Food Allergy in Pediatrics Liver Transplant Recipients

Prevalence of food allergy (FA) has been increasing in pediatrics liver transplants (LT) recipients. This study was aimed to identify relative risk factors and characterize the manifestations of food allergy in this special group. Medical records of pediatrics LT recipients from Jan 2001-Mar 2012 were reviewed. Food allergy was diagnosed from history of symptom and improvement after avoidance. Evidence of sensitization was confirmed by serum specific IgE or skin prick test. Among 46 patients, 25 (54.35%) patients had FA. Median follow up time post-LT was 2.42 (0.42, 11.58) year. FA developed at a median time 2 years post-LT (95%CI 1.25 to 4.33). Manifestations of FA were gastrointestinal symptoms (52%), urticaria/angioedema (32%), eczema (28%), anaphylaxis (8%), anemia (8%), stridor (8%). Fourteen patients (56%) had multiple food allergies. Causative foods were milk (52%), seafood (40%), egg (28%), wheat (28%), soybean (28%) peanut (28%), coconut milk (16%), fish (8%) and monosodium glutamate (4%). Incidence of FA was 33% at the first year post LT then decline to 17%, 10 % and 7% in the following year. Risk factors were aged less than 2 year at transplantation (Hazard ratio 2.62, 95%CI 1.04 to 6.59) and Epstein-Barr (EBV) viremia (Hazard ratio 2.39, 95%CI 1.02 to 5.63). However, neither donors nor recipients atopic status were significantly associated with the risk for developing food allergy. Food allergy after liver transplantation in pediatric patients is not uncommon. Age at transplantation less than 2 years and EBV viremia are risk factors for developing FA.