Tacrolimus immunosuppression - An association with asymptomatic eosinophilia and elevated total and specific IgE levels

被引:62
作者
Granot, E.
Yakobovich, E.
Bardenstein, R.
机构
[1] Kaplan Med Ctr, Dept Pediat, Div Pediat, Pediat Liver Unit, Rehovot, Israel
[2] Hebrew Univ Jerusalem, Hadassah Med Sch, IL-91010 Jerusalem, Israel
[3] Kaplan Med Ctr, Immunol Lab, Rehovot, Israel
关键词
liver transplant; tacrolimus; eosinophilia; IgE;
D O I
10.1111/j.1399-3046.2006.00542.x
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
De novo development of food allergy is an infrequent but potentially serious complication of transplantation. An increased prevalence of food allergy noted specifically in children receiving tacrolimus immunosuppression supports the hypothesis that selective suppression of Th1 lymphocytes by the IL-2 inhibitor immunosuppressants CsA, and the more potent drug, tacrolimus , promotes Th2 lymphocytes and an allergic immune response. This study was undertaken to characterize the IgE-mediated immune response, in CsA and tacrolimus-treated, post-OLT children. Thirty children and adolescents aged 1.9-21 yr, mean: 10.6 yr, (6.4 yr post-tx.) were studied. Immunosuppression-CsA: 10 patients, tacrolimus; 20 patients. Blood eosinophils, total IgE levels and specific IgE antibodies (Immulite 2000 Allergy; Diagnostic Products Corp., Los Angeles, CA, USA) to a panel of food and inhaled allergens were measured and correlated with clinical symptoms of allergy. Eosinophilia (> 500/mm(3)) range: 599-3125, mean: 1294, was present in 10/20 of patients treated with tacrolimus and 1/10 treated with CsA. IgE levels were elevated in eight of these 10 tacrolimus-treated patients and in two CsA patients ; five were < 3 yr of age and IgE levels ranged from 54 to 111 IU/mL (mean: 83), normal for age < 45 IU/mL and five were >= 9 yr and IgE levels ranged from 134 to 1606 IU/mL (mean: 557), normal for age < 87 IU/mL. Specific IgE levels to a wide panel of food allergens were positive in five tacrolimus-treated patients and to both food and inhaled allergens in three patients (two tacrolimus-treated, one CsA). Four children (tacrolimus-treated) had symptoms of food allergy . None had a family history of allergy. Eosinophilia is present in up to 50% of children and adolescents receiving tacrolimus immunosuppression. The majority of these patients also have elevated levels of total and specific (mainly to food allergens) IgE antibodies. Most patients are asymptomatic and do not manifest food allergy or asthma.
引用
收藏
页码:690 / 693
页数:4
相关论文
共 11 条
[1]   Allergic disease after pediatric liver transplantation with systemic tacrolimus and cyclosporine a therapy [J].
Arikan, C ;
Kilic, M ;
Tokat, Y ;
Aydogdu, S .
TRANSPLANTATION PROCEEDINGS, 2003, 35 (08) :3039-3041
[2]  
AsanteKorang A, 1996, J HEART LUNG TRANSPL, V15, P415
[3]   Applications and limitations of blood eosinophilia for the diagnosis of acute cellular rejection in liver transplantation [J].
Barnes, EJ ;
Abdel-Rehim, MM ;
Goulis, Y ;
Abou Ragab, M ;
Davies, S ;
Dhillon, A ;
Davidson, B ;
Rolles, K ;
Burroughs, A .
AMERICAN JOURNAL OF TRANSPLANTATION, 2003, 3 (04) :432-438
[4]   Transfer of atopy following bone marrow transplantation [J].
Bellou, A ;
Kanny, G ;
Fremont, S ;
MoneretVautrin, DA .
ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY, 1997, 78 (05) :513-516
[5]  
Castells M, 1998, NEW ENGL J MED, V338, P202
[6]   De Novo food allergy after intestinal transplantation: A report of three cases [J].
Chehade, M ;
Nowak-Wegrzyn, A ;
Kaufman, SS ;
Fishbein, TM ;
Tschernia, A ;
LeLeiko, NS .
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, 2004, 38 (05) :545-547
[7]   The effect of tacrolimus (FK506) on intestinal barrier function and cellular energy production in humans [J].
Gabe, SM ;
Bjarnason, I ;
Tolou-Ghamari, Z ;
Tredger, JM ;
Johnson, PG ;
Barclay, GR ;
Williams, R ;
Silk, DBA .
GASTROENTEROLOGY, 1998, 115 (01) :67-74
[8]   Life-threatening food allergy in a child treated with FK506 [J].
Lacaille, F ;
Laurent, J ;
Bousquet, J .
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, 1997, 25 (02) :228-229
[9]   Transfer of symptomatic peanut allergy to the recipient of a combined liver-and-kidney transplant [J].
Legendre, C ;
CaillatZucman, S ;
Samuel, D ;
Morelon, S ;
Bismuth, H ;
Bach, JF ;
Kreis, H .
NEW ENGLAND JOURNAL OF MEDICINE, 1997, 337 (12) :822-824
[10]   Angioedema in pediatric liver transplant recipients under tacrolimus immunosuppression [J].
Lykavieris, P ;
Frauger, E ;
Habes, D ;
Bernard, O ;
Debray, D .
TRANSPLANTATION, 2003, 75 (01) :152-155