Pediatric patients receiving liver transplants for conditions such as Alagille syndrome (ALGS) have a 15% chance of developing de novo food allergies, according to a systemic literature review published in Frontiers in Pediatrics.

The risk of developing food allergies appears to be higher for younger patients at the age of transplantation, especially for patients less than 2 years old. The use of tacrolimus for immunosuppression after liver transplants may also increase the risk of developing food allergies.

Out of 249 patients included in the study, it was recorded that 153 (53.2%) of them were affected by multiple concomitant food allergies. For the 267 patients where the trigger foods were included, the most commonly reported food allergies with incidence greater than 10% were eggs (n=142; 53.2%), cow’s milk (n=132; 49.4%), peanuts (n=60; 22.5%), soy (n=53; 19.9%), nuts (n=47; 17.6%), wheat (n=40; 15.0%), and fish (n=37; 13.9%).

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Most patients did not show spontaneous resolution of symptoms, with only 27.0% outgrowing their food allergies with an additional 14% being able to reintroduce at least some of the triggering foods.

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No high-evidence studies were found that could provide information about possible therapeutic strategies for the de novo food allergies seen in the patients. A total of 8 studies including retrospective case reports and small case series found that switching from tacrolimus to cyclosporine led to the successful reintroduction of triggering foods in 71.4% of the patients studied.

Switching from tacrolimus to mycophenolate or adding mycophenolate also showed some evidence of reducing biomarkers of inflammation and improvement or the resolution of food allergies. The addition of sirolimus yielded mixed results for food allergies improvement and a simple reduction in tacrolimus did not enable the reintroduction of triggering foods.

“Prospective multicenter studies are needed to confirm these findings, guide the risk-based stratification of pediatric [liver transplant] recipients, and provide therapeutic strategies for children with de novo [food allergies],” the authors said.

In the review, a total of 40 articles were identified and included in the analysis. The majority of studies were retrospective (n=33) while 4 were prospective and 3 were cross-sectional. A total of 397 pediatric liver transplant patients were combined across all 4 studies.


Bergamo C, Argento EC, Giampetruzzi S, et al. De novo food allergy after pediatric liver transplantation: a systematic review. Front Pediatr. Published online May 12, 2022. doi:10.3389/fped.2022.885942