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Early peanut introduction alters antibody response in high-risk infants

Published: February 12, 2021

Children with peanut sensitization and allergy generate IgE and IgG4 antibodies to peanut proteins. In the Learning Early About Peanut Allergy (LEAP) trial, early consumption of peanut in high-risk infants was found to decrease the rate of symptomatic peanut allergy at 5 years of age. It is still largely unknown how allergenic IgE and IgG4 antibody responses evolve to target conformational (non-sequential) and linear (sequential) epitopes on peanut proteins, the latter of which have been associated with persistent peanut allergy.

In a recent study published in The Journal of Allergy and Clinical Immunology (JACI), Suarez-Farinas et al sought to compare the evolution of peanut linear epitope-specific IgE and IgG4 antibodies in children who did or did not develop peanut allergy as assessed at 5 years of age and to evaluate the effects of early peanut consumption on these adaptive immune responses at baseline, 12 months, 2.5 and 5 years of age.

This study found IgE to linear peanut epitopes developing after 2.5 years of age only in children who avoided peanut, suggesting an “early window” where early peanut introduction could potentially prevent peanut allergy. Development of epitope-specific IgG4 increased in most participants regardless of peanut consumption or allergy status at 5 years. Among infants sensitized to peanut at 4-11 months of age, peanut consumers showed IgE to whole peanut extract (presumably conformational epitopes) but not to linear epitopes while sensitized peanut avoiders also had IgE initially to whole peanut extract and then later developed IgE to sequential epitopes as well.

Early peanut consumption in infants at high-risk of peanut allergy appears to divert the immune system from developing a pathogenic linear epitope-specific IgE antibody response to a “protective” IgG4 response compared to avoiders.

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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