Bergamo Chiara, Argento Emily Claire, Giampetruzzi Stefania, Cutini Maristella, Ciabattoni Francesco, Faggian Giovanna, Gaio Paola, Bosa Luca, Cananzi Mara
Pediatric Residency Program, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy.
Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy.
Front Pediatr. 2022 May 12;10:885942. doi: 10.3389/fped.2022.885942. eCollection 2022.
Liver transplant (LT) recipients, particularly children, have an increased risk of developing food allergies (FAs) after transplantation both compared to all the other transplant groups and to the general population. Little is known about the pathogenesis underlying this phenomenon and comprehensive recommendations or clinical practice guidelines are still lacking, mainly due to the scarcity of high-quality evidence.
We aimed to prepare a systematic review on FA in pediatric LT recipients to assess epidemiology and risk factors, evaluate the correlation to specific food groups, describe clinical manifestations, investigate the rate of tolerance acquisition over time and report available therapeutic strategies.
We conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). MEDLINE, Scopus, Web of Science, Wiley online library, Cochrane Library, and ClinicalTrials.gov databases were systematically searched for studies published from January 1980 to September 2021. All the articles were checked independently by two reviewers in two steps. A total of 323 articles were screened, and 40 were included for data extraction.
We found that FAs develop in the 15% of pediatric LT recipients, especially in the first 2 years after surgery, with higher risk related to younger age at transplantation (especially <2 years of age) and tacrolimus immunosuppression. Subjects are often allergic to multiple foods, and 15% of them suffer from anaphylaxis. The majority of patients do not spontaneously outgrow their symptoms during follow-up. The discontinuation of tacrolimus in favor of cyclosporine or the association of tacrolimus with mycophenolate have been associated with the resolution or the improvement of FA in small retrospective case series and could be considered in case of severe or multiple, difficult to manage FAs. Prospective multicenter studies are needed to confirm these findings, guide the risk-based stratification of pediatric LT recipients, and provide for high-evidence therapeutic strategies for children with FA.
与所有其他移植组以及普通人群相比，肝移植（LT）受者，尤其是儿童，移植后发生食物过敏（FA）的风险增加。关于这一现象背后的发病机制知之甚少，主要由于高质量证据稀缺，全面的建议或临床实践指南仍然缺乏。
我们旨在对小儿肝移植受者的食物过敏进行系统评价，以评估流行病学和危险因素，评估与特定食物组的相关性，描述临床表现，调查随时间推移获得耐受的比率，并报告可用的治疗策略。
我们根据系统评价和Meta分析的首选报告项目（PRISMA）进行了这项系统评价。系统检索了MEDLINE、Scopus、科学网、Wiley在线图书馆、Cochrane图书馆和ClinicalTrials.gov数据库中1980年1月至2021年9月发表的研究。所有文章由两名审稿人分两步独立检查。共筛选了323篇文章，纳入40篇进行数据提取。
我们发现15%的小儿肝移植受者会发生食物过敏，尤其是在术后头2年，移植时年龄较小（尤其是<2岁）和使用他克莫司免疫抑制的风险更高。患者通常对多种食物过敏，其中15%患有过敏反应。大多数患者在随访期间症状不会自行消失。在小型回顾性病例系列中，停用他克莫司改用环孢素或他克莫司与霉酚酸联合使用与食物过敏的缓解或改善有关，对于严重或多种难以控制的食物过敏情况可考虑使用。需要进行前瞻性多中心研究来证实这些发现，指导小儿肝移植受者基于风险的分层，并为患有食物过敏的儿童提供高证据的治疗策略。
