Bellou A, Kanny G, Fremont S, Moneret-Vautrin D A
Department of Internal Medicine, Clinical Immunology, Allergology, University Hospital and Medical Center, Nancy, France.
Ann Allergy Asthma Immunol. 1997 May;78(5):513-6. doi: 10.1016/s1081-1206(10)63240-1.
Bone marrow transplantation is an optimal treatment of acute leukemia and aplastic anemia. Allergic manifestations in recipients long after bone marrow transplantation have been reported. A case involving transfer of atopy manifested as food allergy-induced-atopic dermatitis is reported.
The donor and the patient were investigated by prick tests and RAST to the same food allergens. Single blind, oral challenge to egg documented food allergy in the recipient.
A 5-year-old boy without history of atopy developed severe atopic dermatitis after bone marrow transplantation from his HLA-identical sister for acute lymphoblastic leukemia. The patient's course had been marked previously by acute graft versus host disease and cytomegalovirus infection. Immunoallergic evaluation showed an exquisite sensitization to egg, peanut, and soybean. Total IgE was 6400 KIU/L. Concomitantly, the donor showed the same sensitizations. Absolute avoidance resulted in the regression of atopic dermatitis. Subsequently, new sensitization to wheat flour, Dermatophagoides pteronyssinus, birch, and plantain pollens was detected. The donor developed asthma.
This case gives evidence of the transfer of sensitization from donor to recipient. The passive transfer of memory cells within the bone marrow inoculum is a possible mechanism. The current concept of allergy supports down regulation of Th1 cells to the benefit of Th2 cells. Additional deregulation induced by acute graft versus host disease, cytomegalovirus infection, and immunosuppression is possible.
骨髓移植是急性白血病和再生障碍性贫血的最佳治疗方法。已有报道称骨髓移植受者在术后很长时间出现过敏表现。本文报道了一例因特应性转移导致食物过敏诱发特应性皮炎的病例。
对供者和患者进行相同食物过敏原的点刺试验和放射性变应原吸附试验。采用单盲法口服鸡蛋激发试验证实受者存在食物过敏。
一名5岁男孩，既往无特应性病史，在接受与其HLA配型相合的姐姐的骨髓移植治疗急性淋巴细胞白血病后，发生了严重的特应性皮炎。该患者病程中曾有急性移植物抗宿主病和巨细胞病毒感染。免疫过敏评估显示其对鸡蛋、花生和大豆高度敏感。总IgE为6400 KIU/L。同时，供者也表现出相同的过敏反应。完全避免接触过敏原后，特应性皮炎消退。随后，检测到患者对小麦粉、粉尘螨、桦树和车前草花粉出现新的过敏反应。供者出现了哮喘。
该病例证明了致敏反应从供者转移至受者。骨髓接种物中记忆细胞的被动转移是一种可能的机制。当前的过敏概念支持Th1细胞下调以利于Th2细胞。急性移植物抗宿主病、巨细胞病毒感染和免疫抑制可能导致进一步的调节异常。
