Previously in the literature, it has been described that patients who underwent hematopoietic stem cell transplantation (HSCT) have acquired asthma, allergic rhinitis and even food allergy from their donors. To date, no papers have reported complete resolution of severe food allergy subsequent to HSCT. Here we present a 6 year old female with HyperIgE syndrome, severe persistent asthma and multiple severe near-fatal food allergies who underwent HSCT due to acute mixed myeloid and T-cell leukemia (AML) with subsequent complete resolution of her food allergies.
Skin prick testing (SPT) (Greer), Total IgE and ImmunoCAP testing by Seattle Children’s laboratory,
Patient’s total IgE prior to her diagnosis of AML was 22,500IU/mL. Subsequent to AML chemotherapy treatment, patient’s IgE had reduced to 883. Food ImmunoCAP immediately prior to transplant revealed numerous positives including wheat(80), peanut(23.7) and milk(65.3). Patient underwent non-myeloablative chemotherapy with fludarabine, cyclophosphamide and total body irradiation with a mismatch cord transplant. At day +80, patient had 100% donor chimerisms but food ImmunoCAP testing while decreased remained positive. At one year post-transplant, ImmunoCAP testing revealed negatives(<0.35) to all tested foods, which was confirmed with SPT.
We believe that this is the first reported case to prospectively examine an individual with multiple severe food allergies through their post-HSCT course. The steady decrease in food specific IgE over the year post transplant likely indicates the gradual destruction of peripheral IgE memory B-cells through graft versus host disease. Subsequent oral food challenges confirmed clinical tolerance to each of the foods that had previously provoked anaphylaxis.