Immune Case Study 3


Transfer of symptomatic peanut allergy to the recipient of a combined liver and kidney transplant


Dr. Gregory House, Director of Diagnostic Medicine at Plainsboro Hospital, would like to acknowledge Drs. Cameron, Chase and Foreman for their work on identifying the causative agent of a symptomatic peanut allergy acquired by a 35-year-old male recipient of a combined liver-and-kidney transplant. The following report summarizes their work on this case.

Peanuts are one of the most common causes of food allergy in the United States and Europe. They are also a leading cause of food-induced anaphylaxis and death, which usually follow inadvertent exposures. Allergy to peanuts is an IgE-mediated, mast-cell-dependent, immediate-hypersensitivity reaction. There are numerous reports of the transfer of allergen-specific IgE-mediated hypersensitivity by bone marrow transplantation. We report a case of peanut allergy transmitted through combined liver-and-kidney transplantation.


A 22-year-old man with a history of allergic reactions to peanuts was admitted to our hospital in a coma. After inadvertently ingesting satay sauce, which contains peanuts, during a Chinese meal, he had become unwell and had had a cardiorespiratory arrest that resulted in cerebral anoxia, coma, and brain death and was pronounced dead by the Dr. Lisa Cuddy.


The donor's liver and right kidney were given in transplantation to a 35-year-old man and the left kidney and pancreas were given to a 27-year-old woman.  The recipients received immunosuppressive induction therapy with muromonab-CD3 (OKT3) and corticosteroids, azathioprine, and cyclosporine. Neither had ever had any allergy to peanuts.


Three months after transplantation, the recipient of the liver-kidney transplant reported a skin rash and laryngeal dyspnea after eating peanuts. Allergy to peanuts was diagnosed on the basis of the clinical findings; the absence of specific IgE antibodies before transplantation, their presence at the time the symptoms appeared, and their decline thereafter; and a positive basophil degranulation test.




1.) Briefly describe the role of B cells and T-helper lymphocytes in immune physiology.


2.) What is an "antigen-presenting cell" and what role does this type of cell play in an immune response?


3.) What is the difference between an "allergen" and an "antigen"?


4.) What is a mast cell? What role do mast cells play in the immune response?


5.) What is meant by "anaphylaxis"?


6.) What does MHC stand for?  What does HLA stand for? What is an HLA phenotype?


7.) How does HLA relate to MHC in immune physiology?  Why is it important to understand the "HLA phenotypes" of the individuals in this case?


8.) What are the different classes of antibodies that our bodies produce? Which class is associated with the peanut allergy?


9.) From what you know about the structure of an antibody, explain how an IgE can be "peanut-specific."


10.) Explain the interaction that occurs between a T-helper lymphocyte and a B cell when the B cell is being induced to produce peanut-specific IgE. In your explanation, explain the role that the peanut allergen plays in this interaction.


adapted from

National Center for Case Study Teaching in Science


James A. Hewlett

Science and Technology Department

Finger Lakes Community College

Canandaigua, New York