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Post-transplant food allergy development and chronic diarrhea in pediatric patient taking tacrolimus as major immunosuppressant
S152 Abstracts
J ALLERGY CLIN IMMUNOL FEBRUARY 2004
idazole for two weeks gave no relief. Liver enzymes were normal, urine SG 1.025 to 1.030 and elevated Tacrolimus level (21.5 Ng/ml). Gastrointestinal biopsies found eosinophilic infiltration of the entire mucosae. Stool examinations for bacteria, viruses, ova, and parasites were negative. Cytomegalovirus, Clostidium difficile, Adenovirus, Rotavirus, Giardia and Helicobacter pylori were negative. In vitro IgE antibodies revealed sensitizations to egg white and peanuts with Peripheral eosinophilia at 10%. RESULTS: The patient ate regular table food, eliminating eggs and peanuts, and is diarrhea free without changing the tacrolimus, MMf or steroid treatment. Tacrolimus levels at discharge were 12.8Ng/ml. CONCLUSIONS: Tacrolimus in post-organ transplant patients increases gut permeability impairing intestinal barriers against uptake of antigens and risks developing food hypersensitivity which should be suspected in patients on immunosuppressive drugs. Proper diagnosis of this condition can lead to appropriate treatment and cure of the diarrhea. Funding: Self-funded
SUNDAY 508
Post-Transplant Food Allergy Development and Chronic Diarrhea in Pediatric Patient Taking Tacrolimus as Major Immunosuppressant
A. A. Arrey-Mensah, A. A. Arrey-Mensah, R. U. Sorensen; Pediatrics, LSUHSC, New Orleans, LA. RATIONALE: Complications of solid organ transplantation include chronic diarrhea. The pathogenesis is often unknown, but the development of food hypersensitivity is implicated in some patients taking Tacrolimus. METHODS: A 2-year-old Caucasian female with Argininosuccinic aciduria, post-liver transplant from a related non-food allergic living donor, was referred for evaluation. Treated with Tacrolimus, mycophenolate mofetil and Prednisone she developed chronic non-mucoid, nonbloody diarrhea, five months post-transplant. Dietary restrictions allowed chicken, rice, peanuts and fruits but did not relieve the diarrhea. Metron-
J ALLERGY CLIN IMMUNOL FEBRUARY 2004
idazole for two weeks gave no relief. Liver enzymes were normal, urine SG 1.025 to 1.030 and elevated Tacrolimus level (21.5 Ng/ml). Gastrointestinal biopsies found eosinophilic infiltration of the entire mucosae. Stool examinations for bacteria, viruses, ova, and parasites were negative. Cytomegalovirus, Clostidium difficile, Adenovirus, Rotavirus, Giardia and Helicobacter pylori were negative. In vitro IgE antibodies revealed sensitizations to egg white and peanuts with Peripheral eosinophilia at 10%. RESULTS: The patient ate regular table food, eliminating eggs and peanuts, and is diarrhea free without changing the tacrolimus, MMf or steroid treatment. Tacrolimus levels at discharge were 12.8Ng/ml. CONCLUSIONS: Tacrolimus in post-organ transplant patients increases gut permeability impairing intestinal barriers against uptake of antigens and risks developing food hypersensitivity which should be suspected in patients on immunosuppressive drugs. Proper diagnosis of this condition can lead to appropriate treatment and cure of the diarrhea. Funding: Self-funded
SUNDAY 508
Post-Transplant Food Allergy Development and Chronic Diarrhea in Pediatric Patient Taking Tacrolimus as Major Immunosuppressant
A. A. Arrey-Mensah, A. A. Arrey-Mensah, R. U. Sorensen; Pediatrics, LSUHSC, New Orleans, LA. RATIONALE: Complications of solid organ transplantation include chronic diarrhea. The pathogenesis is often unknown, but the development of food hypersensitivity is implicated in some patients taking Tacrolimus. METHODS: A 2-year-old Caucasian female with Argininosuccinic aciduria, post-liver transplant from a related non-food allergic living donor, was referred for evaluation. Treated with Tacrolimus, mycophenolate mofetil and Prednisone she developed chronic non-mucoid, nonbloody diarrhea, five months post-transplant. Dietary restrictions allowed chicken, rice, peanuts and fruits but did not relieve the diarrhea. Metron-