The risk of donor-acquired allergy in solid-organ transplant recipients

Erika Yue Lee; Kaylee Sohng; Lianne G. Singer; Susan M. Tarlo; Elizabeth J. Phillips

doi:10.1016/j.anai.2025.01.004

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The risk of donor-acquired allergy in solid-organ transplant recipients

Journal article

Open access

Peer reviewed

The risk of donor-acquired allergy in solid-organ transplant recipients

Erika Yue Lee, Kaylee Sohng, Lianne G. Singer, Susan M. Tarlo and Elizabeth J. Phillips

Annals of allergy, asthma, & immunology, Vol.134(4), pp.474-483

2025

DOI: https://doi.org/10.1016/j.anai.2025.01.004

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Abstract

Background Donor-acquired allergy (DAA) occurs when donors transfer their allergies to recipients through solid-organ transplant (SOT). However, the risk of DAA in recipients of organs from allergic donors has not been systematically characterized. Objective To synthesize the available evidence on the risk of DAA in SOT recipients. Methods We searched Embase and MEDLINE databases for original and peer-reviewed articles related to transplant allergy since database inception to February 11, 2024. Two reviewers independently screened records, extracted data, and assessed risk of bias. Results The review included 24 studies with 747 SOT recipients and their 135 allergic donors in the category of food, drug, or venom. Only 40 recipients (5.4%) underwent allergy testing to donor allergens, and 23 of them had the testing done before an exposure to donor allergens. Among the 30 recipients (4.0%) who were diagnosed with having DAA based on a clinical reaction or positive allergy testing result, 19 (2.5%) had anaphylaxis to donor allergens. Only the type of SOT (lung or liver) was associated with an increased risk of DAA (odds ratio 88.0, 95% CI 22.5-481.3), with no association found for other organs. Conclusion Despite the uncommon occurrence, recipients of organs from allergic donors could be at risk of severe allergic reactions to donor allergens. Although infrequently performed, allergy testing to donor allergens can effectively assess the risk of developing DAA. These findings highlight the risk of DAA and underscore the importance of proactive allergy assessment to prevent unnecessary anaphylaxis in this vulnerable population.

Details

Title: The risk of donor-acquired allergy in solid-organ transplant recipients
Authors/Creators: Erika Yue Lee - University of Toronto
Kaylee Sohng - University of Toronto
Lianne G. Singer - University Health Network
Susan M. Tarlo - University Health Network
Elizabeth J. Phillips - Center for Drug Safety and Immunology, Vanderbilt University Medical Centre, Nashville, Tennessee
Publication Details: Annals of allergy, asthma, & immunology, Vol.134(4), pp.474-483
Publisher: Elsevier Inc.
Number of pages: 17
Identifiers: 991005743444807891
Murdoch Affiliation: Research and Innovation Office; Institute for Immunology and Infectious Diseases
Language: English
Resource Type: Journal article

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.65 Allergy; 1.65.264 Allergy Mechanisms
Web Of Science research areas: Allergy; Immunology
ESI research areas: Immunology