Clinical efficacy and immune regulation with peanut oral immunotherapy
Stacie M Jones, Laurent Pons, Joseph L Roberts, Amy M Scurlock, Tamara T Perry, Mike Kulis, Wayne G Shreffler, Pamela Steele, Karen A Henry, Margaret Adair, James M Francis, Stephen Durham, Brian P Vickery, Xiaoping Zhong, A Wesley Burks, Stacie M Jones, Laurent Pons, Joseph L Roberts, Amy M Scurlock, Tamara T Perry, Mike Kulis, Wayne G Shreffler, Pamela Steele, Karen A Henry, Margaret Adair, James M Francis, Stephen Durham, Brian P Vickery, Xiaoping Zhong, A Wesley Burks
Abstract
Background: Oral immunotherapy (OIT) has been thought to induce clinical desensitization to allergenic foods, but trials coupling the clinical response and immunologic effects of peanut OIT have not been reported.
Objective: The study objective was to investigate the clinical efficacy and immunologic changes associated with OIT.
Methods: Children with peanut allergy underwent an OIT protocol including initial day escalation, buildup, and maintenance phases, and then oral food challenge. Clinical response and immunologic changes were evaluated.
Results: Of 29 subjects who completed the protocol, 27 ingested 3.9 g peanut protein during food challenge. Most symptoms noted during OIT resolved spontaneously or with antihistamines. By 6 months, titrated skin prick tests and activation of basophils significantly declined. Peanut-specific IgE decreased by 12 to 18 months, whereas IgG(4) increased significantly. Serum factors inhibited IgE-peanut complex formation in an IgE-facilitated allergen binding assay. Secretion of IL-10, IL-5, IFN-gamma, and TNF-alpha from PBMCs increased over a period of 6 to 12 months. Peanut-specific forkhead box protein 3 T cells increased until 12 months and decreased thereafter. In addition, T-cell microarrays showed downregulation of genes in apoptotic pathways.
Conclusion: Oral immunotherapy induces clinical desensitization to peanut, with significant longer-term humoral and cellular changes. Microarray data suggest a novel role for apoptosis in OIT.
Figures
![Figure 1. Effect of Peanut OIT on…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2725434/bin/nihms120652f1.jpg)
![Figure 2. Serum Levels of Peanut-Specific Immunoglobulins…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2725434/bin/nihms120652f2.jpg)
![Figure 3. Peanut OIT Leads to FAB…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2725434/bin/nihms120652f3.jpg)
![Figure 4. Cytokines Secreted From PBMCs After…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2725434/bin/nihms120652f4.jpg)
![Figure 5. Cytokines Secreted From PBMCs Stimulated…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2725434/bin/nihms120652f5.jpg)
![Figure 6. Changes of FoxP3 + Regulatory…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2725434/bin/nihms120652f6.jpg)
Source: PubMed