Risk factors and evolution of IgE-mediated food allergies before and after liver transplantation in a French pediatric cohort

Introduction. - After liver transplantation (LT), children treated with tacrolimus may develop IgE-mediated food allergy (IMFA). Method. - LT children were referred by hepatologists to an allergist for suspected IMFA. An allergological evaluation before and after LT was performed. The results of the data were compared. Results. - The cohort included 30 children with a mean age of 2.8 years, all treated with basiliximab and tacrolimus combo in post-LT. For 10 children, the clinical history and/or skin and biological tests and/or oral challenge test could rule out the diagnosis of IMFA. The diagnosis of IMFA was confirmed in 20 children (67%), of whom 70% (n = 14) had familial atopy. Thirteen children were switched from tacrolimus to cyclosporine, of whom 3 were cured and 6 had persistent allergy. Children with post-LT sensitization presented IMFA (n = 13, 76%) of which 54% (n = 7) healed spontaneously. Children with pre and post-LT sensitization had IMFA in 63% (n = 7). Only 29% of them (n = 2) recovered. For 71% (n = 5) of them, the allergy persisted. The most frequently incriminated food allergens were, in decreasing order, peas, fish, lentils, peanuts and eggs. Conclusion. - Children sensitized in pre-and post-LT settings have mostly persistent IMFA, whereas those with sensitization that appeared in post-LT tend to become tolerant spontaneously. Long-term follow-up in collaboration between hepatologist and allergist is essential. (c) 2021 Elsevier Masson SAS. All rights reserved.