IgE to peanut epitopes predicts allergy development in children

Published: August 10, 2020

Children with peanut sensitization and allergy generate IgE and IgG4 antibodies to peanut proteins. Quantitating IgE to specific peanut component proteins improves allergy diagnosis. Furthermore, identifying IgE to specific peptide sequences on those proteins, known as sequential epitopes, may enable clinicians to identify infants at risk of developing peanut allergy.

In a recent study published in The Journal of Allergy and Clinical Immunology (JACI), Suprun et al followed the development of IgE and IgG4 antibodies generated against many allergenic peanut proteins and epitopes in 293 high-risk children from the CoFAR “natural history” cohort. Antibodies were measured over time in the same children at ages 3-15 months, 2-3 and 4-11 years. The authors developed a machine learning algorithm that testing whether early antibodies could predict peanut allergy status at 4+ years of age.

This study found that in children allergic to peanut at 4+ years, IgE against peanut proteins were produced earlier than IgE to sequential epitopes, which became detectable around 2-3 years of age. Unlike IgE, increases over time in IgG4 levels were observed in most children, regardless of allergy status. IgE levels as early as 3-15 months could predict allergy development later in life; the predictions were further improved when antibody levels were measured at 2-3 years. The best results were achieved when combining protein- and epitope-specific IgE antibodies. This is the first study that demonstrates the predictive power of combining protein- and epitope-specific antibody levels to predict allergy development. Accurate detection of young children destined to develop persistent peanut allergy will enable clinicians to initiate appropriate therapeutic measures early, when the immune system may be more likely to sustain long-term changes or possibly full tolerance.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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