University Health Network, Toronto Western Hospital, Ontario.
Can Respir J. 2011 May-Jun;18(3):154-6. doi: 10.1155/2011/768750.
A 47-year-old woman underwent bilateral lung transplantation for nonspecific interstitial pneumonitis and received donor lungs from a 12-year-old patient with a known peanut allergy. Post-transplant, the patient experienced four anaphylaxis-like reactions. A skin prick test to peanut was initially positive; however, it steadily declined over serial assessments and reverted to negative one year post-transplant. The patient subsequently had a negative oral peanut challenge. Transfer of food allergy post-transplantation is theorized to occur via transfer of donor B lymphocytes producing peanut-specific immunoglobulin E into the circulation of the recipient. An alternate mechanism proposes passive transfer of immunoglobulin E-sensitized mast cells and⁄or basophils within the transplanted tissue that subsequently migrate into recipient tissues. The gradual decline in the magnitude of the peanut skin prick test and its return to negative over the course of one year supports the gradual depletion of sensitized cells in the recipient (B lymphocytes and, possibly, mast cells), and supports the initial passive transfer of sensitized cells from donor tissue during transplantation. This should be considered when donor organs are obtained from allergic individuals.
一位 47 岁女性因非特异性间质性肺炎接受了双侧肺移植，并接受了一名已知对花生过敏的 12 岁患者的供肺。移植后，该患者经历了四次类似过敏反应的症状。起初，花生皮试呈阳性；然而，在连续评估中，它逐渐下降，并在移植后一年转为阴性。随后，该患者进行了口服花生挑战测试，结果为阴性。据推测，移植后食物过敏的转移是通过将产生花生特异性免疫球蛋白 E 的供体 B 淋巴细胞转移到受体循环中发生的。另一种机制提出，在移植组织内，致敏的免疫球蛋白 E 敏感的肥大细胞和/或嗜碱性粒细胞通过被动转移，并随后迁移到受体内的组织中。花生皮试的大小逐渐下降，并在一年的时间内恢复阴性，这支持了受体内致敏细胞（B 淋巴细胞，可能还有肥大细胞）的逐渐耗竭，并支持了移植期间供体组织中致敏细胞的初始被动转移。在从过敏个体获得供体器官时，应考虑这一点。
