Abstract
Only some peanut-allergic subjects undergoing oral immunotherapy (OIT) achieve sustained clinical response. Basophil activation could provide a functional surrogate of efficacy. We hypothesized that changes in basophil sensitivity and AUC to the immunodominant allergen Ara h 2 correlate with clinical responses to OIT. Peanut-allergic children, aged 7-13, enrolled in a single-center, open-label peanut OIT trial. Specific immunoglobulins were measured throughout OIT. Peripheral blood from multiple time points was stimulated in vitro with peanut allergens for flow cytometry assessment of the percent CD63hi activated basophils. Twenty-two of 30 subjects were successfully treated by OIT; post-avoidance, 9 achieved sustained unresponsiveness (SU) and 13 had transient desensitization (TD). Basophil sensitivity, measured by ED50, to Ara h 2 stimulation decreased from baseline in SU (post-OIT p= 0.0041, post-avoidance p=0.0011). At 3 months of OIT, basophil sensitivity in SU decreased from baseline compared to TD (median 18-fold vs. 3-fold, p=0.01) with an ROC of 0.84 and optimal fold-change of 4.9. Basophil AUC, measured by area-under-the-curve, to Ara h 2 was suppressed post-OIT equally in SU and TD (p=0.4). After avoidance, basophil ...Continue Reading
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