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Peanut oral immunotherapy modifies IgE and IgG4 responses to major peanut allergens  Brian P. Vickery, MD, Jing Lin, PhD, Michael Kulis, PhD, Zhiyan Fu,

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Presentation on theme: "Peanut oral immunotherapy modifies IgE and IgG4 responses to major peanut allergens  Brian P. Vickery, MD, Jing Lin, PhD, Michael Kulis, PhD, Zhiyan Fu,"— Presentation transcript:

1 Peanut oral immunotherapy modifies IgE and IgG4 responses to major peanut allergens 
Brian P. Vickery, MD, Jing Lin, PhD, Michael Kulis, PhD, Zhiyan Fu, PhD, Pamela H. Steele, MSN, CPNP, Stacie M. Jones, MD, Amy M. Scurlock, MD, Gustavo Gimenez, BSc, Ludmilla Bardina, MSc, Hugh A. Sampson, MD, A. Wesley Burks, MD  Journal of Allergy and Clinical Immunology  Volume 131, Issue 1, Pages e3 (January 2013) DOI: /j.jaci Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

2 Fig 1 OIT alters the peanut-specific immunoglobulin response in quantity and intensity. In these figures each data point represents 1 subject. Lines or plus signs indicate medians. A, psIgE, as measured by using conventional CAP-FEIA, decreases from a median of 85.5 kUA/L at baseline to 7.8 kUA/L after OIT treatment (P < .0001). B, The overall IgE repertoire remains stable, even as psIgE levels decrease. All array spots with a z score of greater than 3 were considered positive. C, IgE level and epitope diversity are strongly correlated at baseline and at the time of the last measurement after a median of 41 months of treatment. D, Fewer peanut peptides are bound by IgE with high intensity over the course of OIT treatment. Journal of Allergy and Clinical Immunology  , e3DOI: ( /j.jaci ) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

3 Fig 2 OIT increases the production of broadly diverse IgG4 antibodies, some of which have de novo specificity. A, A polyclonal expansion of IgG4 production occurs during OIT but not during an allergen elimination diet. Plus signs indicate median values. B, The specificity of the IgG4 response after treatment includes both peptides recognized before OIT and new specificities. Each circle or diamond represents 1 subject. Journal of Allergy and Clinical Immunology  , e3DOI: ( /j.jaci ) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

4 Fig 3 Scatter plot comparing IgG4 (A) and IgE (B) binding to the array between the standard protocol (x-axis) and the competition assay (y-axis) from baseline and the last time points of 5 subjects. Each spot represents antibody binding (represented as a z score) to 1 peanut peptide on the array. Journal of Allergy and Clinical Immunology  , e3DOI: ( /j.jaci ) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

5 Fig 4 The peanut IgE repertoire contracts in most but not all subjects treated with OIT. The number of array spots bound by IgE was compared from baseline with that at the last available measurement for each subject. Journal of Allergy and Clinical Immunology  , e3DOI: ( /j.jaci ) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

6 Fig 5 Comparison of IgE and IgG4 binding of peanut OIT–treated patients to peptides of Ara h 1 to 3 between baseline and the last time point. The x-axis shows the overlapping peptides. The left y-axis shows the average IgE and IgG4 binding level (represented as the z score) to each peptide. The right y-axis shows the difference in the percentage of patients with positive binding to each peptide between time points. Binding for IgE is indicated above the x-axis line, and binding for IgG4 is indicated below the line. Regions/peptides with significantly (P < .01, FDR < 0.1, as identified by using TileMap) higher binding at baseline than at the last time point are indicated with red triangles, whereas regions with significantly higher binding at the last time point than baseline are indicated with blue triangles. Green boxes labeled A-F indicate regions at which varied concordance of IgE and IgG4 binding is of interest. Journal of Allergy and Clinical Immunology  , e3DOI: ( /j.jaci ) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

7 Fig E1 Peanut OIT induces production of psIgG4. psIgG4 levels were measured by using ImmunoCAP. Box plots represent 10th and 90th percentile data with medians. Error bars denote the entire range. Journal of Allergy and Clinical Immunology  , e3DOI: ( /j.jaci ) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

8 Fig E2 Comparison of IgE and IgG4 binding of control subjects to peptides of Ara h 1 to 3 between baseline and the last time point. The x-axis shows the overlapping peptides, and the y-axis shows the average IgE and IgG4 binding level (represented as the z score) to each peptide. Binding for IgE is indicated above the x-axis line, whereas binding for IgG4 is indicated below the line. Journal of Allergy and Clinical Immunology  , e3DOI: ( /j.jaci ) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

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