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High prevalence of food sensitisation in young children with liver disease: a clue to food allergy pathogenesis?
MedLine Citation:
PMID:  23050587     Owner:  NLM     Status:  Publisher    
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 IgE 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 IgE and cow's milk, egg and peanut-specific IgE. We quantified hepatic dysfunction pre-transplant using the Paediatric End-stage Liver Disease (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 IgE sensitisation (≥0.35 kUa/l) to ≥1 food pre-transplant and 18 (36%) post-transplant (p = 0.001). Ten (20%) children had food-specific IgE 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 IgE 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.
Chrysothemis Brown; Natasha Haringman; Charlotte Davies; Claudia Gore; Munther Hussain; Giorgina Mieli-Vergani; Diego Vergani; John O Warner; Stephen D Marks; Robert J Boyle
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-11
Journal Detail:
Title:  Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology     Volume:  -     ISSN:  1399-3038     ISO Abbreviation:  Pediatr Allergy Immunol     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9106718     Medline TA:  Pediatr Allergy Immunol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 John Wiley & Sons A/S.
Department of Paediatrics, Imperial College London, London, UK.
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