Transplant-Acquired Food Allergy Following Cord Blood Transplantation in Adult Patients

Background:The development of new food allergy after allogeneic hematopoietic stem cell transplantation (transplant-acquired food allergy: TAFA) has been sporadically reported. Most of such cases were considered as the passive transfer of food allergy through allogeneic hematopoietic stem cell transplantation (HSCT) from donors already allergic to specific allergens. Although cord blood donors are basically considered lacking the known food allergy, there have been some cases of TAFA following cord blood transplantation (CBT). Therefore, we have retrospectively evaluated the adult patients who developed food allergy after cord blood in a single institute.

Patients and methods:Among the patients who underwent CBT for hematological diseases at Keio University Hospital (Tokyo, Japan), patients survived longer than 30 days after CBT with donor cell engraftment were selected from the institutional database. Medical information about food allergy was retrospectively collected from the medical records of each patient.

Results:Of the 51 evaluable patients, 3 patients experienced episodes of new food allergy, in whom food allergy was definitely diagnosed based on the results of radioallergosorbent test and/or the retry test. The characteristics of three patients at transplant are as follows: Case 1, 55-year old male with myelodysplastic syndrome; Case 2, 57-year-old male with Sezary syndrome; Case 3, 19-year-old female with aplastic anemia. All patients received CBT following fludarabine-based reduced-intensity conditioning regimens and received cyclosporine A or tacrolimus with or without short-term methotrexate for graft-versus-host disease prophylaxis. At 10 months after CBT, Case 1 developed severe reactions after ingesting egg-containing meal, including skin rash, shortness of breath, and loss of consciousness. He was successfully treated with steroid and epinephrine. At 6 months after CBT, Case 2 repeatedly experienced the episodes of severe reactions after ingesting buckwheat noodle, including fever, diarrhea, vomiting, and hypotension. He was successfully treated with massive hydration. At 5 months after CBT, Case 3 repeatedly experienced gastrointestinal symptoms such as vomiting and diarrhea after ingesting egg-containing food. At each episode, she recovered without any interventions.

Conclusion: Although the incidence is low, acquisition of new food allergy has been observed within one year after CBT. By accumulating the cases, the epidemiology and clinical feature of TAFA following CBT should be further evaluated.