Fellow-Allergy-Immunology, Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
Assistant Professor of Medicine, Division of Pulmonary,Allergy, and Critical Care, Department of Medicine, Associate Program Director-Allergy-Immunology Fellowship, University of Pittsburgh Medical Center, Pittsburgh, PA.
Yale J Biol Med. 2020 Dec 29;93(5):679-683. eCollection 2020 Dec.
: Transplant-acquired food allergy has become increasingly recognized in solid organ and bone marrow transplantation. As food allergy has no cure and causes considerable impact on the lives of patients who require strict avoidance of foods to avoid potentially severe or fatal reactions, it is crucial for physicians to better understand the risk factors and mechanisms driving development of food allergy post-transplant. We report a case of new food allergy to whitefish in an elderly patient post-bone marrow transplant in which neither donor nor recipient had a history of atopy. : A 70-year-old man experienced an anaphylactic reaction to Swai whitefish () 6 months post-transplant that he had previously tolerated on multiple occasions both pre-transplant and in the preceding months post-transplant. This allergy was investigated by commercial serum specific IgE testing and fresh prick-to-prick skin test to Swai whitefish. : Fresh prick-to-prick demonstrated large positive reaction to the Swai whitefish with wheal of 10 mm and flare of 22 mm compared to positive histamine control with a wheal/flare of 5x8mm. Serum specific IgE testing to commercial whitefish was negative (specific IgE <0.10kU/L). The patient continues to strictly avoid Swai whitefish but tolerates all other fish and shellfish. : The unique development of specific Swai whitefish allergy in an elderly man after bone marrow transplant where both donor and recipient had no prior history of atopy strongly supports transplant-related immunomodulation as a major mechanism for transplant-acquired allergy and suggests that that absence of atopy or advanced age may not necessarily be protective.
移植后获得性食物过敏在实体器官和骨髓移植中越来越受到认识。由于食物过敏无法治愈，并且会对需要严格避免食用食物以避免潜在严重或致命反应的患者的生活造成重大影响，因此医生必须更好地了解导致移植后发生食物过敏的危险因素和机制。我们报告了一例老年骨髓移植后对白鱼的新食物过敏病例，供者和受者均无特应性病史。
一名 70 岁男性在骨髓移植后 6 个月发生了对 Swai 白鱼（）的过敏反应，他此前曾在移植前和移植后几个月多次耐受过这种鱼。通过商业血清特异性 IgE 检测和新鲜点刺皮肤试验对白鱼进行了过敏调查。
新鲜点刺显示对白鱼有大的阳性反应，风团为 10mm，红晕为 22mm，而阳性组胺对照的风团/红晕为 5x8mm。对商业白鱼的血清特异性 IgE 检测为阴性（特异性 IgE<0.10kU/L）。患者继续严格避免食用 Swai 白鱼，但可耐受所有其他鱼类和贝类。
在骨髓移植后，一名老年男性独特地发展为特定的 Swai 白鱼过敏，供者和受者均无特应性病史，这强烈支持移植相关免疫调节是移植后获得性过敏的主要机制，并表明特应性或高龄不一定具有保护作用。
