奥马珠单抗治疗儿童肝移植后严重IgE介导的食物过敏和严重哮喘：病例报告
Omalizumab for severe IgE-mediated food allergy and severe asthma after pediatric liver transplantation: a case report.
摘要(中文译文)
移植相关过敏是一种具有临床意义的现象，已在造血干细胞移植后被描述，尤其在儿科患者中于实体器官移植后出现。儿童肝移植（LT）与IgE介导的过敏相关，包括哮喘、特应性皮炎和严重食物过敏。移植后食物过敏（dnPTFA）是一种涉及多种危险因素的疾病，包括受者年龄小、女性性别、个人或供者特应性病史、钙调神经磷酸酶抑制剂以及EB病毒感染。这些因素可能通过钙调神经磷酸酶抑制剂（CNI）诱导的Th2偏移和病毒免疫调节所驱动的被动和主动机制，共同促进移植后免疫失调。本文对dnPTFA进行叙述性综述，并报告一例临床病例：一名15岁男孩因新生儿急性肝衰竭在28日龄时接受LT。该患者随后出现严重哮喘和多种dnPTFA，并反复发生过敏性休克，尽管由于移植物功能正常，移植后随访期间免疫抑制一直维持在低目标水平。由于持续出现危及生命的反应、过敏性哮喘以及明显的食物选择性影响生长发育，患者于10岁时开始超说明书使用奥马珠单抗治疗。接受奥马珠单抗治疗后，患者哮喘控制极佳，停用背景治疗，并恢复了限制较少的饮食。肝移植物功能保持稳定，在超过5年的随访中未发生移植物相关不良事件，支持该方法的长期安全性和有效性。
Abstract
Transplant-associated allergy represents a clinically relevant phenomenon described after hematopoietic stem cell transplantation and, particularly in pediatric patients, after solid organ transplantation. Liver transplant (LT) in the pediatric population is associated with IgE-mediated allergy, including asthma, atopic dermatitis, and severe food allergies. post-transplant food allergy (dnPTFA) is a condition with multiple risk factors involved, including young recipient age, female sex, personal or donor history of atopy, calcineurin inhibitors, and Epstein-Barr virus infection. These factors likely converge to promote post-transplant immune dysregulation through both passive and active mechanisms driven by calcineurin inhibitor (CNI)-induced Th2 skewing and viral immune modulation. This paper presents a narrative review of dnPTFA and a clinical case of a 15-year-old boy who underwent LT at 28 days of age due to neonatal acute liver failure. The patient subsequently developed severe asthma and multiple dnPTFAs with recurrent anaphylaxis, despite immunosuppression being maintained at low target levels throughout post-transplant follow-up due to normal graft function. Because of persistent life-threatening reactions, allergic asthma, and marked food selectivity compromising growth, off-label treatment with omalizumab was initiated at 10 years of age. Following treatment with omalizumab, the patient achieved excellent asthma control, discontinued background therapy, and resumed a less restricted diet. Liver graft function has remained stable, with no graft-related adverse events over more than 5 years of follow-up, supporting the long-term safety and effectiveness of this approach.
如何引用
AMA
Antonella Mosca, Andrea Ficari, Maria Sole Basso, Carmen Mazzuca, Daniela Liccardo, Alessandro Fiocchi, et al. Omalizumab for severe IgE-mediated food allergy and severe asthma after pediatric liver transplantation: a case report.. Frontiers in pediatrics. 2026; doi:10.3389/fped.2026.1855822.
APA
Antonella Mosca, Andrea Ficari, Maria Sole Basso, Carmen Mazzuca, Daniela Liccardo, Alessandro Fiocchi, et al (2026). Omalizumab for severe IgE-mediated food allergy and severe asthma after pediatric liver transplantation: a case report.. Frontiers in pediatrics. https://doi.org/10.3389/fped.2026.1855822
GB/T 7714
Antonella Mosca, Andrea Ficari, Maria Sole Basso, Carmen Mazzuca, Daniela Liccardo, Alessandro Fiocchi, et al. Omalizumab for severe IgE-mediated food allergy and severe asthma after pediatric liver transplantation: a case report.[J]. Frontiers in pediatrics, 2026 doi:10.3389/fped.2026.1855822.
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