Question

Transfer of symptomatic peanut allergy to the recipient of a combined liver and kidney transplant

Director of Grants and Research at (Hospital name), would like to acknowledge Dr. Christophe Legendre and his team of doctors for their work on identifying the causative agent of a symptomatic peanut allergy acquired by a 35-year-old male recipient of a combined liver-and-kidney transplant.

Peanuts are one of the most common causes of food allergy in the United States and Europe. They are also a leading cause of food-induced anaphylaxis and death, which usually follow inadvertent

exposures. Allergy to peanuts is an IgE-mediated, mast-cell-dependent,

immediate-hypersensitivity reaction. There are numerous reports of

the transfer of allergen-specific IgE-mediated hypersensitivity by bone marrow transplantation. We report a case of peanut allergy transmitted through combined liver-and-kidney transplantation.

A 22-year-old man with a history of allergic reactions to peanuts was admitted to our hospital in a coma. After inadvertently ingesting satay sauce, which contains peanuts, during a Chinese meal, he had become unwell and had had a cardiorespiratory arrest that resulted in cerebral anoxia, coma, and brain death. A high level of peanut-specific IgE was detected in his serum ... multiple organs were subsequently procured. The donor’s HLA phenotype was A1,24;B8,44;DRB1*03,13.

...the donor’s liver and right kidney were given in transplantation to a 35-year-old man, and the left kidney and pancreas were given to a 27-year-old woman. The man (HLA phenotype, A2,19;B12,-;DRB1*07,13) had end-stage renal failure.... The woman (HLA phenotype, A1,24;B8,44;DRB1*03,04) had chronic renal failure....

Both transplant recipients received immunosuppressive induction therapy with muromonab-CD3 (OKT3) and corticosteroids, azathioprine, and cyclosporine. Neither had ever had any allergy to peanuts.

Three months after transplantation, the recipient of the liver-kidney transplant reported a skin rash and laryngeal dyspnea after eating peanuts. Allergy to peanuts was diagnosed on the basis of the clinical findings; the absence of specific IgE antibodies before transplantation, their presence at the time the symptoms appeared, and their decline thereafter; and a positive basophil degranulation test.

Questions

Alexander Kolineski, 22-year-old male organ donor.

D1. Review the records for Mr. Kolineski and summarize the evidence to suggest that death was caused by anaphylaxis.

D2. Without reviewing the records from the other patients, can you positively identify the causative agent for this patient’s anaphylaxis? Why or why not?

Jonathan Forken, 35-year-old male recipient of a liver and right kidney from Mr. Kolineski.

D3. Review the records for Mr. Forken and summarize the evidence to suggest that Mr. Forken was having a peanut- specific hypersensitivity reaction.

Melissa Jachowiz, 27-year-old female recipient of a pancreas and left kidney from Mr. Kolineski.

D4. Review the records of Mrs. Jachowiz and summarize the evidence to support the fact that she did not obtain a peanut-specific hypersensitivity from her transplant

Answer 1

Question 1: Review the records for Mr. Kolineski and summarize the evidence to suggest that death was caused by anaphylaxis.

Answer 1: Patient’s medical history suggested that he was allergic to peanuts and he consumed a meal that contained peanuts. Additionally, presence of high level of peanut-specific IgE and his symptoms confirmed that cause of death was anaphylaxis.

Q 2: Without reviewing the records from the other patients, can you positively identify the causative agent for this patient’s anaphylaxis? Why or why not?

Answer 2: yes, causative agent for this patient’s anaphylaxis can be identified because the patient had presence of high level of peanut-specific IgE detected in serum by blood tests.

Q 3. Review the records for Mr. Forken and summarize the evidence to suggest that Mr. Forken was having a peanut- specific hypersensitivity reaction.

Answer 3: It was reported that 3 months after transplant patient had a skin rash and laryngeal dyspnea after eating peanuts which was confirmed clinically by detection of peanut-specific IgE in serum and positive basophil degranulation test.

Q4. Review the records of Mrs. Jachowiz and summarize the evidence to support the fact that she did not obtain a peanut-specific hypersensitivity from her transplant

Answer 4: There was nothing mentioned about detecting a peanut-specific hypersensitivity in Mrs. Jachowiz in the summary provided. It is also possible that Mr. Forken developed peanut allergy via liver transplant as both of them received kidneys from Mr. Kolineski.