New England Medical Journal

HAL Allergy in the "New England Journal of Medicine", the world's most renowned medical journal New England Journal of Medicine, Vol. 364, 1981-82 (may 19th, 2011) Last month, a letter was published by the New England Journal of Medicine describing a story of a boy who experienced an allergic reaction after receiving a blood transfusion to treat his leukaemia.

The reaction was caused by traces of peanut allergen in the blood product. Our Director of Research & Development of New Products Stef Koppelman contributed to this publication via his affiliation at the University of Nebraska, and explains

"In a collaborative project of the University of Nebraska (USA) and the University Medical Centre of Nijmegen (the Netherlands) an extraordinary clinical case was investigated. A 6-year old boy who needed to undergo a blood transfusion to treat his leukaemia experienced an anaphylactic allergic reaction. This reaction reminded his mother to a situation when the boy -1 year of age then- ate peanuts. Although he was not tested or peanut allergy, his mother withheld peanut strictly for his diet since then. Fortunately, the allergic reaction that occurred upon the transfusion was treated successfully with adrenaline. Retrospectively, the boy was diagnosed with a peanut allergy, based on serology testing and anamnesis.

The question raises why someone with a peanut allergy reacts on a blood transfusion. We hypothesized the following: Peanut allergens can enter the blood stream after ingestion, because they are poorly digested by the stomach. If a donor consumes peanut prior to the donation, intact peanut allergens may enter the blood. Upon intravenous administration of such product into a peanut allergic patient, a systemic reaction can occur quickly.

We know from our earlier work that in particular peanut allergen Ara h2 is highly resistant towards digestion by pepsin and trypsin, the proteolytic enzymes of the stomach and intestines. We have presented this work at the EAACI of 2010, and it's also published in a scientific journal. In the past, I've developed an assay to detect this digestion-resistant part of Ara h2, in collaboration with the University of Nebraska and others. One of the donors did consume peanuts the night before donation, and we could then detect the digestion-resistant part of Ara h2 in several blood products. We thus found an explanation for the severe allergic reaction the boy experienced upon his transfusion. It is now being discussed if blood transfusion practices should be reviewed in order to prevent these kind of allergic transfusion reactions."

NEMJ Article

Harry Flore commented:
"Publication of this case in a top journal like the New England Journal of Medicine shows that a wide representation of the medical profession is interested in peanut allergy. It once again illustrates that our work on a peanut allergy vaccine is relevant. We can count on a large interest from different stakeholders. It is important for us to be involved in research with established academic institutions like the University of Nebraska, and the University Medical Centre of Nijmegen."