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Summary Background Type I allergies have repeatedly been reported after solid organ transplantation despite T cell-targeted immunosuppressive therapy. A causal relationship with tacrolimus has been proposed. Objective The present study directly compared the occurrence of allergic sensitization and disease under tacrolimus- vs. cyclosporin A-based immunosuppressive therapy. Methods The prevalences of IgE-mediated sensitization and allergy were assessed in a cross-sectional study of kidney-transplanted adults receiving tacrolimus (n=100) or cyclosporin A (n=100). Methods included a standardized questionnaire, skin prick test and measurement of total and specific IgE against common nutritive and inhalant allergens. Results The prevalence of sensitization was significantly higher in the tacrolimus- than in the cyclosporin A-treated group (34%, n=34, vs. 20%, n=20; P=0.026). The rate of clinically relevant allergy in patients receiving tacrolimus was twice that in patients receiving cyclosporin A (15%, n=15, vs. 8%, n=8; P=0.12). No other factor (age, serum drug level, concomitant immunosuppressive medication, time since transplantation, underlying disease) was found to have an influence on sensitization or allergy prevalence (logistic regression). Conclusion and Clinical Relevance Our results suggest that post-transplant immunosuppression with tacrolimus is associated with an increased occurrence of IgE-mediated sensitization and probably manifestation of allergic disease, which has to be treated specifically despite immunosuppressive therapy. Cite this as: S. Gruber, K. Tiringer, E. Dehlink, T. Eiwegger, E. Mayer, H. Konstantin, Z. Kikic, A. Graf and Z. Szepfalusi, Clinical & Experimental Allergy, 2011 (41) 1125–1132.

2 and 3 were observed in 43%, 47% and 10% of these specimens. Leucocyte subpopulations were categorized focal vs. diffuse monocytic (11%/24%), focal vs. diffuse granulocytic (4%/4%), or focal vs. diffuse mixed (14%/20%). In 23% of the cases ptc was not classified (e.g. vicinity of tubular necrosis, pyelonephritis or infarct). Ptc scores (1, 2 or 3) were associated with both diagnosis of AMR and cellular rejection (ACR). Diffuse monocytic or mixed ptc (OR=4.51, 95% CI 1.82-11.16, and OR=6.8, 2.44-19.36, p≤0.001), but not granulocytic ptc (OR=3.81, 95% CI 0.41-35.02, p=0.2) were associated with AMR. At the same time, diffuse ptc was associated with ACR, regardless of its composition (monocytic: OR=6.1, 95%CI 3.61-12.44; granulocytic: OR=6.69, 1.58-28.41; mixed: OR=8.05, 4.06-15.96; p≤0.01). In uni- and multivariate analysis ptc 3 (OR=2.56, 95%CI 1.24-1.96, p=0.011), diffuse monocytic or mixed ptc (OR=1.75, 95%CI 1.01-3.06, p=0.048 and OR=1.75, 1.03-3.26, p=0.04) were risk factors for inferior graft survival. Conclusions: Our results underscore a high relevance of the detailed qualitative and quantitative characterization of peritubular capillaritis in indication biopsies as a predictor for inferior clinical outcomes.