Clinical efficacy and immune regulation with peanut oral immunotherapy

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:124

Article

Jones, Stacie M.^2,3  Pons, Laurent¹  Roberts, Joseph L.¹  Scurlock, Amy M.^2,3  Perry, Tamara T.^2,3  Kulis, Mike¹  Shreffler, Wayne G.⁴  Steele, Pamela¹  Henry, Karen A.^2,3  Adair, Margaret¹  Francis, James M.⁵  Durham, Stephen⁵  Vickery, Brian P.¹  Zhong, Xiaoping¹  Burks, A. Wesley¹ 

[1] Duke Univ, Med Ctr, Dept Pediat, Durham, NC 27710 USA

[2] Univ Arkansas Med Sci, Dept Pediat, Little Rock, AR 72205 USA

[3] Arkansas Childrens Hosp, Dept Pediat, Little Rock, AR 72202 USA

[4] Mt Sinai Med Ctr, Dept Pediat, New York, NY 10029 USA

[5] Univ London Imperial Coll Sci Technol & Med, London, England

关键词: Peanut hypersensitivity;    immunotherapy;    immune tolerance;    apoptosis;    IgE;    IgG;    IL-5;    IL-10;   

DOI  :  10.1016/j.jaci.2009.05.022

来源: Elsevier

【 摘 要 】

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 IgG4 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. (J Allergy Clin Immunol 2009;124:292-300.)

【 授权许可】

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