The passive transfer of clinically important nut allergy by the transfusion of fresh frozen plasma (FFP) has, to our knowledge, never before been documented. We report a case of peanut anaphylaxis in a nonatopic recipient of leukocyte-depleted FFP collected from a peanut-allergic donor.
In preparation for gastrointestinal endoscopy, a nonatopic 80-year-old woman receiving long-term warfarin therapy was given a transfusion of 2 U of leukoreduced FFP because her preoperative international normalized ratio was 1.3 (normal range, 0.8-1.2). Two days later, she ate a muffin and some peanut butter and, within minutes, developed throat tightness, dyspnea, dysphagia, and a pruritic rash. Her oxygen saturation was 88%. Aerosolized racemic epinephrine and intravenous corticosteroids were administered, and her symptoms resolved within several hours. She had never before had an allergic reaction to peanuts.