A 54-year old man with end-stage liver disease from Hepatitis C and alcohol abuse received an orthotopic liver transplant from a 24-year-old woman who died after an anaphylactic reaction to an unknown allergen. The donor had known allergies to nuts, kiwi, seafood, and wheat. The recipient had no known allergies. The recipient's operative course was unremarkable. Postoperative immunosuppression was maintained with mycophenolate mofetil, prednisone, and tacrolimus. Eight days postoperatively, the patient consumed ice cream containing nuts and immediately developed tongue and throat swelling with dysphonia and dyspnea. He then developed diffuse urticaria followed by abdominal pain, nausea, and confusion. On presentation to the Emergency Department, his symptoms resolved spontaneously and by the following morning, he had returned to his usual state of health.
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