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Risemberg EL, Smeekens JM, Cruz Cisneros MC, Hampton BK, Hock P, Linnertz CL, Miller DR, Orgel K, Shaw GD, Manuel de Villena FP, Burks AW, Valdar W, Kulis MD, Ferris MT. A mutation in Themis contributes to anaphylaxis severity following oral peanut challenge in CC027 mice. J Allergy Clin Immunol 2024:S0091-6749(24)00411-1. [PMID: 38670234 DOI: 10.1016/j.jaci.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/12/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The development of peanut allergy is due to a combination of genetic and environmental factors, although specific genes have proven difficult to identify. Previously, we reported that peanut-sensitized CC027/GeniUnc (CC027) mice develop anaphylaxis upon oral challenge to peanut, unlike C3H/HeJ (C3H) mice. OBJECTIVE To determine the genetic basis of orally-induced anaphylaxis to peanut in CC027 mice. METHODS A genetic mapping population between CC027 and C3H mice was designed to identify the genetic factors that drive oral anaphylaxis. A total of 356 CC027xC3H backcrossed mice were generated, sensitized to peanut, then challenged to peanut by oral gavage. Anaphylaxis and peanut-specific IgE were quantified for all mice. T-cell phenotyping was conducted on CC027 and five additional CC strains. RESULTS Anaphylaxis to peanut was absent in 77% of backcrossed mice, with 19% showing moderate anaphylaxis, and 4% having severe anaphylaxis. A total of eight genetic loci were associated with variation in response to peanut challenge, six associated with anaphylaxis (temperature decrease) and two associated with peanut-specific IgE levels. There were two major loci that impacted multiple aspects of the severity of acute anaphylaxis, at which the CC027 allele was associated with worse outcome. At one of these loci, CC027 has a private genetic variant in the Themis (thymocyte-expressed molecule involved in selection) gene. Consistent with Themis' described functions, we found that CC027 have more immature T cells with fewer CD8+, CD4+, and CD4+CD25+CD127- regulatory T cells. CONCLUSION Our results demonstrate a key role for Themis in the orally-reactive CC027 mouse model of peanut allergy.
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Affiliation(s)
- Ellen L Risemberg
- Curriculum in Bioinformatics and Computational Biology, UNC Chapel Hill; Department of Genetics, UNC Chapel Hill
| | - Johanna M Smeekens
- Department of Pediatrics, Division of Allergy and Immunology, UNC Chapel Hill
| | - Marta C Cruz Cisneros
- Department of Genetics, UNC Chapel Hill; Curriculum in Genetics and Molecular Biology, UNC Chapel Hill
| | - Brea K Hampton
- Department of Genetics, UNC Chapel Hill; Curriculum in Genetics and Molecular Biology, UNC Chapel Hill
| | | | | | | | - Kelly Orgel
- Department of Pediatrics, Division of Allergy and Immunology, UNC Chapel Hill
| | - Ginger D Shaw
- Department of Genetics, UNC Chapel Hill; Lineberger Comprehensive Cancer Center, UNC Chapel Hill
| | | | - A Wesley Burks
- Department of Pediatrics, Division of Allergy and Immunology, UNC Chapel Hill
| | - William Valdar
- Department of Genetics, UNC Chapel Hill; Lineberger Comprehensive Cancer Center, UNC Chapel Hill
| | - Michael D Kulis
- Department of Pediatrics, Division of Allergy and Immunology, UNC Chapel Hill
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Barshow SM, Islam M, Commins S, Macauley MS, Paulson JC, Kulis MD. Targeting inhibitory Siglec-3 to suppress IgE-mediated human basophil degranulation. J Allergy Clin Immunol 2024:S0091-6749(24)00332-4. [PMID: 38593870 DOI: 10.1016/j.jaci.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/12/2024] [Accepted: 03/08/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Sialic acid-binding immunoglobulin-like lectin-3 (Siglec-3 [CD33]) is a major Siglec expressed on human mast cells and basophils; engagement of CD33 leads to inhibition of cellular signaling via immunoreceptor tyrosine-based inhibitory motifs. OBJECTIVE We sought to inhibit human basophil degranulation by simultaneously recruiting inhibitory CD33 to the IgE-FcεRI complex by using monoclonal anti-IgE directly conjugated to CD33 ligand (CD33L). METHODS Direct and indirect basophil activation tests (BATs) were used to assess both antigen-specific (peanut) and antigen-nonspecific (polyclonal anti-IgE) stimulation. Whole blood from donors with allergy was used for direct BAT, whereas blood from donors with nonfood allergy was passively sensitized with plasma from donors with peanut allergy in the indirect BAT. Blood was incubated with anti-IgE-CD33L or controls for 1 hour or overnight and then stimulated with peanut, polyclonal anti-IgE, or N-formylmethionyl-leucyl-phenylalanine for 30 minutes. Degranulation was determined by measuring CD63 expression on the basophil surface by flow cytometry. RESULTS Incubation for 1 hour with anti-IgE-CD33L significantly reduced basophil degranulation after both allergen-induced (peanut) and polyclonal anti-IgE stimulation, with further suppression after overnight incubation with anti-IgE-CD33L. As expected, anti-IgE-CD33L did not block basophil degranulation due to N-formylmethionyl-leucyl-phenylalanine, providing evidence that this inhibition is IgE pathway-specific. Finally, CD33L is necessary for this suppression, as monoclonal anti-IgE without CD33L was unable to reduce basophil degranulation. CONCLUSIONS Pretreating human basophils with anti-IgE-CD33L significantly suppressed basophil degranulation through the IgE-FcεRI complex. The ability to abrogate IgE-mediated basophil degranulation is of particular interest, as treatment with anti-IgE-CD33L before antigen exposure could have broad implications for the treatment of food, drug, and environmental allergies.
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Affiliation(s)
- Suzanne M Barshow
- Duke University School of Medicine, Durham, NC; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Scott Commins
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Michael D Kulis
- University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Immormino RM, Smeekens JM, Mathai PI, Clough KM, Nguyen JT, Ghio AJ, Cook DN, Kulis MD, Moran TP. Different airborne particulates trigger distinct immune pathways leading to peanut allergy in a mouse model. Allergy 2024; 79:432-444. [PMID: 37804001 PMCID: PMC11017991 DOI: 10.1111/all.15908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/21/2023] [Accepted: 09/13/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Environmental exposure to peanut through non-oral routes is a risk factor for peanut allergy. Early-life exposure to air pollutants, including particulate matter (PM), is associated with sensitization to foods through unknown mechanisms. We investigated whether PM promotes sensitization to environmental peanut and the development of peanut allergy in a mouse model. METHODS C57BL/6J mice were co-exposed to peanut and either urban particulate matter (UPM) or diesel exhaust particles (DEP) via the airways and assessed for peanut sensitization and development of anaphylaxis following peanut challenge. Peanut-specific CD4+ T helper (Th) cell responses were characterized by flow cytometry and Th cytokine production. Mice lacking select innate immune signaling genes were used to study mechanisms of PM-induced peanut allergy. RESULTS Airway co-exposure to peanut and either UPM- or DEP-induced systemic sensitization to peanut and anaphylaxis following peanut challenge. Exposure to UPM or DEP triggered activation and migration of lung dendritic cells to draining lymph nodes and induction of peanut-specific CD4+ Th cells. UPM- and DEP-induced distinct Th responses, but both stimulated expansion of T follicular helper (Tfh) cells essential for peanut allergy development. MyD88 signaling was critical for UPM- and DEP-induced peanut allergy, whereas TLR4 signaling was dispensable. DEP-induced peanut allergy and Tfh-cell differentiation depended on IL-1 but not IL-33 signaling, whereas neither cytokine alone was necessary for UPM-mediated sensitization. CONCLUSION Environmental co-exposure to peanut and PM induces peanut-specific Tfh cells and peanut allergy in mice.
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Affiliation(s)
- Robert M. Immormino
- Department of Pediatrics, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Center for Environmental Medicine, Asthma, and Lung Biology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Johanna M. Smeekens
- Department of Pediatrics, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- UNC Food Allergy Initiative, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Priscilla I. Mathai
- Department of Pediatrics, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Center for Environmental Medicine, Asthma, and Lung Biology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katelyn M. Clough
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Andrew J. Ghio
- Human Studies Facility, United States Environmental Protection Agency, Chapel Hill, North Carolina, USA
| | - Donald N. Cook
- Division of Intramural Research, Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences, NIH, North Carolina, USA
| | - Michael D. Kulis
- Department of Pediatrics, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- UNC Food Allergy Initiative, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Timothy P. Moran
- Department of Pediatrics, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Center for Environmental Medicine, Asthma, and Lung Biology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Smeekens JM, Kesselring JR, Bagley K, Kulis MD. A Mouse Model of Shrimp Allergy with Cross-Reactivity to Crab and Lobster. Methods Mol Biol 2024; 2717:311-319. [PMID: 37737994 DOI: 10.1007/978-1-0716-3453-0_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Food allergies are a growing public health problem with recent estimates of 10% of the US population affected by this immunologic disease. The quality of life is greatly impaired in food allergic individuals and their caregivers due to constant vigilance and fear of accidental exposure. Shellfish allergies are of particular concern because their prevalence has increased over the past 15 years, now affecting an estimated 3% of the adult population and 1.3% of children in the USA. Additionally, they are rarely outgrown, can result in fatal reactions, and there are no FDA-approved therapies for shellfish allergies. Reactions to one type of shellfish, crustaceans (shrimp, lobster, and crab), can be especially severe. The major crustacean allergens are highly conserved across species, resulting in high cross-reactivity of IgE between shrimp, lobster, and crab in allergic individuals. To develop novel therapies for shellfish allergies, preclinical mouse models are required. In this chapter, we present detailed methodology to induce shrimp allergy in CC027 mice. Once sensitized, mice produce shrimp-specific IgE, that is cross-reactive with lobster and crab, and experience anaphylaxis upon shrimp challenge. This model can be used to further investigate mechanisms of sensitization and preclinical testing of therapies.
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Affiliation(s)
- Johanna M Smeekens
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Janelle R Kesselring
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | - Michael D Kulis
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Kim EH, Bird JA, Keet CA, Virkud YV, Herlihy L, Ye P, Smeekens JM, Guo R, Yue X, Penumarti A, Qaqish B, Li Q, Kulis MD, Burks AW. Desensitization and remission after peanut sublingual immunotherapy in 1- to 4-year-old peanut-allergic children: A randomized, placebo-controlled trial. J Allergy Clin Immunol 2024; 153:173-181.e10. [PMID: 37815782 PMCID: PMC10872748 DOI: 10.1016/j.jaci.2023.08.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/05/2023] [Accepted: 08/25/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Prior studies of peanut sublingual immunotherapy (SLIT) have suggested a potential advantage with younger age at treatment initiation. OBJECTIVE We studied the safety and efficacy of SLIT for peanut allergy in 1- to 4-year-old children. METHODS Peanut-allergic 1- to 4-year-old children were randomized to receive 4 mg peanut SLIT versus placebo. Desensitization was assessed by double-blind, placebo-controlled food challenge (DBPCFC) after 36 months of treatment. Participants desensitized to at least 443 mg peanut protein discontinued therapy for 3 months and then underwent DBPCFC to assess for remission. Biomarkers were measured at baseline and longitudinally during treatment. RESULTS Fifty participants (25 peanut SLIT, 25 placebo) with a median age of 2.4 years were enrolled across 2 sites. The primary end point of desensitization was met with actively treated versus placebo participants having a significantly greater median cumulative tolerated dose (4443 mg vs 143 mg), higher likelihood of passing the month 36 DBPCFC (60% vs 0), and higher likelihood of demonstrating remission (48% vs 0). The highest rate of desensitization and remission was seen in 1- to 2-year-olds, followed by 2- to 3-year-olds and 3- to 4-year-olds. Longitudinal changes in peanut skin prick testing, peanut-specific IgG4, and peanut-specific IgG4/IgE ratio were seen in peanut SLIT but not placebo participants. Oropharyngeal itching was more commonly reported by peanut SLIT than placebo participants. Skin, gastrointestinal, upper respiratory, lower respiratory, and multisystem adverse events were similar between treatment groups. CONCLUSION Peanut SLIT safely induces desensitization and remission in 1- to 4-year-old children, with improved outcomes seen with younger age at initiation.
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Affiliation(s)
- Edwin H Kim
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - J Andrew Bird
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Corinne A Keet
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Yamini V Virkud
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Lauren Herlihy
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Ping Ye
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Johanna M Smeekens
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Rishu Guo
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Xiaohong Yue
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Anusha Penumarti
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Bahjat Qaqish
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Quefeng Li
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael D Kulis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - A Wesley Burks
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
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Canon N, Schein CH, Braun W, Negi SS, Chen X, Kulis MD, Kim EH, Pathy V, Pozzoli M, Liu W, Dreskin SC. Alanine Scanning of the Unstructured Region of Ara h 2 and of a Related Mimotope Reveals Critical Amino Acids for IgE Binding. Mol Nutr Food Res 2023; 67:e2300134. [PMID: 37706599 PMCID: PMC10840829 DOI: 10.1002/mnfr.202300134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/26/2023] [Indexed: 09/15/2023]
Abstract
SCOPE The unstructured region of Ara h 2, referred to as epitope 3, contains a repeated motif, DYPSh (h = hydroxyproline) that is important for IgE binding. METHODS AND RESULTS IgE binding assays to 20mer and shorter peptides of epitope 3, defines a 16mer core sequence containing one copy of the DPYSh motif, DEDSYERDPYShSQDP. This study performs alanine scanning of this and a related 12mer mimotope, LLDPYAhRAWTK. IgE binding, using a pool of 10 sera and with individual sera, is greatly reduced when alanine is substituted for aspartate at position 8 (D8; p < 0.01), tyrosine at position 10 (Y10; p < 0.01), and hydroxyproline at position 12 (h12; p < 0.001). IgE binding to alanine-substituted peptides of a mimotope containing the DPY_h motif confirm the critical importance of Y (p < 0.01) and h (p < 0.01), but not D. Molecular modeling of the core and mimotope suggests an h-dependent conformational basis for the recognition of these sequences by polyclonal IgE. CONCLUSIONS IgE from pooled sera and individual sera differentially bound amino acids throughout the sequences of Epitope 3 and its mimotope, with Y10 and h12 being most important for all sera. These results are highly significant for designing hypoallergenic forms of Ara h 2.
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Affiliation(s)
- Nicole Canon
- Division of Allergy and Immunology, Kelsey-Seybold Clinic, Houston, TX
| | - Catherine H. Schein
- Institute for Human Infections and Immunity (IHII), The University of Texas Medical Branch, Galveston, TX
- Sealy Center for Structural Biology and Molecular Biophysics, The University of Texas Medical Branch, Galveston, TX
| | - Werner Braun
- Sealy Center for Structural Biology and Molecular Biophysics, The University of Texas Medical Branch, Galveston, TX
- Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch, Galveston, TX
| | - Surendra S. Negi
- Sealy Center for Structural Biology and Molecular Biophysics, The University of Texas Medical Branch, Galveston, TX
- Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch, Galveston, TX
| | - Xueni Chen
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado Denver, Aurora, CO
| | - Michael D. Kulis
- Division of Pediatric Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Edwin H. Kim
- Division of Pediatric Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Vidya Pathy
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado Denver, Aurora, CO
| | - Marina Pozzoli
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado Denver, Aurora, CO
| | - Weimin Liu
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado Denver, Aurora, CO
| | - Stephen C. Dreskin
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado Denver, Aurora, CO
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Risemberg EL, Smeekens JM, Cisneros MCC, Hampton BK, Hock P, Linnertz CL, Miller DR, Orgel K, Shaw GD, de Villena FPM, Burks AW, Valdar W, Kulis MD, Ferris MT. A mutation in Themis contributes to peanut-induced oral anaphylaxis in CC027 mice. bioRxiv 2023:2023.09.13.557467. [PMID: 37745496 PMCID: PMC10515941 DOI: 10.1101/2023.09.13.557467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background The development of peanut allergy is due to a combination of genetic and environmental factors, although specific genes have proven difficult to identify. Previously, we reported that peanut-sensitized CC027/GeniUnc (CC027) mice develop anaphylaxis upon oral challenge to peanut, unlike C3H/HeJ (C3H) mice. Objective To determine the genetic basis of orally-induced anaphylaxis to peanut in CC027 mice. Methods A genetic mapping population between CC027 and C3H mice was designed to identify the genetic factors that drive oral anaphylaxis. A total of 356 CC027xC3H backcrossed mice were generated, sensitized to peanut, then challenged to peanut by oral gavage. Anaphylaxis and peanut-specific IgE were quantified for all mice. T-cell phenotyping was conducted on CC027 and five additional CC strains. Results Anaphylaxis to peanut was absent in 77% of backcrossed mice, with 19% showing moderate anaphylaxis, and 4% having severe anaphylaxis. A total of eight genetic loci were associated with variation in response to peanut challenge, six associated with anaphylaxis (temperature decrease) and two associated with peanut-specific IgE levels. There were two major loci that impacted multiple aspects of the severity of acute anaphylaxis, at which the CC027 allele was associated with worse outcome. At one of these loci, CC027 has a private genetic variant in the Themis (thymocyte-expressed molecule involved in selection) gene. Consistent with Themis' described functions, we found that CC027 have more immature T cells with fewer CD8+, CD4+, and CD4+CD25+CD127- regulatory T cells. Conclusion Our results demonstrate a key role for Themis in the orally-reactive CC027 mouse model of peanut allergy.
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Affiliation(s)
- Ellen L. Risemberg
- Curriculum in Bioinformatics and Computational Biology, UNC Chapel Hill
- Department of Genetics, UNC Chapel Hill
| | - Johanna M. Smeekens
- Department of Pediatrics, Division of Allergy and Immunology, UNC Chapel Hill
| | - Marta C. Cruz Cisneros
- Department of Genetics, UNC Chapel Hill
- Curriculum in Genetics and Molecular Biology, UNC Chapel Hill
| | - Brea K. Hampton
- Department of Genetics, UNC Chapel Hill
- Curriculum in Genetics and Molecular Biology, UNC Chapel Hill
| | | | | | | | - Kelly Orgel
- Department of Pediatrics, Division of Allergy and Immunology, UNC Chapel Hill
| | - Ginger D. Shaw
- Department of Genetics, UNC Chapel Hill
- Lineberger Comprehensive Cancer Center, UNC Chapel Hill
| | | | - A. Wesley Burks
- Department of Pediatrics, Division of Allergy and Immunology, UNC Chapel Hill
| | - William Valdar
- Department of Genetics, UNC Chapel Hill
- Lineberger Comprehensive Cancer Center, UNC Chapel Hill
| | - Michael D. Kulis
- Department of Pediatrics, Division of Allergy and Immunology, UNC Chapel Hill
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Abramson L, Smeekens JM, Kulis MD, Dellon ES. Food-specific IgA levels in esophageal biopsies are not sufficiently high to predict food triggers in eosinophilic esophagitis. Immun Inflamm Dis 2023; 11:e1029. [PMID: 37773691 PMCID: PMC10523942 DOI: 10.1002/iid3.1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/29/2023] [Accepted: 09/09/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is an immune-mediated disease, characterized by Th2-type inflammation linked to specific foods. No currently available allergy tests reliably identify food triggers in EoE, leading to empiric dietary elimination strategies. Recently, milk- and wheat-specific IgA in esophageal brushings were linked to clinical food triggers. In this study, we aimed to determine whether food-specific IgA from esophageal biopsies is associated with known food triggers. METHODS A prior cohort of 21 patients (median age 39 years) with confirmed EoE underwent empirical elimination diets and subsequent reintroduction of foods to determine triggers. Archived baseline biopsies were used to quantify levels of peanut-, milk-, soy-, egg-, wheat-specific and total IgA by enzyme-linked immunosorbent assay. RESULTS Overall, 13 patients (62%) responded to the dietary elimination as determined by histology (<15 eos/hpf), with milk and egg being the most common triggers. Biopsies had varying amounts of total IgA, while food-specific IgA was only detectable in 48 of 105 (46%) samples. Food-specific IgA was normalized to total IgA for each sample and stratified by whether a food was a known trigger. For all foods tested, there were no significant differences in IgA between positive and negative triggers. CONCLUSIONS Food-specific IgA in esophageal biopsies was not associated with previously identified food triggers in this cohort. Future studies comparing food-specific IgA in esophageal brushings, mucous scrapings, and biopsies from patients with known triggers will be critical to determining whether food-specific IgA may serve as a biomarker for identification of EoE triggers.
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Affiliation(s)
- Lior Abramson
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and SwallowingUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Johanna M. Smeekens
- Division of Allergy and Immunology, Department of PediatricsUNC School of MedicineChapel HillNorth CarolinaUSA
| | - Michael D. Kulis
- Division of Allergy and Immunology, Department of PediatricsUNC School of MedicineChapel HillNorth CarolinaUSA
| | - Evan S. Dellon
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and SwallowingUniversity of North CarolinaChapel HillNorth CarolinaUSA
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Smeekens JM, Immormino RM, Kesselring JR, Turner AV, Kulis MD, Moran TP. A single priming event prevents oral tolerance to peanut. Clin Exp Allergy 2023; 53:930-940. [PMID: 37437951 PMCID: PMC10528191 DOI: 10.1111/cea.14373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/02/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Indoor dust (ID) is a source of peanut proteins and immunostimulatory adjuvants (e.g. LPS) that can promote airway sensitization to peanut. We aimed to determine whether a single airway exposure to peanut plus adjuvant is sufficient to prevent oral tolerance. METHODS To determine the effect of a single priming event, C57BL/6J mice were exposed once to peanut plus adjuvant through the airway, followed by either airway or low-dose oral exposure to peanut, and assessed for peanut allergy. Oral tolerance was investigated by feeding high-dose peanut followed by airway sensitization. To determine whether a single priming could prevent oral tolerance, the high-dose peanut regimen was applied after a single airway exposure to peanut plus adjuvant. Peanut-specific IgE and IgG1 were quantified, and mice were challenged to peanut to assess allergy. Peanut-specific CD4+ memory T cells (CD4+ TCRβ+ CD44hi CD154+ ) were quantified in mediastinal lymph nodes following airway priming. RESULTS Mice co-exposed to peanut with LPS or ID through the airway were primed to develop peanut allergy after subsequent low-dose oral or airway exposures to peanut. Oral tolerance was induced in mice fed high-dose peanut prior to airway sensitization. In contrast, mice fed high-dose peanut following a single airway exposure to peanut plus adjuvant led to allergy. Peanut-specific CD4+ memory T cells were detected as early as 7 days after the single airway priming with peanut plus adjuvant, however, delaying peanut feeding even 1 day following priming led to allergy, whereas peanut feeding the same day as priming led to tolerance. CONCLUSIONS A single airway exposure to peanut plus adjuvant is sufficient to prime the immune system to develop allergy following subsequent high-dose oral exposure. These results highlight the importance of introducing peanut as early as possible to prevent sensitization through a non-oral priming event.
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Affiliation(s)
- Johanna M Smeekens
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Department of Pediatrics, UNC Food Allergy Initiative, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Robert M Immormino
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Janelle R Kesselring
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Department of Pediatrics, UNC Food Allergy Initiative, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Andrew V Turner
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Department of Pediatrics, UNC Food Allergy Initiative, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael D Kulis
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Department of Pediatrics, UNC Food Allergy Initiative, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Timothy P Moran
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
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Immormino RM, Smeekens JM, Mathai PI, Kesselring JR, Turner AV, Kulis MD, Moran TP. Peanut butter feeding induces oral tolerance in genetically diverse collaborative cross mice. Front Allergy 2023; 4:1219268. [PMID: 37528863 PMCID: PMC10387557 DOI: 10.3389/falgy.2023.1219268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/06/2023] [Indexed: 08/03/2023] Open
Abstract
Background Early dietary introduction of peanut has shown efficacy in clinical trials and driven pediatric recommendations for early introduction of peanut to children with heightened allergy risk worldwide. Unfortunately, tolerance is not induced in every case, and a subset of patients are allergic prior to introduction. Here we assess peanut allergic sensitization and oral tolerance in genetically diverse mouse strains. Objective We aimed to determine whether environmental adjuvant-driven airway sensitization and oral tolerance to peanut could be induced in various genetically diverse mouse strains. Methods C57BL/6J and 12 Collaborative Cross (CC) mouse strains were fed regular chow or ad libitum peanut butter to induce tolerance. Tolerance was tested by attempting to sensitize mice via intratracheal exposure to peanut and lipopolysaccharide (LPS), followed by intraperitoneal peanut challenge. Peanut-specific immunoglobulins and peanut-induced anaphylaxis were assessed. Results Without oral peanut feeding, most CC strains (11/12) and C57BL/6J induced peanut-specific IgE and IgG1 following airway exposure to peanut and LPS. With oral peanut feeding none of the CC strains nor C57BL/6J mice became sensitized to peanut or experienced anaphylaxis following peanut challenge. Conclusion Allergic sensitization and oral tolerance to peanut can be achieved across a range of genetically diverse mice. Notably, the same strains that became allergic via airway sensitization were tolerized by feeding high doses of peanut butter before sensitization, suggesting that the order and route of peanut exposure are critical for determining the allergic fate.
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Affiliation(s)
- Robert M. Immormino
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
| | - Johanna M. Smeekens
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
| | - Priscilla I. Mathai
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
| | - Janelle R. Kesselring
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
| | - Andrew V. Turner
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
| | - Michael D. Kulis
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
| | - Timothy P. Moran
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
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11
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Foo ACY, Nesbit JB, Gipson SAY, DeRose EF, Cheng H, Hurlburt BK, Kulis MD, Kim EH, Dreskin SC, Mustafa S, Maleki SJ, Mueller GA. Structure and IgE Cross-Reactivity among Cashew, Pistachio, Walnut, and Peanut Vicilin-Buried Peptides. J Agric Food Chem 2023; 71:2990-2998. [PMID: 36728846 PMCID: PMC10402694 DOI: 10.1021/acs.jafc.2c07061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Peanut and tree-nut allergies are frequently comorbid for reasons not completely understood. Vicilin-buried peptides (VBPs) are an emerging family of food allergens whose conserved structural fold could mediate peanut/tree-nut co-allergy. Peptide microarrays were used to identify immunoglobulin E (IgE) epitopes from the N-terminus of the vicilin allergens Ara h 1, Ana o 1, Jug r 2, and Pis v 3 using serum from three patient diagnosis groups: monoallergic to either peanuts or cashew/pistachio, or dual allergic. IgE binding peptides were highly prevalent in the VBP domains AH1.1, AO1.1, JR2.1, and PV3.1, but not in AO1.2, JR2.2, JR2.3, and PV3.2 nor the unstructured regions. The IgE profiles did not correlate with diagnosis group. The structure of the VBPs from cashew and pistachio was solved using solution-NMR. Comparisons of structural features suggest that the VBP scaffold from peanuts and tree-nuts can support cross-reactivity. This may help understand comorbidity and cross-reactivity despite a distant evolutionary origin.
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Affiliation(s)
- Alexander C Y Foo
- Genome Integrity and Structural Biology Laboratory, National Institute of Environmental Health Sciences, 111 T.W. Alexander Drive, MD-MR01, Durham, North Carolina 27709, United States
| | - Jacqueline B Nesbit
- Agricultural Research Service, United States Department of Agriculture, 1100 Allen Toussaint Boulevard, New Orleans, Louisiana 70124, United States
| | - Stephen A Y Gipson
- Agricultural Research Service, United States Department of Agriculture, 1100 Allen Toussaint Boulevard, New Orleans, Louisiana 70124, United States
| | - Eugene F DeRose
- Genome Integrity and Structural Biology Laboratory, National Institute of Environmental Health Sciences, 111 T.W. Alexander Drive, MD-MR01, Durham, North Carolina 27709, United States
| | - Hsiaopo Cheng
- Agricultural Research Service, United States Department of Agriculture, 1100 Allen Toussaint Boulevard, New Orleans, Louisiana 70124, United States
| | - Barry K Hurlburt
- Agricultural Research Service, United States Department of Agriculture, 1100 Allen Toussaint Boulevard, New Orleans, Louisiana 70124, United States
| | - Michael D Kulis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7220, United States
| | - Edwin H Kim
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7220, United States
| | - Stephen C Dreskin
- Division of Allergy and Clinical Immunology, University of Colorado Denver School of Medicine, Aurora, Colorado 80045-2560, United States
| | - Shahzad Mustafa
- Rochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, United States
| | - Soheila J Maleki
- Agricultural Research Service, United States Department of Agriculture, 1100 Allen Toussaint Boulevard, New Orleans, Louisiana 70124, United States
| | - Geoffrey A Mueller
- Genome Integrity and Structural Biology Laboratory, National Institute of Environmental Health Sciences, 111 T.W. Alexander Drive, MD-MR01, Durham, North Carolina 27709, United States
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12
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Steinbach EC, Smeekens JM, Roy S, Toyonaga T, Cornaby C, Perini L, Berglind A, Kulis MD, Kim EH, Ferris MT, Furey TS, Burks AW, Sheikh SZ. Intestinal epithelial cell barrier dysfunction and elevated Angiopoietin-like 4 identified in orally susceptible peanut allergy model. Clin Exp Allergy 2023; 53:210-215. [PMID: 36336910 PMCID: PMC9976618 DOI: 10.1111/cea.14248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Erin C. Steinbach
- Division of Rheumatology, Allergy, and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Johanna M. Smeekens
- Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Satyaki Roy
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Genetics, Curriculum in Bioinformatics and Computational Biology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Takahiko Toyonaga
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Caleb Cornaby
- Department of Pathology and Lab Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Layna Perini
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ana Berglind
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Genetics, Curriculum in Bioinformatics and Computational Biology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Michael D. Kulis
- Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Edwin H. Kim
- Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Martin T. Ferris
- Department of Genetics, Curriculum in Bioinformatics and Computational Biology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Terrence S. Furey
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Genetics, Curriculum in Bioinformatics and Computational Biology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A. Wesley Burks
- Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Shehzad Z. Sheikh
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Genetics, Curriculum in Bioinformatics and Computational Biology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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13
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Smeekens JM, Baloh C, Lim N, Larson D, Qin T, Wheatley L, Kim EH, Jones SM, Burks AW, Kulis MD. Peanut-Specific IgG4 and IgA in Saliva Are Modulated by Peanut Oral Immunotherapy. J Allergy Clin Immunol Pract 2022; 10:3270-3275. [PMID: 35944894 PMCID: PMC9742136 DOI: 10.1016/j.jaip.2022.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/07/2022] [Accepted: 07/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Antigen-specific immunoglobulin responses have yet to be studied at the oral mucosal surface during peanut oral immunotherapy (PnOIT). OBJECTIVE We aimed to quantify salivary peanut-specific IgG4 (PNsIgG4) and IgA (PNsIgA) and total IgG4 and IgA in participants from the Immune Tolerance Network's IMPACT study, a phase 2 PnOIT trial. METHODS Peanut-allergic children, aged 12 months to younger than 48 months at screening, were enrolled and randomized to PnOIT or placebo oral immunotherapy (OIT) for 134 weeks. Per-protocol analysis included 69 PnOIT and 23 placebo participants. Double-blind, placebo-controlled food challenges were conducted at weeks 134 and 160 to assess desensitization and remission, respectively. Saliva samples were collected at baseline and 30, 82, 134, and 160 weeks to quantify PNsIgG4, PNsIgA, and total IgG4 and IgA. RESULTS Participants who received PnOIT experienced significant increases in PNsIgG4 in saliva, whereas participants on placebo did not (P < .01 at all time points). The PNsIgA/total IgA ratio was also significantly increased in participants treated with PnOIT when compared with those receiving placebo at 30 and 82 weeks (P < .05). During PnOIT, desensitized participants had increased PNsIgA that plateaued, whereas the not desensitized/no remission group did not change over time. Interestingly, when the PnOIT group was evaluated by clinical outcome, PNsIgA was higher at baseline in the not desensitized/no remission group than in the desensitized/remission group (P < .05). CONCLUSIONS PnOIT induces substantial increases in allergen-specific IgG4 and IgA in saliva. These data provide insight into OIT-induced mucosal responses and suggest the utility of these easily obtained samples for biomarker development.
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Affiliation(s)
- Johanna M Smeekens
- Department of Pediatrics, Division of Allergy and Immunology, UNC School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC
| | | | - Noha Lim
- Immune Tolerance Network, Bethesda, Md
| | | | | | - Lisa Wheatley
- National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health, Bethesda, Md
| | - Edwin H Kim
- Department of Pediatrics, Division of Allergy and Immunology, UNC School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC
| | - Stacie M Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark
| | - A Wesley Burks
- Department of Pediatrics, Division of Allergy and Immunology, UNC School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC
| | - Michael D Kulis
- Department of Pediatrics, Division of Allergy and Immunology, UNC School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC.
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14
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Gonzalez-Visiedo M, Kulis MD, Markusic DM. Manipulating the microbiome to enhance oral tolerance in food allergy. Cell Immunol 2022; 382:104633. [PMID: 36347161 DOI: 10.1016/j.cellimm.2022.104633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/06/2022] [Accepted: 10/18/2022] [Indexed: 01/13/2023]
Abstract
Loss of oral tolerance (OT) to food antigens results in food allergies. One component of achieving OT is the symbiotic microorganisms living in the gut (microbiota). The composition of the microbiota can drive either pro-tolerogenic or pro-inflammatory responses against dietary antigens though interactions with the local immune cells within the gut. Products from bacterial fermentation, such as butyrate, are one of the main communication molecules involved in this interaction, however, this is released by a subset of bacterial species. Thus, strategies to specifically expand these bacteria with protolerogenic properties have been explored to complement oral immunotherapy in food allergy. These approaches either provide digestible biomolecules to induce beneficial bacteria species (prebiotics) or the direct administration of live bacteria species (probiotics). While this combined therapy has shown positive outcomes in clinical trials for cow's milk allergy, more research is needed to determine if this therapy can be extended to other food allergens.
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Affiliation(s)
- Miguel Gonzalez-Visiedo
- Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael D Kulis
- Department of Pediatrics, Division of Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - David M Markusic
- Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA.
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15
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Liu EG, Zhang B, Martin V, Anthonypillai J, Kraft M, Grishin A, Grishina G, Catanzaro JR, Chinthrajah S, Sindher T, Manohar M, Quake AZ, Nadeau K, Burks AW, Kim EH, Kulis MD, Henning AK, Jones SM, Leung DYM, Sicherer SH, Wood RA, Yuan Q, Shreffler W, Sampson H, Shabanova V, Eisenbarth SC. Food-specific immunoglobulin A does not correlate with natural tolerance to peanut or egg allergens. Sci Transl Med 2022; 14:eabq0599. [PMID: 36383680 PMCID: PMC10219469 DOI: 10.1126/scitranslmed.abq0599] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ImmunoglobulinA (IgA) is the predominant antibody isotype in the gut, where it regulates commensal flora and neutralizes toxins and pathogens. The function of food-specific IgA in the gut is unknown but is presumed to protect from food allergy. Specifically, it has been hypothesized that food-specific IgA binds ingested allergens and promotes tolerance by immune exclusion; however, the evidence to support this hypothesis is indirect and mixed. Although it is known that healthy adults have peanut-specific IgA in the gut, it is unclear whether children also have gut peanut-specific IgA. We found in a cohort of non-food-allergic infants (n = 112) that there is detectable stool peanut-specific IgA that is similar to adult quantities of gut peanut-specific IgA. To investigate whether this peanut-specific IgA is associated with peanut tolerance, we examined a separate cohort of atopic children (n = 441) and found that gut peanut-specific IgA does not predict protection from development of future peanut allergy in infants nor does it correlate with concurrent oral tolerance of peanut in older children. We observed higher plasma peanut-specific IgA in those with peanut allergy. Similarly, egg white-specific IgA was detectable in infant stools and did not predict egg tolerance or outgrowth of egg allergy. Bead-based epitope assay analysis of gut peanut-specific IgA revealed similar epitope specificity between children with peanut allergy and those without; however, gut peanut-specific IgA and plasma peanut-specific IgE had different epitope specificities. These findings call into question the presumed protective role of food-specific IgA in food allergy.
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Affiliation(s)
- Elise G. Liu
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06519, USA
- Department of Medicine, Section of Rheumatology, Allergy, and Immunology, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Biyan Zhang
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06519, USA
- Singapore Immunology Network, Agency for Science, Technology, and Research, Singapore 138648, Singapore
| | - Victoria Martin
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA 02115, USA
- Food Allergy Center, Massachusetts General Hospital, MGH Professional Office Building, Suite 530, 275 Cambridge Street, Boston, MA 02114, USA
- Food Allergy Science Initiative, Broad Institute, Cambridge, MA 02142, USA
| | - John Anthonypillai
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06519, USA
- Department of Medicine, Section of Rheumatology, Allergy, and Immunology, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Magdalena Kraft
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Alexander Grishin
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Galina Grishina
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jason R. Catanzaro
- Section of Pulmonology, Allergy, Immunology, and Sleep Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94040, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA
| | - Tina Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94040, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA
| | - Monali Manohar
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94040, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA
| | - Antonia Zoe Quake
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94040, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94040, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA
| | - A. Wesley Burks
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Edwin H. Kim
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Michael D. Kulis
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | | | - Stacie M. Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, AR 72205, USA
| | - Donald Y. M. Leung
- Department of Pediatrics, Division of Pediatric Allergy-Immunology, National Jewish Health, Denver, CO 80206, USA
| | - Scott H. Sicherer
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Robert A. Wood
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Qian Yuan
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA 02115, USA
- Food Allergy Center, Massachusetts General Hospital, MGH Professional Office Building, Suite 530, 275 Cambridge Street, Boston, MA 02114, USA
- Food Allergy Science Initiative, Broad Institute, Cambridge, MA 02142, USA
- Pediatrics at Newton Wellesley, Newton, MA 02462, USA
| | - Wayne Shreffler
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA 02115, USA
- Food Allergy Center, Massachusetts General Hospital, MGH Professional Office Building, Suite 530, 275 Cambridge Street, Boston, MA 02114, USA
- Food Allergy Science Initiative, Broad Institute, Cambridge, MA 02142, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Hugh Sampson
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Stephanie C. Eisenbarth
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06519, USA
- Department of Medicine, Section of Rheumatology, Allergy, and Immunology, Yale University School of Medicine, New Haven, CT 06519, USA
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Kulis MD, Smeekens JM, Burk C, Yue X, Guo R, Orgel KA, Ye P, Herlihy L, Hamilton D, Li Q, Keet C, Shreffler W, Vickery BP, Burks AW, Kim EH. Kinetics of basophil hyporesponsiveness during short-course peanut oral immunotherapy. J Allergy Clin Immunol 2022; 150:1144-1153. [PMID: 35716952 PMCID: PMC9643597 DOI: 10.1016/j.jaci.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/29/2022] [Accepted: 05/24/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Oral immunotherapy (OIT) leads to suppression of mast cell and basophil degranulation along with changes in the adaptive immune response. OBJECTIVES This study aimed to determine how rapidly these effects occur during OIT and more broadly, the kinetics of basophil and mast cell suppression throughout the course of therapy. METHODS Twenty participants, age 4 to 12 years, were enrolled in a peanut OIT trial and assessed for desensitization and sustained unresponsiveness after 9 months of therapy. Blood was collected 5 times in the first month and then intermittently throughout to quantify immunoglobulins and assess basophil activation by CD63, CD203c, and phosphorylated SYK (pSYK). RESULTS Twelve of 16 participants that completed the trial were desensitized after OIT, with 9 achieving sustained unresponsiveness after discontinuing OIT for 4 weeks. Basophil hyporesponsiveness, defined by lower CD63 expression, was detected as early as day 90. pSYK was correlated with CD63 expression, and there was a significant decrease in pSYK by day 250. CD203c expression remained unchanged throughout therapy. Interestingly, although basophil activation was decreased across the cohort during OIT, basophil activation did not correlate with individual clinical outcomes. Serum peanut-specific IgG4 and IgA increased throughout therapy, whereas IgE remained unchanged. CONCLUSIONS Suppression of basophil activation occurs within the first 90 days of peanut OIT, ultimately leading to suppression of signaling through pSYK.
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Affiliation(s)
- Michael D Kulis
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC.
| | - Johanna M Smeekens
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Caitlin Burk
- Food Allergy Center and the Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass
| | - Xiaohong Yue
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Rishu Guo
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Kelly A Orgel
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Ping Ye
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Lauren Herlihy
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Deanna Hamilton
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Quefeng Li
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Corinne Keet
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Wayne Shreffler
- Food Allergy Center and the Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass
| | | | - A Wesley Burks
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Edwin H Kim
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
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17
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Suber J, Zhang Y, Ye P, Guo R, Burks AW, Kulis MD, Smith SA, Iweala OI. Novel peanut-specific human IgE monoclonal antibodies enable screens for inhibitors of the effector phase in food allergy. Front Immunol 2022; 13:974374. [PMID: 36248809 PMCID: PMC9556733 DOI: 10.3389/fimmu.2022.974374] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/09/2022] [Indexed: 11/15/2022] Open
Abstract
Background 10% of US residents have food allergies, including 2% with peanut allergy. Mast cell mediators released during the allergy effector phase drive allergic reactions. Therefore, targeting sensitized mast cells may prevent food allergy symptoms. Objective We used novel, human, allergen-specific, IgE monoclonal antibodies (mAbs) created using human hybridoma techniques to design an in vitro system to evaluate potential therapeutics targeting sensitized effector cells. Methods Two human IgE mAbs specific for peanut, generated through human hybridoma techniques, were used to sensitize rat basophilic leukemia (RBL) SX-38 cells expressing the human IgE receptor (FcϵRI). Beta-hexosaminidase release (a marker of degranulation), cytokine production, and phosphorylation of signal transduction proteins downstream of FcϵRI were measured after stimulation with peanut. Degranulation was also measured after engaging inhibitory receptors CD300a and Siglec-8. Results Peanut-specific human IgE mAbs bound FcϵRI, triggering degranulation after stimulation with peanut in RBL SX-38 cells. Sensitized RBL SX-38 cells stimulated with peanut increased levels of phosphorylated SYK and ERK, signal transduction proteins downstream of FcϵRI. Engaging inhibitory cell surface receptors CD300a or Siglec-8 blunted peanut-specific activation. Conclusion Allergen-specific human IgE mAbs, expressed from human hybridomas and specific for a clinically relevant food allergen, passively sensitize allergy effector cells central to the in vitro models of the effector phase of food allergy. Peanut reproducibly activates and induces degranulation of RBL SX-38 cells sensitized with peanut-specific human IgE mAbs. This system provides a unique screening tool to assess the efficacy of therapeutics that target allergy effector cells and inhibit food allergen-induced effector cell activation.
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Affiliation(s)
- Jada Suber
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, United States
- Department of Medicine, Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, United States
- Department of Pediatrics, Division of Allergy and Immunology, University of North Carolina Food Allergy Initiative, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Yugen Zhang
- Department of Medicine, Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, United States
| | - Ping Ye
- Department of Pediatrics, Division of Allergy and Immunology, University of North Carolina Food Allergy Initiative, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Rishu Guo
- Department of Pediatrics, Division of Allergy and Immunology, University of North Carolina Food Allergy Initiative, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - A. Wesley Burks
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, United States
- Department of Pediatrics, Division of Allergy and Immunology, University of North Carolina Food Allergy Initiative, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Michael D. Kulis
- Department of Pediatrics, Division of Allergy and Immunology, University of North Carolina Food Allergy Initiative, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Scott A. Smith
- Department of Medicine, and Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, United States
| | - Onyinye I. Iweala
- Department of Medicine, Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, United States
- Department of Pediatrics, Division of Allergy and Immunology, University of North Carolina Food Allergy Initiative, University of North Carolina School of Medicine, Chapel Hill, NC, United States
- *Correspondence: Onyinye I. Iweala,
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Smeekens JM, Kesselring JR, Frizzell H, Bagley KC, Kulis MD. Induction of food-specific IgG by Gene Gun-delivered DNA vaccines. Front Allergy 2022; 3:969337. [PMID: 36340020 PMCID: PMC9632862 DOI: 10.3389/falgy.2022.969337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/30/2022] [Indexed: 11/18/2022] Open
Abstract
Background Shellfish and tree nut allergies are among the most prevalent food allergies, now affecting 2%–3% and 1% of the US population, respectively. Currently, there are no approved therapies for shellfish or tree nut allergies, with strict avoidance being the standard of care. However, oral immunotherapy for peanut allergy and subcutaneous immunotherapy for environmental allergens are efficacious and lead to the production of allergen-specific IgG, which causes suppression of allergen effector cell degranulation. Since allergen-specific IgG is a desired response to alleviate IgE-mediated allergies, we tested transcutaneously-delivered DNA vaccines targeting shellfish and tree nut allergens for their ability to induce antigen-specific IgG, which would have therapeutic potential for food allergies. Methods We assessed Gene Gun-delivered DNA vaccines targeting either crustacean shellfish or walnut/pecan allergens, with or without IL-12, in naïve mice. Three strains of mice, BALB/cJ, C3H/HeJ and CC027/GeniUnc, were evaluated for IgG production following vaccination. Vaccines were administered twice via Gene Gun, three weeks apart and then blood was collected three weeks following the final vaccination. Results Vaccination with shellfish allergen DNA led to increased shrimp-specific IgG in all three strains, with the highest production in C3H/HeJ from the vaccine alone, whereas the vaccine with IL-12 led to the highest IgG production in BALB/cJ and CC027/GeniUnc mice. Similar IgG production was also induced against lobster and crab allergens. For walnut/pecan vaccines, BALB/cJ and C3H/HeJ mice produced significantly higher walnut- and pecan-specific IgG with the vaccine alone compared to the vaccine with IL-12, while the CC027 mice made significantly higher IgG with the addition of IL-12. Notably, intramuscular administration of the vaccines did not lead to increased antigen-specific IgG production, indicating that Gene Gun administration is a superior delivery modality. Conclusions Overall, these data demonstrate the utility of DNA vaccines against two lifelong food allergies, shellfish and tree nuts, suggesting their potential as a food allergy therapy in the future.
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Affiliation(s)
- Johanna M. Smeekens
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- Correspondence: Johanna M. Smeekens
| | - Janelle R. Kesselring
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | | | | | - Michael D. Kulis
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
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19
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Gonzalez-Visiedo M, Li X, Munoz-Melero M, Kulis MD, Daniell H, Markusic DM. Single-dose AAV vector gene immunotherapy to treat food allergy. Mol Ther Methods Clin Dev 2022; 26:309-322. [PMID: 35990748 PMCID: PMC9361215 DOI: 10.1016/j.omtm.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022]
Abstract
Immunotherapies for patients with food allergy have shown some success in limiting allergic responses. However, these approaches require lengthy protocols with repeated allergen dosing and patients can relapse following discontinuation of treatment. The purpose of this study was to test if a single dose of an adeno-associated virus (AAV) vector can safely prevent and treat egg allergy in a mouse model. AAV vectors expressing ovalbumin (OVA) under an ubiquitous or liver-specific promoter were injected prior to or after epicutaneous sensitization with OVA. Mice treated with either AAV8-OVA vector were completely protected from allergy sensitization. These animals had a significant reduction in anaphylaxis mediated by a reduction in OVA-specific IgE titers. In mice with established OVA allergy, allergic responses were mitigated only in mice treated with an AAV8-OVA vector expressing OVA from an ubiquitous promoter. In conclusion, an AAV vector with a liver-specific promoter was more effective for allergy prevention, but higher OVA levels were necessary for reducing symptoms in preexisting allergy. Overall, our AAV gene immunotherapy resulted in an expansion of OVA-specific FoxP3+ CD4+ T cells, an increase in the regulatory cytokine IL-10, and a reduction in the IgE promoting cytokine IL-13.
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Affiliation(s)
- Miguel Gonzalez-Visiedo
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, 1044 West Walnut Street, R4-155, Indianapolis, IN 46202, USA
| | - Xin Li
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, 1044 West Walnut Street, R4-155, Indianapolis, IN 46202, USA
| | - Maite Munoz-Melero
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, 1044 West Walnut Street, R4-155, Indianapolis, IN 46202, USA
| | - Michael D Kulis
- Department of Pediatrics, Division of Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC 27599, USA
| | - Henry Daniell
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David M Markusic
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, 1044 West Walnut Street, R4-155, Indianapolis, IN 46202, USA
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Abstract
The prevalence of IgE-mediated food allergies has increased dramatically in the past three decades, now affecting up to 10% of the US population. IgE-mediated food allergy is an immunologic disease, involving a variety of cells, including B and T cells, mast cells, basophils, ILC2s, and epithelial cells. Mouse models of food allergy mimic the overall immunologic processes known to exist in humans. Due to the limitations of invasive sampling of human tissue and the similarities of the human and mouse immune systems, comprehensive pathogenesis studies of food allergy have been performed in mouse models. Mouse models have been effective in elucidating the roles of non-oral routes of sensitization and identifying key cells and molecules involved in allergic sensitization. Furthermore, the development of novel therapeutic approaches for food allergy has been accelerated through the use of pre-clinical mouse models. Despite the groundbreaking findings stemming from research in mice, there are continued efforts to improve the translational utility of these models. Here, we highlight the achievements in understanding food allergy development and efforts to bring novel treatment approaches into clinical trials.
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Affiliation(s)
- Johanna M. Smeekens
- Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, United States
- University of North Carolina Food Allergy Initiative, Chapel Hill, NC, United States
- *Correspondence: Johanna M. Smeekens
| | - Michael D. Kulis
- Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, United States
- University of North Carolina Food Allergy Initiative, Chapel Hill, NC, United States
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21
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Kulis MD, Smeekens JM, Immormino RM, Moran TP. The airway as a route of sensitization to peanut: An update to the dual allergen exposure hypothesis. J Allergy Clin Immunol 2021; 148:689-693. [PMID: 34111450 DOI: 10.1016/j.jaci.2021.05.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 01/17/2023]
Abstract
Food allergies have increased at an alarming rate over the past 2 decades, indicating that environmental factors are driving disease progression. It has been postulated that sensitization to foods, in particular, peanut, occurs through impaired skin. Peanut allergens have been quantified in household dust and may be the culprit source. Indeed, TH2 cell-skewing innate cytokines can be driven by application of food antigens on both intact and impaired skin of mice, resulting in antigen-specific IgE production and anaphylaxis following allergen exposure. However, allergy induction through the skin can be prevented by induction of oral tolerance before skin exposure. These observations led to the dual allergen exposure hypothesis, according to which oral exposure to food antigens leads to tolerance and antigen exposure on impaired skin leads to allergy. Here, we propose the airway as an alternative route of sensitization in the dual allergen exposure hypothesis that leads to food allergy. Specifically, we will provide evidence from mouse models and human cell-based studies that together implicate the airway as a plausible route of sensitization.
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Affiliation(s)
- Michael D Kulis
- Department of Pediatrics, Division of Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC.
| | - Johanna M Smeekens
- Department of Pediatrics, Division of Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Robert M Immormino
- Department of Pediatrics, Division of Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Timothy P Moran
- Department of Pediatrics, Division of Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC
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22
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Abstract
Food allergy presents a significant global health concern with up to 10% of the population affected in developed nations and a steadily increasing prevalence. In many cases, particularly with peanut, tree nut and shellfish, food allergy is a lifelong and potentially life-threatening diagnosis. While no 'cure' for IgE-mediated food allergy exists, oral immunotherapy (OIT) is a promising treatment modality with the peanut OIT drug Palforzia (Aimmune Therapeutics) the only treatment for food allergy that is currently approved by the United States Food and Drug Administration. OIT primarily induces a state of desensitization with only a minority of subjects achieving sustained unresponsiveness, a state of limited clinical remission that appears to be immunologically distinct from natural tolerance. Early humoural changes during OIT include an initial increase in allergen-specific IgE, which eventually decreases to below baseline levels as OIT progresses, and a gradual increase in allergen-specific IgA and IgG4 that continues throughout the course of OIT. Basophil hyporesponsiveness and decreased skin prick test wheal size are observed within the first year of OIT, and persistence after completion of therapy has been associated with sustained unresponsiveness. In the T-cell compartment, there is an initial expansion followed by a decline in the number and activity of T helper 2 (TH 2) cells, the latter of which may be dependent on an expansion of IL-10-producing cells, including regulatory T-cells. Our understanding of the immunomodulatory effects of OIT continues to evolve, with new technologies such as single-cell transcriptional profiling and antibody epitope analysis allowing for more detailed study of T-cell and B-cell responses to OIT. In this review, we present evidence to illustrate what is currently known about the immunologic changes induced by OIT, explore potential mechanisms and emphasize knowledge gaps where future research is needed.
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Affiliation(s)
- Suzanne M Barshow
- University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Michael D Kulis
- University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - A Wesley Burks
- University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Edwin H Kim
- University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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23
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Smeekens JM, Johnson-Weaver BT, Hinton AL, Azcarate-Peril MA, Moran TP, Immormino RM, Kesselring JR, Steinbach EC, Orgel KA, Staats HF, Burks AW, Mucha PJ, Ferris MT, Kulis MD. Fecal IgA, Antigen Absorption, and Gut Microbiome Composition Are Associated With Food Antigen Sensitization in Genetically Susceptible Mice. Front Immunol 2021; 11:599637. [PMID: 33542716 PMCID: PMC7850988 DOI: 10.3389/fimmu.2020.599637] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/25/2020] [Indexed: 01/04/2023] Open
Abstract
Food allergy is a potentially fatal disease affecting 8% of children and has become increasingly common in the past two decades. Despite the prevalence and severe nature of the disease, the mechanisms underlying sensitization remain to be further elucidated. The Collaborative Cross is a genetically diverse panel of inbred mice that were specifically developed to study the influence of genetics on complex diseases. Using this panel of mouse strains, we previously demonstrated CC027/GeniUnc mice, but not C3H/HeJ mice, develop peanut allergy after oral exposure to peanut in the absence of a Th2-skewing adjuvant. Here, we investigated factors associated with sensitization in CC027/GeniUnc mice following oral exposure to peanut, walnut, milk, or egg. CC027/GeniUnc mice mounted antigen-specific IgE responses to peanut, walnut and egg, but not milk, while C3H/HeJ mice were not sensitized to any antigen. Naïve CC027/GeniUnc mice had markedly lower total fecal IgA compared to C3H/HeJ, which was accompanied by stark differences in gut microbiome composition. Sensitized CC027/GeniUnc mice had significantly fewer CD3+ T cells but higher numbers of CXCR5+ B cells and T follicular helper cells in the mesenteric lymph nodes compared to C3H/HeJ mice, which is consistent with their relative immunoglobulin production. After oral challenge to the corresponding food, peanut- and walnut-sensitized CC027/GeniUnc mice experienced anaphylaxis, whereas mice exposed to milk and egg did not. Ara h 2 was detected in serum collected post-challenge from peanut-sensitized mice, indicating increased absorption of this allergen, while Bos d 5 and Gal d 2 were not detected in mice exposed to milk and egg, respectively. Machine learning on the change in gut microbiome composition as a result of food protein exposure identified a unique signature in CC027/GeniUnc mice that experienced anaphylaxis, including the depletion of Akkermansia. Overall, these results demonstrate several factors associated with enteral sensitization in CC027/GeniUnc mice, including diminished total fecal IgA, increased allergen absorption and altered gut microbiome composition. Furthermore, peanuts and tree nuts may have inherent properties distinct from milk and eggs that contribute to allergy.
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Affiliation(s)
- Johanna M. Smeekens
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | | | - Andrew L. Hinton
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- Curriculum in Bioinformatics and Computational Biology, University of North Carolina, Chapel Hill, NC, United States
| | - M. Andrea Azcarate-Peril
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, United States
- UNC Microbiome Core, Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, United States
| | - Timothy P. Moran
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Robert M. Immormino
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Janelle R. Kesselring
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Erin C. Steinbach
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Kelly A. Orgel
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Herman F. Staats
- Department of Pathology, Duke University School of Medicine, Durham, NC, United States
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, United States
- Department of Immunology, Duke University School of Medicine, Durham, NC, United States
| | - A. Wesley Burks
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Peter J. Mucha
- Curriculum in Bioinformatics and Computational Biology, University of North Carolina, Chapel Hill, NC, United States
- Department of Mathematics and Department of Applied Physical Sciences, University of North Carolina, Chapel Hill, NC, United States
| | - Martin T. Ferris
- Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Michael D. Kulis
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
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24
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Penumarti A, Szczepanski N, Kesselring J, Gabel E, Sheth R, Berglund J, Kim EH, Burks AW, Kulis MD. Irradiated Tree Nut Flours for Use in Oral Immunotherapy. J Allergy Clin Immunol Pract 2021; 9:321-327. [PMID: 33217614 DOI: 10.1016/j.jaip.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Tree nut allergies affect an estimated 1% of the US population and is lifelong in 90% of allergic individuals. Oral immunotherapy (OIT) for food allergies is an effective method to induce desensitization in a majority of participants in trials of peanut, egg, and milk OIT. Limited trials using tree nut OIT have been reported, possibly due to the lack of standardized drug products. OBJECTIVE Food products used in OIT are considered drugs by the Food and Drug Administration (FDA) because they are intended to modulate the individuals' immune responses to the food allergens. As such, OIT drug products must meet FDA standards for acceptable levels of microbes and undergo testing for allergenic proteins. We aimed to determine the suitability of walnut, cashew, hazelnut, and almond flours for use in OIT trials. METHODS We employed gamma irradiation on commercially available walnut, cashew, hazelnut, and almond flours and tested their levels of microbial contamination, total protein, and allergen content, along with stability of these parameters over time. RESULTS Our results demonstrate that irradiation of tree nut flours greatly diminishes the levels of total aerobic bacteria, mold, yeast, Escherichia coli, and Salmonella, whereas there are no substantial changes in total protein or allergen content. Importantly, the microbial levels, protein, and allergen content remained stable over a 24-month period. CONCLUSION Irradiation of tree nut flours is a safe and effective method of processing to allow tree nut products to meet the FDA standards for OIT drug products.
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Affiliation(s)
- Anusha Penumarti
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC.
| | - Nicole Szczepanski
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC
| | - Janelle Kesselring
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC
| | - Elizabeth Gabel
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC
| | - Rohini Sheth
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC
| | - Jelena Berglund
- Duke Translational Medicine Institute, Duke University Medical Center, Durham, NC
| | - Edwin H Kim
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A Wesley Burks
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC
| | - Michael D Kulis
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC
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Smeekens JM, Orgel KA, Kesselring J, Bagley K, Kulis MD. Model of Walnut Allergy in CC027/GeniUnc Mice Recapitulates Key Features of Human Disease. Yale J Biol Med 2020; 93:669-673. [PMID: 33380927 PMCID: PMC7757060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Tree nut allergies affect 1% of the United States population, are often severe in nature and rarely outgrown. Despite the severity and prevalence, there are no FDA-approved treatments for tree nut allergy. Development of a therapeutic would be expedited by having a mouse model that mimics the human disease. We utilized the CC027/GeniUnc mouse strain, which was previously identified as an orally reactive model of peanut allergy, to develop a model of walnut allergy. Mice were sensitized with walnut and cholera toxin for 4 weeks and subsequently challenged by oral gavage. Blood samples were collected to measure serum IgE. Walnut-sensitized mice produced high levels of walnut-IgE and were cross-sensitized to pecan. Oral challenges with walnut resulted in severe anaphylaxis and accompanying allergic symptoms. Importantly, pecan challenges also led to severe allergic reactions, indicating cross-reactivity to pecan. Overall, this novel mouse model reproduces key characteristics of human walnut allergy, which provides a platform to develop novel therapies and better understand sensitization mechanisms.
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Affiliation(s)
- Johanna M. Smeekens
- Department of Pediatrics, School of Medicine,
University of North Carolina, Chapel Hill, NC,UNC Food Allergy Initiative, School of Medicine,
University of North Carolina, Chapel Hill, NC,To whom all correspondence should be addressed:
Johanna M. Smeekens, 116 Manning Dr., Room 3004, Chapel Hill, NC 27599; Tel:
919-537-3335, ; ORCID iD: https://orcid.org/0000-0001-9651-3852.
| | - Kelly A. Orgel
- Department of Pediatrics, School of Medicine,
University of North Carolina, Chapel Hill, NC,UNC Food Allergy Initiative, School of Medicine,
University of North Carolina, Chapel Hill, NC
| | - Janelle Kesselring
- Department of Pediatrics, School of Medicine,
University of North Carolina, Chapel Hill, NC,UNC Food Allergy Initiative, School of Medicine,
University of North Carolina, Chapel Hill, NC
| | | | - Michael D. Kulis
- Department of Pediatrics, School of Medicine,
University of North Carolina, Chapel Hill, NC,UNC Food Allergy Initiative, School of Medicine,
University of North Carolina, Chapel Hill, NC
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26
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Smeekens JM, Immormino RM, Kulis MD, Moran TP. Timing of exposure to environmental adjuvants is critical to mitigate peanut allergy. J Allergy Clin Immunol 2020; 147:387-390.e4. [PMID: 32980426 DOI: 10.1016/j.jaci.2020.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/27/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Johanna M Smeekens
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, Chapel Hill, NC.
| | - Robert M Immormino
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC
| | - Michael D Kulis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, Chapel Hill, NC
| | - Timothy P Moran
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC
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Kulis MD, Smeekens JM, Kavanagh K, Jorgensen MJ. Peanut applied to the skin of nonhuman primates induces antigen-specific IgG but not IgE. Immun Inflamm Dis 2020; 8:211-215. [PMID: 32220059 PMCID: PMC7212195 DOI: 10.1002/iid3.296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/23/2020] [Accepted: 02/25/2020] [Indexed: 02/02/2023]
Abstract
Introduction Previous studies in humans support the dual‐allergen exposure hypothesis, and several studies in mouse models have demonstrated that cutaneous exposure to disrupted or intact skin can lead to sensitization to peanut. However, the field lacks definitive evidence that cutaneous exposure leads to peanut allergy in humans or other primates. Methods Peanut extract was applied to the shaved back of the neck of four male and four female African green monkeys three times per week for 4 weeks. An oral food challenge (OFC) was performed the following week by gavage of 200 mg of peanut protein, and vital signs were monitored for 30 minutes post‐OFC. Blood was collected at baseline, day 11, day 32, and 30 minutes post‐OFC. Total IgE, and peanut‐specific immunoglobulin E (IgE) and immunoglobulin G (IgG) were quantified in serum collected throughout the 4 weeks. Histamine was measured in serum collected 30 minutes post‐OFC. Results Peanut‐specific IgE was undetectable at any time points in any of the monkeys, and there was no consistent increase in total IgE. During the oral challenge, none of the monkeys experienced allergic symptoms and histamine levels did not change. However, seven of the eight monkeys produced increasing peanut‐specific IgG by day 32, indicating that repeated skin exposure to peanut is immunogenic. Conclusions Skin exposure to peanut did not lead to sensitization in this study, and monkeys did not experience anaphylaxis upon peanut challenge. However, monkeys produced increased peanut‐specific IgG throughout peanut exposure, indicating that repeated skin exposure to peanut is immunogenic.
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Affiliation(s)
- Michael D Kulis
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina.,Department of Pediatrics, University of North Carolina Food Allergy Initiative, University of North Carolina, Chapel Hill, North Carolina
| | - Johanna M Smeekens
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina.,Department of Pediatrics, University of North Carolina Food Allergy Initiative, University of North Carolina, Chapel Hill, North Carolina
| | - Kylie Kavanagh
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Biomedicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Matthew J Jorgensen
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Abstract
PURPOSE OF REVIEW Investigational allergen immunotherapies (AITs) including oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT) have proven to increase allergen thresholds required to elicit an allergic reaction in a majority of subjects. However, these studies lack consistent biomarkers to predict therapy outcomes. Here, we will review biomarkers that are currently being investigated for AIT. RECENT FINDINGS The mechanisms underlying the therapeutic benefit of AIT involve various cell types, including mast cells, basophils, T cells, and B cells. Skin prick and basophil activation tests assess effector cell sensitivity to allergen and are decreased in subjects on AIT. Allergen-specific IgE increases initially and decreases with continued therapy, while allergen-specific IgG and IgA increase throughout therapy. Allergen-induced regulatory T cells (Tregs) increase throughout therapy and were found to be associated with sustained unresponsiveness after OIT. Subjects on OIT and SLIT have decreased Th2 cytokine production during therapy. Although trends have been reported, a common limitation of these biomarkers is that none are able to reproducibly predict prognosis during AIT. Further studies are needed to expand the currently available biomarker repertoire to provide personalized approaches to AIT.
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Affiliation(s)
- LaKeya C Hardy
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, 116 Manning Dr., Mary Ellen Jones Building Rm 3310, Chapel Hill, NC, 27599, USA.
- UNC Food Allergy Initiative, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Johanna M Smeekens
- UNC Food Allergy Initiative, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Michael D Kulis
- UNC Food Allergy Initiative, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Abstract
Food allergies are a growing public health concern affecting approximately 8% of children and 10% of adults in the United States. Several immunotherapy approaches are under active investigation, including oral immunotherapy, epicutaneous immunotherapy, and sublingual immunotherapy. Each of these approaches uses a similar strategy of administering small, increasing amounts of allergen to the allergic subject. Immunologic studies have described changes in the T-cell compartment, serum and salivary immunoglobulin profile, and mast cell and basophil degranulation status in response to allergens. This review highlights the immunologic changes induced by food allergen-specific immunotherapy and discusses future directions in this field.
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Affiliation(s)
- Johanna M Smeekens
- UNC Department of Pediatrics, UNC Food Allergy Initiative, UNC Chapel Hill, 116 Manning Drive, Mary Ellen Jones Building, Room 3004, Chapel Hill, NC 27599, USA.
| | - Michael D Kulis
- UNC Department of Pediatrics, UNC Food Allergy Initiative, UNC Chapel Hill, 116 Manning Drive, Mary Ellen Jones Building, Room 3004, Chapel Hill, NC 27599, USA
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30
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Smeekens JM, Immormino RM, Balogh PA, Randell SH, Kulis MD, Moran TP. Indoor dust acts as an adjuvant to promote sensitization to peanut through the airway. Clin Exp Allergy 2019; 49:1500-1511. [PMID: 31444814 DOI: 10.1111/cea.13486] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/26/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is growing evidence that environmental peanut exposure through non-oral routes, including the skin and respiratory tract, can result in peanut sensitization. Environmental adjuvants in indoor dust can promote sensitization to inhaled antigens, but whether they contribute to peanut allergy development is unclear. OBJECTIVE We investigated whether indoor dust promotes airway sensitization to peanut and peanut allergy development in mice. METHODS Female and male C57BL/6J mice were exposed via the airways to peanut, indoor dust extract, or both for 2 weeks. Mice were then challenged with peanut and assessed for anaphylaxis. Peanut-specific immunoglobulins, peanut uptake by lung conventional dendritic cells (cDCs), lung innate cytokines, and T cell differentiation in lung-draining lymph nodes were quantified. Innate cytokine production by primary human bronchial epithelial cells exposed to indoor dust was also determined. RESULTS Inhalational exposure to low levels of peanut in combination with indoor dust, but neither alone, resulted in production of peanut-specific IgE and development of anaphylaxis upon peanut challenge. Indoor dust triggered production of innate cytokines in murine lungs and in primary human bronchial epithelial cells. Additionally, inhaled indoor dust stimulated maturation and migration of peanut-laden lung type 1 cDCs to draining lymph nodes. Inhalational exposure to peanut and indoor dust induced peanut-specific T helper 2 cell differentiation and accumulation of T follicular helper cells in draining lymph nodes, which were associated with increased B cell numbers and peanut-specific immunoglobulin production. CONCLUSIONS & CLINICAL RELEVANCE Indoor dust promotes airway sensitization to peanut and development of peanut allergy in mice. Our findings suggest that environmental adjuvants in indoor dust may be determinants of peanut allergy development in children.
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Affiliation(s)
- Johanna M Smeekens
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC.,UNC Food Allergy Initiative, Chapel Hill, NC
| | | | - Peter A Balogh
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC
| | - Scott H Randell
- Department of Cell Biology and Physiology, UNC School of Medicine, Chapel Hill, NC
| | - Michael D Kulis
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC.,UNC Food Allergy Initiative, Chapel Hill, NC
| | - Timothy P Moran
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC
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31
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Kim EH, Yang L, Ye P, Guo R, Li Q, Kulis MD, Burks AW. Long-term sublingual immunotherapy for peanut allergy in children: Clinical and immunologic evidence of desensitization. J Allergy Clin Immunol 2019; 144:1320-1326.e1. [PMID: 31493887 DOI: 10.1016/j.jaci.2019.07.030] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/12/2019] [Accepted: 07/18/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Peanut sublingual immunotherapy (SLIT) for 1 year has been shown to induce modest clinical desensitization in allergic children. Studies of oral immunotherapy, epicutaneous immunotherapy, and SLIT have suggested additional benefit with extended treatment. OBJECTIVE We sought to investigate the safety, clinical effectiveness, and immunologic changes with long-term SLIT in children with peanut allergy. METHODS Children with peanut allergy aged 1 to 11 years underwent extended maintenance SLIT with 2 mg/d peanut protein for up to 5 years. Subjects with peanut skin test wheals of less than 5 mm and peanut-specific IgE levels of less than 15 kU/L were allowed to discontinue therapy early. Desensitization was assessed through a double-blind, placebo-controlled food challenge (DBPCFC) with up to 5000 mg of peanut protein after completion of SLIT dosing. Sustained unresponsiveness was further assessed by using identical DBPCFCs after 2 to 4 weeks without peanut exposure. RESULTS Thirty-seven of 48 subjects completed 3 to 5 years of peanut SLIT, with 67% (32/48) successfully consuming 750 mg or more during DBPCFCs. Furthermore, 25% (12/48) passed the 5000-mg DBPCFC without clinical symptoms, with 10 of these 12 demonstrating sustained unresponsiveness after 2 to 4 weeks. Side effects were reported with 4.8% of doses, with transient oropharyngeal itching reported most commonly. Side effects requiring antihistamine treatment were uncommon (0.21%), and no epinephrine was administered. Peanut skin test wheals, peanut-specific IgE levels, and basophil activation decreased significantly, and peanut-specific IgG4 levels increased significantly after peanut SLIT. CONCLUSION Extended-therapy peanut SLIT provided clinically meaningful desensitization in the majority of children with peanut allergy that was balanced with ease of administration and a favorable safety profile.
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Affiliation(s)
- Edwin H Kim
- Department of Medicine, Division of Rheumatology, Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Luanna Yang
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Ping Ye
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Rishu Guo
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Quefeng Li
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Michael D Kulis
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - A Wesley Burks
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, University of North Carolina School of Medicine, Chapel Hill, NC
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Suber J, Kulis MD, Burks AW. Utilizing Members of the CD300 Multigene Family to Inhibit Mast Cell Degranulation in Peanut Allergy. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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33
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Smeekens J, Immormino R, Kulis MD, Moran TP. House dust promotes sensitization to peanut through the airway. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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34
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Orgel K, Smeekens JM, Ye P, Fotsch L, Guo R, Miller DR, Pardo-Manuel de Villena F, Burks AW, Ferris MT, Kulis MD. Genetic diversity between mouse strains allows identification of the CC027/GeniUnc strain as an orally reactive model of peanut allergy. J Allergy Clin Immunol 2018; 143:1027-1037.e7. [PMID: 30342892 PMCID: PMC7252586 DOI: 10.1016/j.jaci.2018.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 09/17/2018] [Accepted: 10/01/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Improved animal models are needed to understand the genetic and environmental factors that contribute to food allergy. OBJECTIVE We sought to assess food allergy phenotypes in a genetically diverse collection of mice. METHODS We selected 16 Collaborative Cross (CC) mouse strains, as well as the classic inbred C57BL/6J, C3H/HeJ, and BALB/cJ strains, for screening. Female mice were sensitized to peanut intragastrically with or without cholera toxin and then challenged with peanut by means of oral gavage or intraperitoneal injection and assessed for anaphylaxis. Peanut-specific immunoglobulins, T-cell cytokines, regulatory T cells, mast cells, and basophils were quantified. RESULTS Eleven of the 16 CC strains had allergic reactions to intraperitoneal peanut challenge, whereas only CC027/GeniUnc mice reproducibly experienced severe symptoms after oral food challenge (OFC). CC027/GeniUnc, C3H/HeJ, and C57BL/6J mice all mounted a TH2 response against peanut, leading to production of IL-4 and IgE, but only the CC027/GeniUnc mice reacted to OFC. Orally induced anaphylaxis in CC027/GeniUnc mice was correlated with serum levels of Ara h 2 in circulation but not with allergen-specific IgE or mucosal mast cell protease 1 levels, indicating systemic allergen absorption is important for anaphylaxis through the gastrointestinal tract. Furthermore, CC027/GeniUnc, but not C3H/HeJ or BALB/cJ, mice can be sensitized in the absence of cholera toxin and react on OFC to peanut. CONCLUSIONS We have identified and characterized CC027/GeniUnc mice as a strain that is genetically susceptible to peanut allergy and prone to severe reactions after OFC. More broadly, these findings demonstrate the untapped potential of the CC population in developing novel models for allergy research.
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Affiliation(s)
- Kelly Orgel
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, Chapel Hill, NC
| | - Johanna M Smeekens
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, Chapel Hill, NC
| | - Ping Ye
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, Chapel Hill, NC
| | - Lauren Fotsch
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, Chapel Hill, NC
| | - Rishu Guo
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, Chapel Hill, NC
| | - Darla R Miller
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Fernando Pardo-Manuel de Villena
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - A Wesley Burks
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, Chapel Hill, NC
| | - Martin T Ferris
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Michael D Kulis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, Chapel Hill, NC.
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35
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Abstract
Food allergies are a growing public health concern with an estimated 8% of US children affected. Peanut allergies are also on the rise and often do not spontaneously resolve, leaving individuals at-risk for potentially life-threatening anaphylaxis throughout their lifetime. Currently, two forms of peanut immunotherapy, oral immunotherapy (OIT) and epicutaneous immunotherapy (EPIT), are in Phase III clinical trials and have shown promise to induce desensitization in many subjects. However, there are several limitations with OIT and EPIT, such as allergic side effects, daily dosing requirements, and the infrequent outcome of long-term tolerance. Next-generation therapies for peanut allergy should aim to overcome these limitations, which may be achievable with adjuvanted immunotherapy. An adjuvant can be defined as anything that enhances, accelerates, or modifies an immune response to a particular antigen. Adjuvants may allow for lower doses of antigen to be given leading to decreased side effects; may only need to be administered every few weeks or months rather than daily exposures; and may induce a long-lasting protective effect. In this review article, we highlight examples of adjuvants and formulations that have shown pre-clinical efficacy in treating peanut allergy.
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Affiliation(s)
| | - Herman F Staats
- Department of Pathology, Duke University School of Medicine, Durham, NC, United States.,Department of Immunology, Duke University School of Medicine, Durham, NC, United States.,Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, United States
| | - A Wesley Burks
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,University of North Carolina Food Allergy Initiative, Chapel Hill, NC, United States
| | - Michael D Kulis
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,University of North Carolina Food Allergy Initiative, Chapel Hill, NC, United States
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36
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Hardy LC, Orgel K, Duan S, Maleki SJ, Burks AW, Paulson JC, Macauley M, Kulis MD. Using Siglec-engaging Tolerance-inducing Antigenic Liposomes (STALs) to reduce memory B cell responses to the major peanut allergen Ara h 2. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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37
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Kulis MD, Orgel K, Smeekens J, Maleki SJ, Hurlburt BK, Bagley K. A mouse model of walnut allergy mimics key features of the human disease. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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38
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Kulis MD, Patil SU, Wambre E, Vickery BP. Immune mechanisms of oral immunotherapy. J Allergy Clin Immunol 2017; 141:491-498. [PMID: 29288078 DOI: 10.1016/j.jaci.2017.12.979] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/30/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
Oral immunotherapy (OIT) has demonstrated reproducibly successful desensitization in patients with food allergy completing clinical trials and, in some studies, sustained unresponsiveness. These clinical outcomes have been associated with characteristic modifications in the allergen-specific immune response, but a detailed synthesis of OIT's mechanisms of action is lacking. In this rostrum we review the current evidence regarding the human immune response to OIT, explore possible mechanisms, and identify knowledge gaps for future research.
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Affiliation(s)
- Michael D Kulis
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Sarita U Patil
- Department of Pediatrics, Massachusetts General Hospital, Boston, Mass
| | - Erik Wambre
- Department of Immunology, Benaroya Research Institute, Seattle, Wash
| | - Brian P Vickery
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC.
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39
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Bednar KJ, Shanina E, Ballet R, Connors EP, Duan S, Juan J, Arlian BM, Kulis MD, Butcher EC, Fung-Leung WP, Rao TS, Paulson JC, Macauley MS. Human CD22 Inhibits Murine B Cell Receptor Activation in a Human CD22 Transgenic Mouse Model. J Immunol 2017; 199:3116-3128. [PMID: 28972089 DOI: 10.4049/jimmunol.1700898] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/28/2017] [Indexed: 01/12/2023]
Abstract
CD22, a sialic acid-binding Ig-type lectin (Siglec) family member, is an inhibitory coreceptor of the BCR with established roles in health and disease. The restricted expression pattern of CD22 on B cells and most B cell lymphomas has made CD22 a therapeutic target for B cell-mediated diseases. Models to better understand how in vivo targeting of CD22 translates to human disease are needed. In this article, we report the development of a transgenic mouse expressing human CD22 (hCD22) in B cells and assess its ability to functionally substitute for murine CD22 (mCD22) for regulation of BCR signaling, Ab responses, homing, and tolerance. Expression of hCD22 on transgenic murine B cells is comparable to expression on human primary B cells, and it colocalizes with mCD22 on the cell surface. Murine B cells expressing only hCD22 have identical calcium (Ca2+) flux responses to anti-IgM as mCD22-expressing wild-type B cells. Furthermore, hCD22 transgenic mice on an mCD22-/- background have restored levels of marginal zone B cells and Ab responses compared with deficiencies observed in CD22-/- mice. Consistent with these observations, hCD22 transgenic mice develop normal humoral responses in a peanut allergy oral sensitization model. Homing of B cells to Peyer's patches was partially rescued by expression of hCD22 compared with CD22-/- B cells, although not to wild-type levels. Notably, Siglec-engaging antigenic liposomes formulated with an hCD22 ligand were shown to prevent B cell activation, increase cell death, and induce tolerance in vivo. This hCD22 transgenic mouse will be a valuable model for investigating the function of hCD22 and preclinical studies targeting hCD22.
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Affiliation(s)
- Kyle J Bednar
- Immunology Team, Janssen Research and Development, LLC, Raritan, NJ 08869.,Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037
| | - Elena Shanina
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037
| | - Romain Ballet
- Laboratory of Immunology and Vascular Biology, Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305.,Palo Alto Veterans Institute for Research, Palo Alto, CA 94304.,The Center for Molecular Biology and Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - Edward P Connors
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037
| | - Shiteng Duan
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037.,Department of Immunology and Microbial Sciences, The Scripps Research Institute; La Jolla, CA 92037; and
| | - Joana Juan
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037
| | - Britni M Arlian
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037.,Department of Immunology and Microbial Sciences, The Scripps Research Institute; La Jolla, CA 92037; and
| | - Michael D Kulis
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Eugene C Butcher
- Laboratory of Immunology and Vascular Biology, Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305.,Palo Alto Veterans Institute for Research, Palo Alto, CA 94304.,The Center for Molecular Biology and Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | | | - Tadimeti S Rao
- Immunology Team, Janssen Research and Development, LLC, Raritan, NJ 08869
| | - James C Paulson
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037; .,Department of Immunology and Microbial Sciences, The Scripps Research Institute; La Jolla, CA 92037; and
| | - Matthew S Macauley
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037;
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40
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Kulis MD, Burk CM, Yue X, Zhang H, Guo R, Orgel K, Ye P, Vickery BP, Kim E, Burks AW. Six month course of peanut OIT leads to suppression of basophil activation which begins to wane within four weeks after OIT is stopped. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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41
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Orgel K, Kulis MD, Ferris MT, Ye P, Guo R, Miller DR, Pardo-Manuel de Villena F, Burks AW. Antigen Absorption is Correlated With Allergic Reaction Severity Upon Oral Peanut Challenge in Mice. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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42
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Ye P, Kulis MD, Guo R, Kim EH, Vickery BP, Burks AW. Sublingual Immunotherapy (SLIT) Regulates the Expression of Transcription Factors and Interleukins in Peanut Allergic Children. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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43
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Kulis MD, Burk C, Yue X, Zhang H, Steele PH, Hamilton DK, Beavers A, Wright BL, Abraham SN, Vickery BP, Burks AW. Basophil Hyporesponsiveness Following Six Months of Peanut Oral Immunotherapy (OIT) Is Associated with Suppression of Syk Phosphorylation. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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Virkud Y, Vickery BP, Steele PH, Kulis MD, Burks AW. Predictors of Elevated Rates of Adverse Events While on Peanut Oral Immunotherapy. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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45
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Chervinskiy SK, Smeester L, Kulis MD, Peden DB, Vickery BP, Fry RC. Glutathione S-Transferase Mu 1 (GSTM1) Gene Associated with Allergic Rhinitis in a Food Allergy Cohort. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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46
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Orgel K, Wright BL, Guo R, Kulis MD, Burks AW. Oral Tolerance and Unresponsiveness to Allergen Challenge after Immunotherapy Are Not Associated with a Change in B10 Cell Number in Mice. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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47
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Wright BL, Kulis MD, Orgel K, Burks AW, Dawson P, Jones SM, Wood RA, Sicherer SH, Lindblad RW, Stablein D, Liu AH, Leung DY, Vickery BP, Sampson HA. Egg-Specific IgA and IgA2 Are Associated with Sustained Unresponsiveness to Egg Following Oral Immunotherapy. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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48
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Kim EH, Steele PH, Kulis MD, Beavers A, Hamilton DK, Guo R, Vickery BP, Burks AW. Peanut Sublingual Immunotherapy (SLIT) Results in Sustained Unresponsiveness in a Subset of Peanut Allergic Children. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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49
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Yancey AL, Kulis MD, Steele PH, Kim E, Vickery BP, Burks AW. Increases In Peanut-Specific IgA1 and IgA2 During Peanut Immunotherapy Do Not Correlate With Clinical Tolerance. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kulis MD, Guo R, Vickery BP, Steele PH, Kim E, Burks AW. Length Of Avoidance Period Following Peanut Oral Immunotherapy Influences Effector Cell Suppression and Clinical Outcomes. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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