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Early decrease in basophil sensitivity to Ara h 2 precedes sustained unresponsiveness after peanut oral

Sarita U Patil1, Johanna Steinbrecher2, Agustin Calatroni3

  • 1Food Allergy Center, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Center for Immunology & Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass; Food Allergy Science Initiative at Broad Institute at Massachusetts Institute of Technology and Harvard, Boston, Mass.

The Journal of Allergy and Clinical Immunology
|August 5, 2019
PubMed
Summary
This summary is machine-generated.

Oral immunotherapy (OIT) for peanut allergy shows variable success. Early decreases in basophil sensitivity to Ara h 2 correlate with sustained unresponsiveness, suggesting a potential biomarker for OIT efficacy.

Keywords:
Ara h 2Basophil activationIgEIgG(4)food allergyimmunoglobulinimmunotherapyoral immunotherapypeanut allergy

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Area of Science:

  • Immunology
  • Allergy and Immunology
  • Clinical Trials

Background:

  • Oral immunotherapy (OIT) for peanut allergy has variable success rates.
  • Identifying reliable biomarkers for OIT efficacy is crucial.

Purpose of the Study:

  • To investigate the correlation between basophil activation markers and clinical outcomes in children undergoing peanut OIT.
  • To determine if changes in basophil sensitivity and area under the curve (AUC) to Ara h 2 predict treatment success.

Main Methods:

  • A single-center, open-label trial involving children (7-13 years) with peanut allergy receiving OIT.
  • Measurement of specific immunoglobulins and in vitro basophil activation (CD63hi) stimulated by peanut allergens.
  • Assessment of basophil sensitivity (50% maximal response dose) and AUC to Ara h 2.

Main Results:

  • Twenty-two of 30 subjects achieved successful OIT, with 9 showing sustained unresponsiveness (SU) and 13 transient desensitization (TD).
  • Decreased basophil sensitivity to Ara h 2 was observed in subjects with SU (P=.0041) and correlated with SU at 3 months (18-fold vs 3-fold, P=.01).
  • Basophil AUC to Ara h 2 was suppressed post-OIT in both SU and TD groups, but rebounded in TD subjects after avoidance (P<.001).

Conclusions:

  • Early reductions in basophil sensitivity to Ara h 2 are associated with sustained unresponsiveness to peanut OIT.
  • Basophil activation markers, specifically sensitivity and AUC changes, may serve as valuable tools for monitoring OIT efficacy.
  • Distinct patterns of basophil activation after OIT and avoidance differentiate sustained unresponsiveness from transient desensitization.