Published online: December 7, 2018
Recent clinical trials have shown that oral immunotherapy (OIT) can induce desensitization in the majority and sustained unresponsiveness (SU) in up to one-half of food-allergic patients undergoing 2 – 3 years of immunotherapy. Suarez-Farinas and colleagues utilized a novel high-throughput Luminex-based peptide assay to assess serum samples from 47 subjects completing a milk OIT (MOIT) +omalizumab trial to evaluate whether IgE and IgG4 antibody binding to 66 sequential allergenic milk protein epitopes changed with MOIT and whether profiling epitope binding prior to initiating MOIT could predict the development of SU.
MOIT profoundly altered IgE and IgG4 binding to allergenic epitopes regardless of treatment outcome. At the initiation of MOIT, subjects achieving SU exhibited significantly less antibody binding to 40 allergenic epitopes than subjects desensitized only (FDR≤0.05, FCH>1.5). Based on baseline epitope-specific antibody binding, predictive models of SU were developed. Using simulations, average IgE-binding to allergenic epitopes alone was significantly more accurate in predicting SU than models utilizing standard serum component proteins (average AUC>97% vs 80%). The optimum model using 6 IgE-binding epitopes achieved 95% AUC and 87% accuracy. These findings suggest that it may be possible to screen food-allergic patients to determine who would receive the most benefit from OIT prior to initiating therapy.
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.
JACI 18-00334, Predicting development of "sustained unresponsiveness" to milk oral immunotherapy using epitope profiles