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High prevalence of food sensitisation in young children with liver disease: a clue to food allergy pathogenesis?
Author(s) -
Brown Chrysothemis,
Haringman Natasha,
Davies Charlotte,
Gore Claudia,
Hussain Munther,
MieliVergani Giorgina,
Vergani Diego,
Warner John O.,
Marks Stephen D.,
Boyle Robert J.
Publication year - 2012
Publication title -
pediatric allergy and immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.269
H-Index - 89
eISSN - 1399-3038
pISSN - 0905-6157
DOI - 10.1111/pai.12011
Subject(s) - medicine , food allergy , pathogenesis , allergy , liver transplantation , immunology , liver disease , transplantation , gastroenterology
Background The pathogenesis of food allergy is not completely understood – animal models suggest hepatic mechanisms may be important for immune tolerance to orally ingested antigens, but there is little direct evidence for this in humans. Objectives We investigated whether there is an association between liver dysfunction or transplantation in young children and I g E sensitisation to food. Methods We evaluated paired pre‐ and post‐ liver transplant sera from children aged 0–36 months treated at a single centre during 2001–2008. Sera were assayed for total I g E and cow's milk, egg and peanut‐specific I g E . We quantified hepatic dysfunction pre‐transplant using the P aediatric E nd‐stage L iver D isease ( PELD ) score. We also assessed 70 children after renal transplant to establish whether any association between liver transplant and food sensitisation was organ specific. Results Paired sera were available from 50 of 94 children who had a liver transplant during the study period. 35 of 50 (70%) had I g E sensitisation (≥0.35 kUa/l) to ≥1 food pre‐transplant and 18 (36%) post‐transplant (p = 0.001). Ten (20%) children had food‐specific I g E levels that carry high probability of challenge‐confirmed food allergy pre‐transplant. Food sensitisation pre‐transplant was associated with severity of liver dysfunction [mean (s.d.) pre‐transplant PELD score 1.52 (0.13) in food sensitised, 0.77 (0.22) in non‐sensitised children p = 0.004]. Total I g E level was raised in 34/42 (81%) pre‐transplant and fell significantly post‐transplant. Interview assessment of the parents of 40 children revealed that 13 (33%) had a history consistent with food allergy. These findings were not replicated in the renal transplant group. Conclusions Young children with severe liver dysfunction appear to have a high prevalence of food sensitisation. Hepatic mechanisms may therefore be important for establishing immune tolerance to dietary antigens in humans.