplantation developed new-onset food allergy.4 In contrast to the extensive investigation of food allergy after liver transplantation, food allergy after hematopoietic stem cell transplantation has not been fully evaluated. In bone marrow or peripheral blood stem cell transplantation, allergic disease can be transferred from donors.5 However, cord blood donors are considered free from allergic disease, and the development of food allergy in cord blood transplantation (CBT) recipients is probably due to the dysregulated immune reconstitution. Recently, sporadic cases of new-onset food allergy after CBT have been reported, including five pediatric and two adult patients.6, 7, 8 To elucidate its incidence and clinical features, we retrospectively evaluated patients who developed new-onset food allergy after CBT.

This is a single-institutional retrospective study using the institutional database and medical records of adult patients who underwent CBT for hematological disorders between October 2001 and June 2014 at Keio University Hospital (Tokyo, Japan). This retrospective study was approved by the Ethical Committee of Keio University School of Medicine. After excluding three cases of graft rejection, one case of autologous bone marrow recovery and three cases of insufficient data, 51 patients (male, 31; female, 20) who achieved donor cell myeloid engraftment and survived longer than 30 days after CBT were selected and enrolled into the analysis. Median age of the patients at transplantation was 49 years (range, 18–64), and median follow-up time was 16.9 months (range, 1.4–149.7). Underlying diseases were hematological malignancies, except in one patient with aplastic anemia. The GvHD prophylaxis was cyclosporine A (CsA)-based in 25 patients and tacrolimus-based in 26. Raw foods were avoided during the neutropenic period after transplantation, and grapefruit was avoided until calcineurin inhibitors were discontinued. A diagnosis of food allergy was made on the basis of the clinical presentations repeatedly observed after the oral intake of a specific food, and on the basis of the positive results of the oral food challenge and/or radioallergosorbent tests for specific IgE against the allergens. The probability of food allergy was estimated on the basis of cumulative incidence curves to accommodate deaths due to any causes and the second hematopoietic stem cell transplantation as the competing event. Analyses were performed with EZR, a graphical user interface for R.9

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Acknowledgements

The authors are indebted to Yuri Niizuma for her skillful data management and to Satomi Yamanaka for her excellent care of patients and their family members.

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    T Mori, J Kato, M Sakurai, N Hashimoto, S Kohashi, R Hashida, M Saburi, T Kikuchi, Y Yamane & S Okamoto

  2. Department of Medical Oncology and Hematology, Oita University Faculty of Medicine, Oita, Japan

    M Saburi

  3. Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan

    K Hoshino

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  1. T Mori
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Correspondence to T Mori.

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Mori, T., Kato, J., Sakurai, M. et al. New-onset food allergy following cord blood transplantation in adult patients. Bone Marrow Transplant 51, 295–296 (2016). https://doi.org/10.1038/bmt.2015.243

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