The symptoms: The woman underwent a lung transplant to treat interstitial lung disease, which involves harmful inflammation and scarring of lung tissue. While recovering in the hospital, she ate a bowl of breakfast cereal, which activated a nearly two-hour episode of flushing, itching, shortness of breath and low blood pressure.
(Treatment for anaphylaxis involves epinephrine (also called adrenaline), and it can also require antihistamines, cortisone, oxygen and beta-agonists, such as albuterol, which help improve breathing.)
The diagnosis: Two months after her lung transplant, the woman underwent a skin-prick allergy test, which revealed a sensitivity to peanut and pine nut allergens. She did not have an allergic response to tree nuts, such as the almonds in the candy bar, nor to coconut. None of the foods that triggered her symptoms were known to contain peanuts, but none were certified as peanut-free, either.
The treatment: The woman did not receive a specific treatment to get rid of this new allergic response. However, the sensitivity subsided in follow-up skin-prick tests, and they had disappeared completely by a year after her surgery. She ate peanuts in a supervised setting a few months after the one-year mark and had no reaction.
What makes the case unique: Only one other case of peanut allergy following a lung transplant had been documented before the woman's case was published in 2011.
The authors of the 2025 review noted that donor-acquired allergies are more commonly associated with lung and liver transplants than with transplants of other solid organs. That could be because these organs are rich in a type of immune cell that produces allergen-specific antibodies, called B lymphocytes.
In the woman's case, a blood test for peanut-specific antibodies came back negative. This suggested that her body was not continually generating the antibodies. That could serve as possible evidence that her reaction was caused by antibodies bound to mast cells or basophils within the donor tissue, rather than antibodies produced by lymphocytes.
OTHER DILEMMASThat said, the woman's reaction to the skin-prick test could imply that lymphocytes were still involved in the allergic reaction, the doctors added, as they did not know whether mast cells or basophils could migrate to the skin the way circulating antibodies could.
For more intriguing medical cases, check out our Diagnostic Dilemma archives.
This article is for informational purposes only and is not meant to offer medical advice.
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