Nut allergy transferred via liver transplant
7 February 2003
Australian doctors have described the case of a man who developed nut allergy after receiving a liver transplant from a boy who died from nut-related anaphylaxis.
(Anaphylaxis is a severe, sudden, allergic reaction that can be life-threatening. A person having this reaction will often get a rash, tightness in the throat, swelling of the mouth and face, feel dizzy, and have difficulty breathing.)
However, the doctors from Sydney's Royal Prince Alfred Hospital could not explain how this happened, as no other recipients of the boy's organs developed a nut allergy (Archives of Internal Medicine 2003; 163: 237-39).
The 15-year-old liver donor had a history of atopic dermatitis (allergic skin rash), moderately severe asthma and intolerance to a number of food additives. He had always avoided nuts, but was never formally diagnosed with nut allergy.
Immediately after eating fried rice with satay sauce he developed anaphylaxis and irreversible anoxic (lack of oxygen) brain damage.
Blood tests showed he was allergic to peanut, cashew nut and sesame seed. Multiple organs from his body were donated.
The 60-year-old man who received the liver had chronic hepatitis B, cirrhosis and a hepatoma (malignant liver tumour), and was discharged 24 days after the liver transplant on 3 immunosuppressants (medications to suppress the immune system and help prevent rejection of the donated organ). The next day, within 15 minutes of eating cashew nuts, he developed anaphylaxis despite having eaten cashews regularly in the past.
He developed a red flushed face, tight throat, dizziness and blurred vision followed by severe nausea, vomiting and profuse watery diarrhoea. He was treated with promethazine hydrochloride (an antihistamine) and admitted to hospital for observation.
Skin-prick testing confirmed allergy to peanut, cashew nut and sesame seed. He was advised to avoid nuts and nut-containing foods and prescribed an adrenaline auto-injector (a medication device used to treat anaphylaxis quickly) that he needed 32 weeks later for anaphylaxis from accidental exposure to peanuts.
Last Reviewed: 07 February 2003
- 1. Medical Observer Weekly 7/02/03
