Q:

12/3/2012
If a patient without allergies is receiving an allergenic stem cell transplant from a donor with penicillin allergy, should the recipient be labeled as penicillin allergic after the transplant?

A:

Thank you for your inquiry.

The transference of immediate hypersensitivity from donor to recipient via autologous stem cell transplant as well as bone marrow transplant has been well documented (see references and abstract 1 through 4 copied below). However, the frequency of this occurrence is unknown. Thus, all one can say is that if a donor were truly allergic to penicillin, the recipient would be at risk for transference of immediate hypersensitivity to this allergen. The most conservative course, therefore, would be to consider such a patient allergic, and proceed accordingly.

Thank you again for your inquiry and we hope this response is helpful to you.

1) Hallstrand et al: Blood November 15, 2004 vol. 104 no. 10 3086-3090 Long-term acquisition of allergen-specific IgE and asthma following allogeneic bone marrow transplantation from allergic donors.

2) Agosti JM, Sprenger JD, Lum LG, Witherspoon RP, Fisher LD, Storb R, Henderson WR Jr
Department of Medicine, University of Washington, Seattle 98195.
The New England Journal of Medicine [1988, 319(25):1623-1628]
Transfer of allergen-specific IgE-mediated hypersensitivity with allogeneic bone marrow transplantation.

3) Blood. 2009 Jan 8;113(2):279-90. Epub 2008 May 9.Is allergic disease curable or transferable with allogeneic hematopoietic cell transplantationKhan F, Hallstrand TS, Geddes MN, Henderson WR Jr, Store
Abstract
In the pathogenesis of allergic asthma/rhinitis, 2 main types of cells play a role: hematolymphatic cells (mast cells, eosinophils, T cells, B cells) and nonhematolymphatic cells (airway smooth muscle cells, epithelial cells). It is not known which one of the 2 cell types plays the primary role. Here we review the literature on allergic disease transfer and potential cure with allogeneic hematopoietic cell transplantation (HCT), as transferability and curability would support a primary role of hematolymphatic cells and have implications for donor selection for HCT and possible future treatment of severe allergic disease with HCT. A total of 18 nonallergic recipients were reported to develop allergic disease after transplantation; however, conclusive information for transfer was available for only 5 cases. Allergic disease was reported to abate in 3 allergic recipients; however, conclusive information for "cure" was available for only 2 cases. Problems in interpreting the reports include incomplete data on allergic disease in the donor or recipient before transplantation, not knowing the denominator, and the lack of controls. In summary, review of the literature generates the hypothesis that allergic disease is transferable and curable with HCT. A prospective study, including appropriate controls, is needed to evaluate this hypothesis.

4) Eur Ann Allergy Clin Immunol. 2011 Dec;43(6):196-8.
Transfer of IgE-mediated hypersensitivity with autologous stem cell transplantation.
Sánchez-Borges M, Goldsztajn HJ

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology