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High Frequency of Concomitant Food Allergy Development and Autoantibody Formation in Children Who Have Undergone Liver Transplantation

Käppi, Timo MD1; Rabe, Hardis PhD2; Lingblom, Christine PhD2; Hesselmar, Bill MD, PhD3; Kullberg-Lindh, Carola MD, PhD1; Wold, Agnes E. MD, PhD2; Wennerås, Christine MD, PhD2; Saalman, Robert MD, PhD1

doi: 10.1097/TP.0000000000002751
Original Clinical Science–Liver

Background. Allergy and other immune-mediated diseases are more frequently reported in children who have undergone liver transplantation. Furthermore, autoantibodies are also prevalent, suggesting a state of immune dysregulation in these patients. Whether or not these processes occur simultaneously in the same individual has not been studied previously.

Methods. A cohort of 43 children who had undergone liver transplantation for nonautoimmune liver disease at median age of 1.3 years was investigated for allergy and autoimmune disease. Sensitization to food and inhalant allergens was assessed, and autoantibodies were measured.

Results. The prevalence of food allergy was 26% and that of respiratory allergy was 23%, whereas 33% and 26% of the subjects were sensitized to food and inhalant allergens, respectively. Autoimmune disease (ie, autoimmune hepatitis) occurred in a single individual (2%), whereas autoantibodies were present in 44% of the children. Food allergy and autoantibodies occurred concomitantly in 19% of the children, which was almost twice the frequency expected by chance (11%, P = 0.04). Respiratory allergy and the presence of autoantibodies were unrelated (12% concurrence versus the expected 10%, P = 0.73). In the logistic regression analysis, autoantibody formation was associated with discontinued immunosuppression and food allergy, with odds ratios of 13 (P = 0.01) and 7.1 (P = 0.03), respectively.

Conclusions. In contrast to respiratory allergy, food allergy and autoantibody formation occurred together in the same children who underwent liver transplantation at a frequency higher than would be expected by chance. This may reflect an underlying immune dysregulation that impairs immune tolerance to both food allergens and autoantigens.

1 Department of Pediatric Gastroenterology, Hepatology and Nutrition, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.

2 Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.

3 Department of Pediatric Allergy and Pulmonology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.

Received 7 December 2018. Revision received 14 March 2019.

Accepted 25 March 2019.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

T.K. and R.S. participated in the performance of the research, research design, data analysis and interpretation, and writing of the article. C.W. and A.W. participated in research design, data interpretation, and writing of the article. H.R. and C.L. participated in data analysis and interpretation. C.K.-L. and B.H. participated in revising the manuscript critically for important intellectual content. All authors approved the final version of the article.

The authors declare no conflicts of interest.

The study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALF-70420), the Professor Lars-Erik Gelin Memorial Foundation for Transplant Research, and the Queen Silvia Children’s Hospital Research Fund, Gothenburg, Sweden (The Märtha and Gustaf Ågren Foundation).

Correspondence: Timo Käppi, MD, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Queen Silvia Children’s Hospital, 416 85 Göteborg, Sweden. (

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