Introduction: Adoptive transfer of food allergy by transplanted organs has been reported after most solid organ transplants. Here we describe two cases of multivisceral transplantation where the recipients acquired the food allergies of their donor.

Methods: Case note review

Results: Case 1 – A 62 year old male with cirrhosis secondary to NASH was dependent on parenteral nutrition for two years prior to decompensation following small bowel resection for intestinal obstruction. The donor was a young adult female with food allergies to peanut, shellfish and baked beans who died of anaphylaxis after eating a cereal bar. Intestine, liver, pancreas and colon were transplanted . The donor serum demonstrated a total IgE of 1059 u/l, and specific IgE positivity to peanut (32.6kua/l), Ara h1, h2 and h3. Following transplant the recipient avoided all nuts, shellfish and baked beans for 6 months. Specific IgE was positive to peanut and ara h1-3 but became negative after one month, and negative to shellfish and tree nuts. Skin prick tests were positive to peanut and grass pollen but negative to other allergens which were subsequently re-introduced. Skin prick positivity to peanut persisted beyond three years post transplant. He avoids peanuts and carries an adrenaline auto-injector.

Case 2 – A 29 year old female who underwent liver transplantation for alpha-1 antitrypsin deficiency at the age of 3 years became parenteral nutrition-dependent following intestinal resections for adhesional obstruction. She underwent liver, intestine, pancreas and colon transplant from a paediatric donor with a history of food allergy who died of anaphylaxis. The donor serum revealed strong specific IgE positivity to cow’s milk (14.9kua/l), whey, casein and hazel nuts and ara H8 peanut allergen only. Total IgE was 301. Post transplant the recipient demonstrated brief IgE positivity to cow’s milk only. Skin prick tests were positive only to cow’s milk and remain positive at 5 months. The patient has reintroduced all other foods with the exception of hazel nuts without incident but continues to avoid milk.

Conclusions: Food allergy transfer by intestine containing grafts may persist longer than with other solid organ transplants, presumably due to persistence of sensitised passenger lymphocytes in the graft . Skin prick tests may be more accurate than specific IgE antibodies and patients should carefully avoid known allergens and take precautions against anaphylaxis.