tacrolimus and Angioedema

Angioedema and chronic diarrhea in patients taking immunosuppressants are not always because of side effects and could be a new onset of food allergy. Our aim is to discuss the pathogenesis and treatment of the post-transplant development of food allergies. The first patient was receiving tacrolimus subsequent to heart transplantation and developed angioedema after consumption of dairy products at 12 months after transplantation. He was found to be allergic to multiple foods by both RAST and ImmunoCAP tests. The second patient with argininosuccinic aciduria, post-liver transplant, also received tacrolimus and developed chronic non-mucoid/bloody diarrhea at seven months following transplantation. ImmunoCAP test was positive only for egg white and peanuts. Biopsy showed eosinophilic infiltration of the mucosa from the stomach to the rectum. Elimination diets in both patients resolved the symptoms. These cases suggest a direct relationship between tacrolimus and development of food allergy.

Topics: Angioedema; Child, Preschool; Food Hypersensitivity; Heart Transplantation; Humans; Immunoglobulin E; Immunosuppressive Agents; Liver Transplantation; Male; Skin Tests; Tacrolimus; Time Factors

The authors report on their experience with food-induced angioedema in tacrolimus-immunosuppressed pediatric liver recipients.. Among 121 children treated with tacrolimus after liver transplantation, those who presented with angioedema are reported.. Twelve children (10%) experienced angioedema related to food allergy while on tacrolimus. Mean ages at transplantation and angioedema were 1.3 years and 3.75 years, respectively. Angioedema occurred within a mean of 28 months from onset of tacrolimus. Eleven children experienced two or more angioedema attacks without consequences. One child presented with anaphylactic shock that caused postischemic cerebral damage. Besides eviction of food allergens, eight children were switched from tacrolimus to cyclosporine, whereas tacrolimus dosage was decreased in four. Reintroduction of food allergens was successfully performed only in those who were switched to cyclosporine.. A causal relationship between tacrolimus and the occurrence of food-induced angioedema is suggested. The switch from tacrolimus to cyclosporine should be considered.

Topics: Angioedema; Child, Preschool; Female; Food Hypersensitivity; Humans; Immunosuppressive Agents; Infant; Liver Transplantation; Male; Tacrolimus

Topics: Angioedema; Child; Food Hypersensitivity; Humans; Immunosuppressive Agents; Liver Transplantation; Postoperative Complications; Tacrolimus