title: Management of tacrolimus-associated food allergy after liver transplantation.
abstract: Increasingly, food allergy associated with tacrolimus after pediatric living-donor liver transplantation (LT) has been reported. Tacrolimus prevents the activation of T cells by blocking calcineurin, thus producing an immunosuppressive effect, but tacrolimus induces an imbalance in T-helper type 1 (Th1) and Th2 cells in the food allergy process. This report describes a case of tacrolimus-associated food allergy after pediatric living-donor LT. The patient was a 7-year-old Japanese girl who had undergone living-donor LT at 12 months of age, and whom we first saw in the clinic at age 18 months. She received immunosuppressive therapy by tacrolimus after transplantation. Atopic dermatitis developed in post-transplant month 18. Stridor, facial edema, lip swelling, and skin erythema after consuming tempura udon containing wheat occurred in post-transplant month 39, and she was subsequently diagnosed with anaphylactic shock. Eosinophilic leukocyte and serum immunoglobulin (Ig)E increased, and specific IgE was positive for some food allergens. Pharmacotherapy was therefore changed from tacrolimus to cyclosporine A, after which eosinophilic leukocyte and serum IgE decreased and atopic dermatitis improved.
authors.affiliation: Departments of Pediatrics, Tokyo, Japan.
authors.forename: Naho
authors.initials: N
authors.lastname: Obayashi
authors.affiliation: Departments of Pediatrics, Tokyo, Japan.
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Departments of Pediatrics, Tokyo, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Yokokura
authors.affiliation: Departments of Pediatrics, Tokyo, Japan.
authors.forename: Nakayuki
authors.initials: N
authors.lastname: Naritaka
authors.affiliation: Departments of Pediatrics, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakano
authors.affiliation: Departments of Pediatrics, Tokyo, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Ohtsuka
authors.affiliation: Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugo
authors.affiliation: Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Kawasaki
authors.affiliation: Departments of Pediatrics, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shimizu
mesh_terms: D016572:Cyclosporine / Q000627:therapeutic use*; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D005512:Food Hypersensitivity / Q000188:drug therapy / Q000209:etiology*; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007223:Infant; D008103:Liver Cirrhosis / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D004791:Enzyme Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus
keywords: cyclosporine A; food allergy; liver transplantation; tacrolimus