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Keet CA, Wood RA, Dantzer J, Plesa M, Taneja I, Andre M, Shreffler W, Togias A, Pistiner M. Frequency and predictors of multisystem reactions to peanut in infant oral food challenges. J Allergy Clin Immunol Pract 2024; 12:252-254. [PMID: 37852442 DOI: 10.1016/j.jaip.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/20/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Corinne A Keet
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC.
| | - Robert A Wood
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Jennifer Dantzer
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Mihaela Plesa
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Isha Taneja
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, MassGeneral for Children, Harvard Medical School, Boston, Mass
| | - Mharlove Andre
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, MassGeneral for Children, Harvard Medical School, Boston, Mass
| | - Wayne Shreffler
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, MassGeneral for Children, Harvard Medical School, Boston, Mass
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Washington, DC
| | - Michael Pistiner
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, MassGeneral for Children, Harvard Medical School, Boston, Mass
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Keet C, Sicherer SH, Bunyavanich S, Visness C, Fulkerson PC, Togias A, Davidson W, Perry S, Hamrah S, Calatroni A, Robinson K, Dunaway L, Davis CM, Anvari S, Leong-Kee SM, Hershey GK, DeFranco E, Devonshire A, Kim H, Joseph C, Davidson B, Strong NK, Tsuang AJ, Groetch M, Wang J, Dantzer J, Mudd K, Aina A, Shreffler W, Yuan Q, Simmons V, Leung DY, Hui-Beckman J, Ramos JA, Chinthrajah S, Winn V, Sindher T, Jones SM, Manning NA, Scurlock AM, Kim E, Stuebe A, Gern JE, Singh AM, Krupp J, Wood RA. The SunBEAm birth cohort: Protocol design. J Allergy Clin Immunol Glob 2023; 2:100124. [PMID: 37771674 PMCID: PMC10509956 DOI: 10.1016/j.jacig.2023.100124] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 09/30/2023]
Abstract
Background Food allergy (FA) and atopic dermatitis (AD) are common conditions that often present in the first year of life. Identification of underlying mechanisms and environmental determinants of FA and AD is essential to develop and implement effective prevention and treatment strategies. Objectives: We sought to describe the design of the Systems Biology of Early Atopy (SunBEAm) birth cohort. Methods Funded by the National Institute of Allergy and Infectious Diseases (NIAID) and administered through the Consortium for Food Allergy Research (CoFAR), SunBEAm is a US population-based, multicenter birth cohort that enrolls pregnant mothers, fathers, and their newborns and follows them to 3 years. Questionnaire and biosampling strategies were developed to apply a systems biology approach to identify environmental, immunologic, and multiomic determinants of AD, FA, and other allergic outcomes. Results Enrollment is currently underway. On the basis of an estimated FA prevalence of 6%, the enrollment goal is 2500 infants. AD is defined on the basis of questionnaire and assessment, and FA is defined by an algorithm combining history and testing. Although any FA will be recorded, we focus on the diagnosis of egg, milk, and peanut at 5 months, adding wheat, soy, cashew, hazelnut, walnut, codfish, shrimp, and sesame starting at 12 months. Sampling includes blood, hair, stool, dust, water, tape strips, skin swabs, nasal secretions, nasal swabs, saliva, urine, functional aspects of the skin, and maternal breast milk and vaginal swabs. Conclusions The SunBEAm birth cohort will provide a rich repository of data and specimens to interrogate mechanisms and determinants of early allergic outcomes, with an emphasis on FA, AD, and systems biology.
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Affiliation(s)
- Corinne Keet
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | | | | | | | - Patricia C. Fulkerson
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Wendy Davidson
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Susan Perry
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Sanaz Hamrah
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | | | | | - Lars Dunaway
- Rho Inc, Federal Research Operations, Durham, NC
| | - Carla M. Davis
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Sara Anvari
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Susan M. Leong-Kee
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex
| | | | | | | | | | | | | | | | | | | | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jennifer Dantzer
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Kim Mudd
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Abimbola Aina
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Qian Yuan
- Massachusetts General Hospital, Newton-Wellesley Hospital, Newton, Mass
| | - Virginia Simmons
- Massachusetts General Hospital, Newton-Wellesley Hospital, Newton, Mass
| | | | | | | | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, Calif
| | - Virginia Winn
- Division Maternal Fetal Medicine and Obstetrics, Stanford University, Palo Alto, Calif
| | - Tina Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, Calif
| | - Stacie M. Jones
- University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Ark
| | | | - Amy M. Scurlock
- University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Ark
| | - Edwin Kim
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Alison Stuebe
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC
| | - James E. Gern
- Department of Pediatrics, University of Wisconsin, Madison, Wis
| | | | - Jennifer Krupp
- Maternal and Fetal Medicine, Obstetrics and Gynecology, SSM Health, Madison, Wis
| | - Robert A. Wood
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Md
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Ramirez L, Roy I, Taneja I, Yap S, Mendez-Reyes J, Andre M, Hazi A, Esteban C, Ongaro Z, Pan L, Shreffler W, Pistiner M. Systemic Reactions in Infants and Toddlers: A Prospective Study of Oral Food Challenge Outcomes. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.689] [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: 02/05/2023]
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Davis CM, Lange L, Beyer K, Fleischer DM, Ford L, Sussman G, Oriel RC, Pongracic JA, Shreffler W, Bee KJ, Campbell DE, Green TD, Lambert R, Peillon A, Bégin P. Efficacy and safety of peanut epicutaneous immunotherapy in patients with atopic comorbidities. J Allergy Clin Immunol Glob 2023; 2:69-75. [PMID: 37780103 PMCID: PMC10509968 DOI: 10.1016/j.jacig.2022.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 10/03/2023]
Abstract
Background Co-occurring atopic conditions are common in children with peanut allergy. As such, it is important to examine the safety and efficacy of epicutaneous immunotherapy with Viaskin Peanut 250 μg patch (VP250) in peanut-allergic children with these conditions. Objective We sought to compare efficacy and safety of VP250 versus placebo in peanut-allergic children with/without ongoing atopic conditions at baseline, including asthma, atopic dermatitis/eczema, or concomitant food allergy. Methods A subgroup analysis of peanut-allergic children aged 4 to 11 years enrolled in PEPITES (12 months) and REALISE (6 months) randomized, placebo-controlled, phase 3 trials was conducted. The efficacy outcome measure was the difference in prespecified responder rate between placebo and VP250 groups at month 12 based on eliciting dose of peanut protein using double-blind, placebo-controlled food challenge in PEPITES. Safety profiles were evaluated by baseline concomitant disease subgroup in all randomized subjects who received 1 or more dose of the study drug in PEPITES and REALISE pooled data. Results Responder rates were significantly (P < .05, all comparisons) greater with VP250 compared with placebo treatment regardless of whether subjects had other atopic conditions. Safety and tolerability profiles were generally similar across subgroups, with no new safety concerns detected. A trend for both higher responder rates and rates of local reactions was observed in subjects with baseline atopic dermatitis versus those without. In subjects with concomitant food allergy at baseline, higher rates of treatment-emergent adverse events, but not study discontinuations or overall rates of anaphylaxis, were observed. Conclusions The results support the safety and efficacy of VP250 for treating peanut-allergic children with or without concomitant atopic conditions.
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Affiliation(s)
- Carla M. Davis
- Department of Pediatrics, Immunology, Allergy and Retrovirology Section, Baylor College of Medicine, Houston, Tex
| | - Lars Lange
- Department of Pediatrics, St. Marien Hospital Bonn, Bonn, Germany
| | - Kirsten Beyer
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Universitatsmedizin Berlin, Berlin, Germany
| | - David M. Fleischer
- Children’s Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Colo
| | - Lara Ford
- Department of Allergy and Immunology, The Children’s Hospital at Westmead, Sydney, Australia
- Discipline of Child and Adolescent Health, University of Sydney School of Medicine, Sydney, Australia
| | - Gordon Sussman
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Gordon Sussman Clinical Research, Toronto, Ontario, Canada
| | - Roxanne C. Oriel
- Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Wayne Shreffler
- Food Allergy Center, Departments of Pediatrics and Medicine, Massachusetts General Hospital, Boston, Mass
| | | | | | - Todd D. Green
- DBV Technologies SA, Montrouge, France
- UPMC Children’s Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | | | | | - Philippe Bégin
- Oral Immunotherapy Clinic, CHU Sainte-Justine, Montreal, Quebec, Canada
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Liu A, Shreffler W, Rosenberg C. Food Protein-induced Enterocolitis Syndrome: Outcomes from Standardized Oral Food Challenges. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.304] [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: 02/05/2023]
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Groetch M, Mudd K, Woch M, Schaible A, Gray BE, Babineau DC, Bird JA, Jones S, Kim EH, Lanser BJ, Poyser J, Rogers N, Shreffler W, Sicherer S, Spergel AKR, Spergel J, Vickery BP, Chinthrajah RS, Wood R. Retail Food Equivalents for Post-Oral Immunotherapy Dosing in the Omalizumab as Monotherapy and as Adjunct Therapy to Multi-Allergen Oral Immunotherapy in Food-Allergic Children and Adults (OUtMATCH) Clinical Trial. J Allergy Clin Immunol Pract 2023; 11:572-580.e2. [PMID: 37113037 PMCID: PMC10147955 DOI: 10.1016/j.jaip.2022.10.022] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients with food allergy may be advised to introduce specific foods into their diets, both to increase tolerance gradually and as next steps after completing oral immunotherapy or other therapeutic interventions. However, the safe use of retail foods depends on the ability to establish the specific allergen protein content of these foods. OBJECTIVE To develop a systematic approach to estimate the protein content of peanut, milk, egg, wheat, cashew, hazelnut, and walnut in a variety of retail food equivalents for each allergen and associated patient education materials. METHOD We created an algorithm that used a multistep process with information from product food labels, nutrient databases, independent weighing and measuring of foods, and information provided by manufacturers, including certificates of analysis, and e-mail communication to estimate the allergen protein content of multiple retail foods for each of seven allergens. Once a variety of retail food equivalents for each allergen and allergen serving size was determined, we developed participant education handouts, which were reviewed by study teams at 10 food allergy centers, the National Institute of Allergy and Infectious Diseases, and the Consortium for Food Allergy Research coordinating center. After 1 year of use, multiple queries were addressed and the retail food equivalents and educational materials were reviewed and edited. RESULTS We identified a variety of retail food equivalents for seven allergens at six serving sizes, and created 48 unique patient education materials. CONCLUSION Our results provide extensive guidance on a variety of retail equivalents for seven foods, and a method to estimate retail food protein equivalents systematically with ongoing reassessment.
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Affiliation(s)
- Marion Groetch
- Jaffe Food Allergy Institute, Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Kim Mudd
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Margaret Woch
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Allison Schaible
- Jaffe Food Allergy Institute, Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brianna E Gray
- Translational and Clinical Research Centers, Massachusetts General Hospital, Boston, Mass
| | | | - J Andrew Bird
- Division of Allergy and Immunology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stacie Jones
- Division of Allergy and Immunology, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark
| | - Edwin H Kim
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Bruce J Lanser
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Julian Poyser
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | | | - Wayne Shreffler
- Translational and Clinical Research Centers, Massachusetts General Hospital, Boston, Mass
| | - Scott Sicherer
- Jaffe Food Allergy Institute, Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amanda K Rudman Spergel
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Jonathan Spergel
- Center for Pediatric Eosinophilic Diseases, Division of Allergy-Immunology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Brian P Vickery
- Division of Allergy/Immunology at Emory University and Children's Healthcare of Atlanta, Atlanta, Ga
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Robert Wood
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
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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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9
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Chinthrajah RS, Jones SM, Kim EH, Sicherer SH, Shreffler W, Lanser BJ, Atri N, Babineau DC, Adelman DC, Iqbal A, Limb SL, Rudman Spergel AK, Togias A, Wood RA. Updating the CoFAR Grading Scale for Systemic Allergic Reactions in Food Allergy. J Allergy Clin Immunol 2022; 149:2166-2170.e1. [PMID: 35026206 PMCID: PMC9177543 DOI: 10.1016/j.jaci.2021.12.789] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 09/03/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Immunotherapy is promising as an efficacious treatment for food allergy. Other food allergy treatments are also under development. However, adverse allergic events during treatment, as well as during oral food challenges, are common and reporting is not standardized. OBJECTIVE A more nuanced grading scale is needed to create a comprehensive and universal system to categorize adverse events and their severity for food allergy clinical trials. METHODS Starting with the 2012 Consortium for Food Allergy Research (CoFAR) Grading Scale and the World Allergy Organization Grading System, we developed the CoFAR Grading Scale for Systemic Allergic Reactions, Version 3.0, in collaboration with industry partners with expert opinion. RESULTS The revised CoFAR Grading Scale for Systemic Allergic Reactions has 5 levels of increasing severity, ranging from generalized urticaria, localized angioedema, rhinitis, and abdominal pain (grade 1) to death (grade 5). Systemic reactions are further categorized within each grade by relevant organ system. Mild, single-system reactions are differentiated from mild, multisystem reactions. Lower respiratory tract symptoms are graded on the basis of response to therapy; those that are refractory to standard treatment (eg, requiring >3 doses of intramuscular epinephrine, continuous intravenous epinephrine infusion, and continuous albuterol nebulization) and respiratory compromise requiring mechanical ventilation are classified as grade 4, life-threatening reactions. CONCLUSIONS Universal and consistent use of the revised CoFAR Grading Scale beyond the CoFAR centers would allow for better data aggregation and safety comparisons in clinical trials for food allergy.
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Affiliation(s)
- R. Sharon Chinthrajah
- Sean N Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, CA
| | - Stacie M. Jones
- University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, AR
| | - Edwin H Kim
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Scott H. Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children’s Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York
| | - Wayne Shreffler
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Bruce J. Lanser
- Department of Pediatrics, National Jewish Health, Denver, CO
| | - Negin Atri
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD
| | | | - Daniel C. Adelman
- Department of Medicine, Allergy/Immunology, University of California, San Francisco
| | - Ahmar Iqbal
- Medical Affairs, Genentech/Roche, South San Francisco, CA
| | | | - Amanda K. Rudman Spergel
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD
| | - Robert A. Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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10
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Baker J, Beyer K, du Toit G, Shreffler W, Brown KR, Norval D, Vereda A, Adelman D, Jones SM, Burks W, Casale T. Reply. J Allergy Clin Immunol 2022; 150:230-232. [PMID: 35491264 DOI: 10.1016/j.jaci.2022.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022]
Affiliation(s)
- James Baker
- Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, Mich.
| | | | - George du Toit
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | - Daniel Adelman
- Aimmune Therapeutics, Brisbane, Calif; Department of Medicine, University of California San Francisco, San Francisco, Calif
| | - Stacie M Jones
- University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark
| | - Wesley Burks
- Department of Pediatrics, University of North Carolina Food Allergy Initiative, Division of Allergy, Immunology and Rheumatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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11
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Burk C, Morgan D, Ruiter B, Yuan Q, Love JC, Shreffler W. IFNG is constitutively expressed by esophagus-resident CD8+ T cells and is poised to mediate a disease-specific effect via its action on IFNGR+ eosinophils during active EoE. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.025] [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: 10/19/2022]
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12
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Swensen A, Stieb E, Hesterberg P, Küpper V, Shreffler W, Virkud Y, Rosenberg C. Analysis of Oral Food Challenge Outcomes to Sesame. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.390] [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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13
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Marget M, Martin V, Virkud Y, Seay H, Rosow R, Yuan Q, Shreffler W. Impact of the LEAP Study on Age at Introduction of Peanut in a Suburban U.S. Cohort. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.364] [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: 11/30/2022]
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14
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Stidham S, Villareal V, Chellappa V, Yoder L, Alley O, Shreffler W, Spergel J, Fleischer D, Sampson H, Gilboa-Geffen A. Aptamer based point of care diagnostic for the detection of food allergens. Sci Rep 2022; 12:1303. [PMID: 35079047 PMCID: PMC8789827 DOI: 10.1038/s41598-022-05265-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/07/2022] [Indexed: 02/07/2023] Open
Abstract
Aptamers, due to their small size, strong target affinity, and ease of chemical modification, are ideally suited for molecular detection technologies. Here, we describe successful use of aptamer technology in a consumer device for the detection of peanut antigen in food. The novel aptamer-based protein detection method is robust across a wide variety of food matrices and sensitive to peanut protein at concentrations as low as 12.5 ppm (37.5 µg peanut protein in the sample). Integration of the assay into a sensitive, stable, and consumer friendly portable device will empower users to easily and quickly assess the presence of peanut allergens in foods before eating. With many food reactions occurring outside the home, the type of technology described here has significant potential to improve lives for children and families.
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15
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Bartsch YC, St Denis KJ, Kaplonek P, Kang J, Lam EC, Burns MD, Farkas EJ, Davis JP, Boribong BP, Edlow AG, Fasano A, Shreffler W, Zavadska D, Johnson M, Goldblatt D, Balazs AB, Yonker LM, Alter G. Comprehensive antibody profiling of mRNA vaccination in children. bioRxiv 2022:2021.10.07.463592. [PMID: 35018376 PMCID: PMC8750651 DOI: 10.1101/2021.10.07.463592] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
While children have been largely spared from COVID-19 disease, the emergence of viral variants of concern (VOC) with increased transmissibility, combined with fluctuating mask mandates and school re-openings have led to increased infections and disease among children. Thus, there is an urgent need to roll out COVID-19 vaccines to children of all ages. However, whether children respond equivalently to adults to mRNA vaccines and whether dosing will elicit optimal immunity remains unclear. Given the recent announcement of incomplete immunity induced by the pediatric dose of the BNT162b2 vaccine in young children, here we aimed to deeply profile and compare the vaccine-induced humoral immune response in 6-11 year old children receiving the pediatric (50μg) or adult (100μg) dose of the mRNA-1273 vaccine compared to adults and naturally infected children or children that experienced multi inflammatory syndrome in children (MIS-C) for the first time. Children elicited an IgG dominant vaccine induced immune response, surpassing adults at a matched 100μg dose, but more variable immunity at a 50μg dose. Irrespective of titer, children generated antibodies with enhanced Fc-receptor binding capacity. Moreover, like adults, children generated cross-VOC humoral immunity, marked by a decline of omicron receptor binding domain-binding, but robustly preserved omicron Spike-receptor binding, with robustly preserved Fc-receptor binding capabilities, in a dose dependent manner. These data indicate that while both 50μg and 100μg of mRNA vaccination in children elicits robust cross-VOC antibody responses, 100ug of mRNA in children results in highly preserved omicron-specific functional humoral immunity.
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Affiliation(s)
| | | | - Paulina Kaplonek
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA, USA
- Massachusetts General Hospital Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Vincent Center for Reproductive Biology, Boston, MA, USA
- Massachusetts General Hospital Food Allergy Center, Division of Pediatric Allergy and Immunology, Boston, MA, USA
- Children's Clinical University Hospital, Riga, Latvia
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | - Jaewon Kang
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Evan C Lam
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Madeleine D Burns
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA, USA
| | - Eva J Farkas
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA, USA
| | - Jameson P Davis
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA, USA
| | - Brittany P Boribong
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA, USA
| | - Andrea G Edlow
- Massachusetts General Hospital Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Vincent Center for Reproductive Biology, Boston, MA, USA
| | - Alessio Fasano
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA, USA
| | - Wayne Shreffler
- Massachusetts General Hospital Food Allergy Center, Division of Pediatric Allergy and Immunology, Boston, MA, USA
| | - Dace Zavadska
- Children's Clinical University Hospital, Riga, Latvia
| | - Marina Johnson
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | - David Goldblatt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | | | - Lael M Yonker
- Massachusetts General Hospital Department of Pediatrics, Mucosal Immunology and Biology Research Center, Boston, MA, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
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16
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Brown KR, Baker J, Vereda A, Beyer K, Burks AW, du Toit G, O'B Hourihane J, Jones SM, Norval D, Dana A, Shreffler W, Vickery BP, Casale T, Skeel B, Adelman D. Safety of Peanut (Arachis hypogaea) Allergen Powder-dnfp in Children and Teenagers With Peanut Allergy: A Pooled Summary of Phase 3 and Extension Trials. J Allergy Clin Immunol 2021; 149:2043-2052.e9. [PMID: 34971646 DOI: 10.1016/j.jaci.2021.12.780] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 12/09/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Peanut (Arachis hypogaea) allergen powder-dnfp (PTAH; previously known as AR101) is a daily oral immunotherapy approved to mitigate allergic reactions following accidental peanut exposure in peanut-allergic individuals aged 4-17 years. OBJECTIVE To comprehensively summarize the PTAH safety profile for up to ∼2 years of treatment. METHODS Safety and adverse event (AE) data from participants aged 4-17 years from three controlled, phase 3 and two open-label extension trials were pooled and assessed. RESULTS Of the 944 individuals receiving ≥1 PTAH dose, median exposure was ∼49 weeks; most participants experienced ≥1 treatment-related AE (TRAE; n=853; 90.4%). A total of 829 participants experienced TRAEs with a maximum severity of mild (n=497; 52.6%) or moderate (n=332; 35.2%); 24 participants (2.5%) experienced TRAEs graded as severe. Overall, 80 (9.5%) participants discontinued due to AEs; most experienced gastrointestinal symptoms and discontinued during the first 6 months. When adjusted for exposure, AEs and TRAEs occurred at a rate of 76.4 and 58.7 events/participant-year of exposure (PYE), respectively, during updosing; AEs and TRAEs decreased to 23.0 and 14.2, respectively, during 300-mg maintenance. Overall, exposure-adjusted rates of systemic allergic reactions were 0.12 events/PYE (mild), 0.11 events/PYE (moderate), and 0.01 events/PYE (severe [anaphylaxis]). CONCLUSION The safety profile of PTAH was consistent across trials, manageable, and improved over time. AEs were predominantly mild to moderate and all grades declined in frequency with continued treatment. These data can be used to facilitate shared decision-making discussions with patients and families considering treatment with PTAH. CLINICAL IMPLICATIONS During treatment with PTAH, the majority of children and teenagers experienced allergic symptoms that decreased in frequency and severity over time. These symptoms were consistent across PTAH trials, comparable with other allergen immunotherapies, and are familiar to allergists who practice allergen immunotherapy.
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Affiliation(s)
- Kari R Brown
- Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, CA, USA.
| | - James Baker
- Mary H Weiser Food Allergy Center, University of Michigan, Ann Arbor, MI, USA
| | - Andrea Vereda
- Aimmune Therapeutics, a Nestlé Health Science company, London, United Kingdom
| | | | - A Wesley Burks
- Department of Pediatrics, University of North Carolina Food Allergy Initiative, Division of Allergy, Immunology and Rheumatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - George du Toit
- Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Stacie M Jones
- University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA
| | - David Norval
- Aimmune Therapeutics, a Nestlé Health Science company, London, United Kingdom
| | - Adrian Dana
- Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, CA, USA
| | | | | | | | - Ben Skeel
- Aimmune Therapeutics, a Nestlé Health Science company, London, United Kingdom
| | - Daniel Adelman
- Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, CA, USA; Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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17
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Keet C, Shreffler W, Togias A, Pistiner M. Reply. J Allergy Clin Immunol 2021; 148:275. [PMID: 33966897 DOI: 10.1016/j.jaci.2021.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Corinne Keet
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
| | - Wayne Shreffler
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Mass General Hospital for Children, Harvard Medical School, Boston, Mass
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Michael Pistiner
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Mass General Hospital for Children, Harvard Medical School, Boston, Mass
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18
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Keet C, Shreffler W, Wood R, Togias A, Pistiner M. Reply. J Allergy Clin Immunol 2021; 148:273. [PMID: 33926728 DOI: 10.1016/j.jaci.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Corinne Keet
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
| | - Wayne Shreffler
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Mass General Hospital for Children, Harvard Medical School, Boston, Mass
| | - Robert Wood
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Michael Pistiner
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Mass General Hospital for Children, Harvard Medical School, Boston, Mass
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19
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Keet C, Plesa M, Szelag D, Shreffler W, Wood R, Dunlop J, Peng R, Dantzer J, Hamilton RG, Togias A, Pistiner M. Ara h 2–specific IgE is superior to whole peanut extract–based serology or skin prick test for diagnosis of peanut allergy in infancy. J Allergy Clin Immunol 2021; 147:977-983.e2. [DOI: 10.1016/j.jaci.2020.11.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 12/23/2022]
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20
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Keet C, Pistiner M, Plesa M, Szelag D, Shreffler W, Wood R, Dunlop J, Peng R, Dantzer J, Togias A. Age and eczema severity, but not family history, are major risk factors for peanut allergy in infancy. J Allergy Clin Immunol 2021; 147:984-991.e5. [PMID: 33483153 PMCID: PMC8462937 DOI: 10.1016/j.jaci.2020.11.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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: 07/28/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Whether to screen high-risk groups before early peanut introduction is controversial. OBJECTIVE We sought to determine the risk of peanut allergy (PA) before peanut introduction for infants with (1) moderate-severe eczema, (2) another food allergy (FA), and/or (3) a first-degree relative with peanut allergy (FH). METHODS Infants aged 4 to 11 months with no history of peanut ingestion, testing, or reaction and at least 1 of the above risk factors received peanut skin prick test and, depending on skin prick test wheal size, oral food challenge or observed feeding. RESULTS A total of 321 subjects completed the enrollment visit (median age, 7.2 months; 58% males); 78 had eczema only, 11 FA only, 107 FH only, and 125 had multiple risk factors. Overall, 18% of 195 with eczema, 19% of 59 with FA, and 4% of 201 with FH had PA. Only 1% of 115 with FH and no eczema had PA. Among those with eczema, older age (odds ratio [OR], 1.3; 95% CI, 1.04-1.68 per month), higher SCORing Atopic Dermatitis score (OR, 1.19; 95% CI, 1.06-1.34 per 5 points), black (OR, 5.79; 95% CI, 1.92-17.4 compared with white), or Asian race (OR, 6.98; 95% CI, 1.92-25.44) and suspected or diagnosed other FA (OR, 3.98; 95% CI, 1.62-9.80) were associated with PA. CONCLUSIONS PA is common in infants with moderate-severe eczema, whereas FH without eczema is not a major risk factor, suggesting screening only in those with significant eczema. Even within the first year of life, introduction at later ages is associated with a higher risk of PA among those with eczema, supporting introduction of peanut as early as possible.
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Affiliation(s)
- Corinne Keet
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
| | - Michael Pistiner
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass
| | - Mihaela Plesa
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Daria Szelag
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Wayne Shreffler
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass
| | - Robert Wood
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Joan Dunlop
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Roger Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Jennifer Dantzer
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
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21
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Rosow R, Virkud Y, Martin V, Shreffler W, Yuan Q. Early Growth in Children with IgE and Non-IgE-Mediated Food Allergy in a Healthy Infant Cohort. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.381] [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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22
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Virkud Y, Ruiter B, Smith N, Pyle D, Patil S, Shreffler W. Transcriptomic and Gene Set Enrichment Analysis of Peanut stimulated CD4+ T cells during Peanut Oral Immunotherapy. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.588] [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: 12/01/2022]
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23
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Banerjee A, Pistiner M, Shreffler W, Wood R, Dunlop J, Dantzer J, Plesa M, Szelag D, Peng R, Togias A, Keet C. Rates of Peanut Discontinuation After Introduction Among High-Risk Infants. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.587] [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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24
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Pepper AN, Assa'ad A, Blaiss M, Brown E, Chinthrajah S, Ciaccio C, Fasano MB, Gupta R, Hong N, Lang D, Mahr T, Malawer E, Roach A, Shreffler W, Sicherer S, Vickers K, Vickery BP, Wasserman R, Yates K, Casale TB. Consensus report from the Food Allergy Research & Education (FARE) 2019 Oral Immunotherapy for Food Allergy Summit. J Allergy Clin Immunol 2020; 146:244-249. [PMID: 32505612 DOI: 10.1016/j.jaci.2020.05.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022]
Abstract
Food allergy is a major health problem affecting 5% to 10% of the population in developed nations, including an estimated 32 million Americans. Despite the large number of patients suffering from food allergies, up until the end of January 2020, no treatment for food allergies had been approved by the US Food and Drug Administration. The only options were avoidance of food allergen triggers and acute management of allergic reactions. A considerable body of data exists supporting oral immunotherapy (OIT) as a promising, novel treatment option, including that for the now Food and Drug Administration-approved peanut OIT product Palforzia (Aimmune Therapeutics, Brisbane, Calif). However, data for long-term quality-of-life improvement with OIT varies, depending on the measures used for analysis. Like many therapies, OIT is not without potential harms, and burdens, and the evaluation of patient-specific risk-benefit ratio of food OIT produces challenges for clinicians and patients alike, with many unanswered questions. Food Allergy Research & Education organized the Oral Immunotherapy for Food Allergy Summit on November 6, 2019, modeled after the PRACTALL sessions between the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology to address these critical issues. Health care providers, patient representatives, researchers, regulators, and food allergy advocates came together to discuss OIT and identify areas of common ground as well as gaps in existing research and areas of uncertainty and disagreement. The purpose of this article was to summarize that discussion and facilitate collaboration among clinicians and patients to help them make better-informed decisions about offering and accepting OIT, respectively, as a therapeutic option.
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Affiliation(s)
- Amber N Pepper
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Amal Assa'ad
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael Blaiss
- Medical College of Georgia at Augusta University, Augusta, Ga
| | | | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif
| | | | | | - Ruchi Gupta
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Nurry Hong
- FARE (Food Allergy Research & Education), McLean, Va
| | - David Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Todd Mahr
- Gundersen Health System, La Crosse, Wis
| | | | - Anita Roach
- FARE (Food Allergy Research & Education), McLean, Va
| | - Wayne Shreffler
- Food Allergy Center, Departments of Pediatrics and Medicine, Massachusetts General Hospital, Boston, Mass
| | - Scott Sicherer
- the Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | - Thomas B Casale
- Food Allergy Research & Education (FARE), University of South Florida, Tampa, Fla.
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Fleischer D, Sussman G, Beyer K, Hourihane J, Oriel R, Ford L, Shreffler W, Campbell D, Green T, Mukherjee R, Begin P. Open-Label Follow-Up of the PEPITES Study (PEOPLE) to Evaluate the Long-Term Efficacy and Safety of Epicutaneous Peanut Immunotherapy in Peanut-Allergic Children. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.453] [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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Pyle D, Virkud Y, Ruiter B, Smith N, Shreffler W. Differences In Transcriptional Phenotype Between Highly Reactive And Hyporeactive Peanut Allergic Patients Are Not Reflected In Different Outcomes Of Oral Immunotherapy. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.531] [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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Shreffler W, Jones S, Fineman S, Griffin N, Vereda A, Smith A, Brown K, Adelman D, Burks AW. Identifying Demographics and Baseline Clinical Characteristics Associated with Safety Outcomes During AR101 Therapy. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rosow R, Davila M, Martin V, Virkud Y, Yuan Q, Shreffler W. The Incidence of Drug Allergy and Presentation of Symptoms in a Healthy, Birth Cohort. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.599] [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: 11/24/2022]
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Virkud Y, Kelly R, Patil S, Ruiter B, Smith N, Litonjua A, Weiss S, Su JL, Shreffler W. The Role of Bile Acids in Food Allergy and Responses to Oral Immunotherapy by Metabolomic Profiling. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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LaHood N, Patil S, Shreffler W, Virkud Y, Ruiter B, Tang H, Yeung C, Love JC. Ara h 2 Specific IgA B Cell Repertoire Matures During Peanut Oral Immunotherapy. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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Davila M, Rosow R, Martin V, Virkud Y, Seay H, Yuan Q, Shreffler W. Atopic Associations with Reported Penicillin Allergy in a Pediatric Cohort. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.616] [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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Southall K, Mendes Reyes JE, Hazi A, Andre M, Virkud Y, Shreffler W, Pistiner M. Epinephrine Auto-Injector Parental Survey and Skills Demonstration. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.111] [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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Keet C, Szelag D, Togias A, Dunlop J, Shreffler W, Pistiner M. High rate of peanut allergy among infants with atopic dermatitis before peanut introduction. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.075] [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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34
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Andre M, Virkud Y, Hazi A, Shreffler W, Pistiner M. Determining Safety and Predictive Success of Baked Egg Oral Food Challenges in Infants/Toddlers. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.260] [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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35
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Fleischer DM, Greenhawt M, Sussman G, Bégin P, Nowak-Wegrzyn A, Petroni D, Beyer K, Brown-Whitehorn T, Hebert J, Hourihane JO, Campbell DE, Leonard S, Chinthrajah RS, Pongracic JA, Jones SM, Lange L, Chong H, Green TD, Wood R, Cheema A, Prescott SL, Smith P, Yang W, Chan ES, Byrne A, Assa’ad A, Bird JA, Kim EH, Schneider L, Davis CM, Lanser BJ, Lambert R, Shreffler W. Effect of Epicutaneous Immunotherapy vs Placebo on Reaction to Peanut Protein Ingestion Among Children With Peanut Allergy: The PEPITES Randomized Clinical Trial. JAMA 2019; 321:946-955. [PMID: 30794314 PMCID: PMC6439674 DOI: 10.1001/jama.2019.1113] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE There are currently no approved treatments for peanut allergy. OBJECTIVE To assess the efficacy and adverse events of epicutaneous immunotherapy with a peanut patch among peanut-allergic children. DESIGN, SETTING, AND PARTICIPANTS Phase 3, randomized, double-blind, placebo-controlled trial conducted at 31 sites in 5 countries between January 8, 2016, and August 18, 2017. Participants included peanut-allergic children (aged 4-11 years [n = 356] without a history of a severe anaphylactic reaction) developing objective symptoms during a double-blind, placebo-controlled food challenge at an eliciting dose of 300 mg or less of peanut protein. INTERVENTIONS Daily treatment with peanut patch containing either 250 μg of peanut protein (n = 238) or placebo (n = 118) for 12 months. MAIN OUTCOMES AND MEASURES The primary outcome was the percentage difference in responders between the peanut patch and placebo patch based on eliciting dose (highest dose at which objective signs/symptoms of an immediate hypersensitivity reaction developed) determined by food challenges at baseline and month 12. Participants with baseline eliciting dose of 10 mg or less were responders if the posttreatment eliciting dose was 300 mg or more; participants with baseline eliciting dose greater than 10 to 300 mg were responders if the posttreatment eliciting dose was 1000 mg or more. A threshold of 15% or more on the lower bound of a 95% CI around responder rate difference was prespecified to determine a positive trial result. Adverse event evaluation included collection of treatment-emergent adverse events (TEAEs). RESULTS Among 356 participants randomized (median age, 7 years; 61.2% male), 89.9% completed the trial; the mean treatment adherence was 98.5%. The responder rate was 35.3% with peanut-patch treatment vs 13.6% with placebo (difference, 21.7% [95% CI, 12.4%-29.8%; P < .001]). The prespecified lower bound of the CI threshold was not met. TEAEs, primarily patch application site reactions, occurred in 95.4% and 89% of active and placebo groups, respectively. The all-causes rate of discontinuation was 10.5% in the peanut-patch group vs 9.3% in the placebo group. CONCLUSIONS AND RELEVANCE Among peanut-allergic children aged 4 to 11 years, the percentage difference in responders at 12 months with the 250-μg peanut-patch therapy vs placebo was 21.7% and was statistically significant, but did not meet the prespecified lower bound of the confidence interval criterion for a positive trial result. The clinical relevance of not meeting this lower bound of the confidence interval with respect to the treatment of peanut-allergic children with epicutaneous immunotherapy remains to be determined. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02636699.
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Affiliation(s)
- David M. Fleischer
- Children’s Hospital Colorado, University of Colorado Denver School of Medicine, Aurora
| | - Matthew Greenhawt
- Children’s Hospital Colorado, University of Colorado Denver School of Medicine, Aurora
| | - Gordon Sussman
- Gordon Sussman Clinical Research, Toronto, Ontario, Canada
| | - Philippe Bégin
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | | | - Daniel Petroni
- Northwest Allergy and Asthma Center, University of Washington Children’s Hospital and Regional Medical Center, Seattle
| | | | | | - Jacques Hebert
- Clinique Spécialisée en Allergie de la Capital, Quebec, Quebec, Canada
| | - Jonathan O’B Hourihane
- Paediatrics and Child Health, INFANT Centre and HRB-Clinical Research Facility, University College Cork, Cork, Ireland
| | | | - Stephanie Leonard
- University of California, San Diego, Rady Children's Hospital, San Diego
| | - R. Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | | | - Stacie M. Jones
- University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock
| | | | - Hey Chong
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Todd D. Green
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
- DBV Technologies, Montrouge, France
| | | | | | - Susan L. Prescott
- Division of Paediatrics, University of Western Australia School of Medicine, Perth, Children’s Hospital, Nedlands, Australia
| | | | - William Yang
- Ottawa Allergy Research Corporation, Ottawa, Ontario, Canada
| | - Edmond S. Chan
- British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Amal Assa’ad
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | - Carla M. Davis
- Baylor College of Medicine, Texas Children’s Hospital, Houston
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Waserman S, Shreffler W, Jordana M. Probiotics and oral immunotherapy for peanut allergy. Lancet Child Adolesc Health 2018; 1:e1. [PMID: 30169173 DOI: 10.1016/s2352-4642(17)30100-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/15/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Susan Waserman
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Wayne Shreffler
- Food Allergy Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Manel Jordana
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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Newton AN, Davis M, Koehler K, Shreffler W, Ahluwalia S, Metwali N, Thorne PS, Paigen BJ, Matsui EC. Atopy as a Modifier of the Relationships Between Endotoxin Exposure and Symptoms Among Laboratory Animal Workers. Ann Work Expo Health 2018; 61:1024-1028. [PMID: 29028247 DOI: 10.1093/annweh/wxx061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 06/30/2017] [Indexed: 01/13/2023] Open
Abstract
Background Exposure to endotoxin is known to trigger airway inflammation and symptoms, and atopy may modify the relationship between endotoxin exposure and symptom development. Objective To test the a priori hypothesis that atopic status modifies the relationship between endotoxin exposure and respiratory symptom development. Methods A prospective study of laboratory workers at The Jackson Laboratories was conducted. Allergy skin testing was performed and population demographic and clinical information was obtained at baseline. Personal exposure assessments for airborne endotoxin and surveys of self-reported symptoms were performed every 6 months. Cox proportional hazards models were used to examine the relationship between endotoxin exposure and development of mouse-associated symptoms and multivariate regression was used to test for interaction. Results Overall, 16 (9%) of 174 worker-participants developed mouse-associated rhinoconjunctivitis symptoms by 24 months and 8 (5%) developed mouse-associated lower respiratory symptoms by 24 months. Among workers with endotoxin exposure above the median (≥2.4 EU m-3), 5 (6% of 80) atopics reported mouse-associated rhinoconjunctivitis symptoms at 24 months as compared to 3 (3% of 94) non-atopics. Among workers below the median endotoxin exposure (<2.4 EU m-3), 1 (1% of 80) atopic reported mouse-associated rhinoconjunctivitis symptoms at 24 months as compared to 7 (7% of 94) non-atopics. For the combination of symptoms, the adjusted hazard ratio was 6.8 (95% confidence interval: 0.7-67.2) for atopics and 0.07 (95% confidence interval: 0.01-0.5) for non-atopics. Conclusion In this occupational cohort, atopic workers may be more susceptible to, and non-atopic workers protected from, endotoxin-associated upper and lower respiratory symptoms.
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Affiliation(s)
- Ashley N Newton
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health
| | - Meghan Davis
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health
| | - Kirsten Koehler
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health
| | | | - Sharon Ahluwalia
- Walter Reed National Military Medical Center, Allergy, Immunology and Immunizations
| | - Nervana Metwali
- Department of Occupational and Environmental Health, University of Iowa
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa
| | | | - Elizabeth C Matsui
- Division of Pediatric Allergy and Immunology, Johns Hopkins School of Medicine
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Grant T, Dantzer J, Keet C, Peng R, Paigen BJ, Krevans M, Hagberg K, Curtin-Brosnan J, Shreffler W, Matsui EC. Physician-diagnosed eczema is an independent risk factor for incident mouse skin test sensitization in adults. Allergy Asthma Proc 2018; 39:311-315. [PMID: 30111442 DOI: 10.2500/aap.2018.39.4137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The disrupted skin barrier in eczema has been associated with an increased risk of immunoglobulin E (IgE) sensitization in childhood. However, it is unclear whether eczema, independent of atopy, is a risk factor for the development of allergic sensitization in adulthood. OBJECTIVE To determine if skin barrier dysfunction, independent of atopy, is a risk factor for incident sensitization in adult workers at a mouse production and research facility. METHODS New employees at The Jackson Laboratory enrolled in a cohort study and underwent skin-prick testing (SPT) at baseline and every 6 months to mouse and to a panel of aeroallergens (net wheal ≥3 mm indicated a positive SPT result). Mouse allergen exposure was measured every 6 months by using personal air monitors. Physician-diagnosed eczema was defined as self-reported physician-diagnosed eczema. Cox proportional hazard modeling was used to examine the association between baseline physician-diagnosed eczema and incident mouse skin test sensitization and adjusted for potential confounders. RESULTS The participants (N = 394) were followed up for a median of 24 months. Fifty-four percent were women, 89% were white, and 64% handled mice. At baseline, 7% of the participants reported physician-diagnosed eczema and 9% reported current asthma; 61% had at least one positive skin test result. At 30 months, 36% of those with eczema versus 14% of those without eczema had developed a positive mouse skin test result (p = 0.02, log-rank test). After adjusting for age, race, sex, smoking status (current, former, never), current asthma, hay fever, the number of positive SPT results at baseline, and mouse allergen exposure, physician-diagnosed eczema was an independent risk factor for incident mouse SPT sensitization (hazard ratio 5.6 [95% confidence interval, 2.1-15.2]; p = 0.001). CONCLUSION Among adult workers at a mouse production and research facility, physician-diagnosed eczema was a risk factor for incident mouse sensitization, independent of atopy, which indicated that a defect in skin barrier alone may increase the risk of skin sensitization, not just in childhood, but throughout life.
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Affiliation(s)
- Torie Grant
- From the Division of Pediatric Allergy/Immunology, Johns Hopkins School of Medicine, Baltimore, Maryl
| | - Jennifer Dantzer
- From the Division of Pediatric Allergy/Immunology, Johns Hopkins School of Medicine, Baltimore, Maryl
| | - Corinne Keet
- From the Division of Pediatric Allergy/Immunology, Johns Hopkins School of Medicine, Baltimore, Maryl
| | - Roger Peng
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryl
| | | | | | | | - Jean Curtin-Brosnan
- From the Division of Pediatric Allergy/Immunology, Johns Hopkins School of Medicine, Baltimore, Maryl
| | - Wayne Shreffler
- Divsions of Allergy and Immunology, Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth C. Matsui
- From the Division of Pediatric Allergy/Immunology, Johns Hopkins School of Medicine, Baltimore, Maryl
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Vimalathas P, Farris A, Letner D, Deshpande V, Yajnik V, Shreffler W, Garber J. Integrin αM activation and upregulation on esophageal eosinophils and periostin-mediated eosinophil survival in eosinophilic esophagitis. Immunol Cell Biol 2018; 96:426-438. [PMID: 29424023 DOI: 10.1111/imcb.12018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 12/12/2022]
Abstract
Eosinophilic esophagitis (EoE) is an increasingly recognized allergic disease associated with dysphagia and esophageal fibrosis. We aimed to determine expression patterns of specific eosinophil integrins that promote eosinophilic infiltration of the esophageal epithelium, and to determine how key EoE-related cytokines influence eosinophil activation and survival. Esophageal and peripheral eosinophils were isolated from 20 adult subjects with EoE for immunophenotyping and integrin profiling using multicolor flow cytometry and immunohistochemistry. Expression signatures of eosinophil integrins were further assessed by immunohistochemistry using serial sections of esophageal biopsy specimens. Purified eosinophils were used to assess the effect of EoE-relevant cytokines and recombinant periostin on expression of known eosinophil integrins and eosinophil survival and activation. We found that resting eosinophils express high levels of the β2-pairing integrins αL and αM, and lower levels of α4, α6 and α4β7. The migration of peripheral eosinophils to the esophagus is characterized by the specific induction of αM, and a significant increase in the proportion of αM in high-activity conformation. Periostin, a secreted extracellular matrix protein that is significantly overexpressed in EoE, enhances eosinophil survival, and this effect is mediated by αM interaction. Integrin αM is a specific marker of activated tissue eosinophils in EoE, and promotes eosinophil survival through interactions with periostin. The ability of αMβ2 to mediate eosinophil tissue residency via periostin represents a key mechanism for disease development and a potential therapeutic target in EoE.
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Affiliation(s)
| | - Alexandra Farris
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Dorothea Letner
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Vikram Deshpande
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Vijay Yajnik
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Wayne Shreffler
- Food Allergy Center, Division of Allergy & Immunology, Massachusetts General Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - John Garber
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
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Gruchalla RS, Sampson HA, Liu AH, Shreffler W, Wallace PK, Togias A, David G, Calatroni A, LeBeau P. Effects of omalizumab on T lymphocyte function in inner-city children with asthma. Pediatr Allergy Immunol 2016; 27:328-31. [PMID: 26573086 PMCID: PMC4888877 DOI: 10.1111/pai.12508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
While omalizumab treatment of inner city children and adolescents with asthma results in improvement in clinical parameters, no change in peripheral blood T cell responses could be demonstrated. Thus, omalizumab appears not to affect T cell function.
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Affiliation(s)
- R S Gruchalla
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - H A Sampson
- Mount Sinai School of Medicine, New York, NY, USA
| | - A H Liu
- National Jewish Health, University of Colorado Denver School of Medicine, Denver, CO, USA
| | | | - P K Wallace
- Roswell Park Cancer Institute, Buffalo, NY, USA
| | - A Togias
- Division of Allergy, Immunology and Transplantation, NIH, Bethesda, MD, USA
| | - G David
- Rho Federal Systems Division Inc., Chapel Hill, NC, USA
| | - A Calatroni
- Rho Federal Systems Division Inc., Chapel Hill, NC, USA
| | - P LeBeau
- Rho Federal Systems Division Inc., Chapel Hill, NC, USA
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Patil SU, Steinbrecher J, Ma A, Smith N, Washburn C, Hickey A, Southwick C, Tracy L, Ruiter B, Virkud Y, Schneider M, Shreffler W. Early Peanut OIT-Induced Suppression of Basophil Reactivity Is a Marker of Sustained Unresponsiveness. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.547] [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: 11/29/2022]
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42
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Tuttle KS, Stieb ES, Hesterberg PE, Shreffler W, Virkud Y. Mild Ocular and Nasal Symptoms Are Not Indicative of Reactions during Open Oral Food Challenges. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.539] [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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Hickey AJ, Virkud Y, Washburn C, Smith N, Patil SU, Shreffler W. Peanut and Arah2 Specific Immunoglobulin E Is Predictive of Sustained Unresponsiveness Following Peanut Oral Immunotherapy. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.765] [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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Hesterberg PE, Virkud Y, Southwick C, Alejos AR, Stieb ES, Shreffler W. Analysis of Oral Food Challenges for Almond Hypersensitivity. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.538] [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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Swenson T, Virk Hundal N, Chapin C, Elliott C, Leung J, Katz A, Hesterberg P, Shreffler W, Yuan Q. Quality of life for children with eosinophilic esophagitis: a comparison of patients’ and parents’ perceptions and associated factors using the PedsQL™ 3.0 Eosinophilic Esophagitis Module. Clin Transl Allergy 2015. [PMCID: PMC4412546 DOI: 10.1186/2045-7022-5-s3-p159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | | | | | | | - John Leung
- Massachusetts General HospitalBostonMAUSA
| | | | | | | | - Qian Yuan
- Massachusetts General HospitalBostonMAUSA
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46
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Keet C, Radano MC, Shreffler W. Re: Reply to Lifschitz. J Allergy Clin Immunol Pract 2014; 2:643-4. [PMID: 25213070 DOI: 10.1016/j.jaip.2014.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 06/17/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Corinne Keet
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Marcella C Radano
- Division of Gastroenterology, Massachusetts General Hospital (MGH), and Harvard Medical School, Boston, Mass
| | - Wayne Shreffler
- The Food Allergy Center at MGH, Division of Allergy and Immunology, Department of Pediatrics, Massachusetts General Hospital, and Harvard Medical School, Boston, Mass
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Tabatabaei N, Kang D, Wu T, Kim M, Carruth RW, Leung J, Sauk JS, Shreffler W, Yuan Q, Katz A, Nishioka NS, Tearney GJ. Tethered confocal endomicroscopy capsule for diagnosis and monitoring of eosinophilic esophagitis. Biomed Opt Express 2013; 5:197-207. [PMID: 24466487 PMCID: PMC3891332 DOI: 10.1364/boe.5.000197] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/13/2013] [Accepted: 11/18/2013] [Indexed: 05/04/2023]
Abstract
Eosinophilic esophagitis (EoE) is an allergic condition that is characterized by eosinophils infiltrating the esophageal wall. The treatment of the disease may require multiple follow up sedated endoscopies and biopsies to confirm elimination of eosinophils. These procedures are expensive, time consuming, and may be difficult for patients to tolerate. Here we report on the development of a confocal microscopy capsule for diagnosis and monitoring of EoE. The swallowable capsule implements a high-speed fiber-based reflectance confocal microscopy technique termed Spectrally Encoded Confocal Microscopy (SECM). SECM scans the sample in one dimension without moving parts by using wavelength swept source illumination and a diffraction grating at the back plane of the objective lens. As the wavelength of the source is tuned, the SECM optics within the 7 x 30 mm capsule are rotated using a driveshaft enclosed in a 0.8 mm flexible tether. A single rotation of the optics covered a field of view of 22 mm x 223 µm. The lateral and axial resolutions of the device were measured to be 2.1 and 14 µm, respectively. Images of Acetic Acid stained swine esophagus obtained with the capsule ex vivo and in vivo clearly showed squamous epithelial nuclei, which are smaller and less reflective than eosinophils. Imaging of esophageal biopsies from EoE patients ex vivo demonstrated the capability of this technology to visualize individual eosinophils. Based on the results of this study, we believe that this capsule will be a simpler and more effective device for diagnosing EoE and monitoring the therapeutic response of this disease.
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Affiliation(s)
- Nima Tabatabaei
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - DongKyun Kang
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Tao Wu
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Minkyu Kim
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
- School of Engineering, The University of Tokyo, Yayoi 2-11-16 Bunkyo, Tokyo 113-8656, Japan
| | - Robert W. Carruth
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - John Leung
- Food Allergy Center and Pediatric Allergy & Immunology, Harvard Medical School/Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jenny S Sauk
- Department of Gastroenterology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Wayne Shreffler
- Food Allergy Center and Pediatric Allergy & Immunology, Harvard Medical School/Massachusetts General Hospital, Boston, MA 02114, USA
| | - Qian Yuan
- Department of Pediatrics, Harvard Medical School/Massachusetts General Hospital, Boston, MA 02114, USA
| | - Aubrey Katz
- Department of Pediatrics, Harvard Medical School/Massachusetts General Hospital, Boston, MA 02114, USA
| | - Norman S Nishioka
- Department of Gastroenterology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Guillermo J. Tearney
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
- Harvard-MIT Division of Health Sciences and Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
- Department of Pathology, Harvard Medical School/Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Abstract
Food allergy is an emerging epidemic in the United States and the Western world. The determination of factors that make certain foods allergenic is still not clearly understood. Only a tiny fraction of thousands of proteins and other molecules is responsible for inducing food allergy. In this review, the authors present 3 examples of food allergies with disparate clinical presentations: peanut, soy, and mammalian meat. The potential relationships between allergen structure and function, emphasizing the importance of cross-reactive determinants, immunoglobulin E antibodies to the oligosaccharides, and the immune responses induced in humans are discussed.
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Affiliation(s)
- Madhan Masilamani
- Division of Allergy and Immunology, Department of Pediatrics, The Jaffe Food Allergy Institute, Mount Sinai School of Medicine, Anbg 17-40, One Gustave L Levy Place, New York, NY 10029, USA
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50
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Rosenfeld L, Shreffler W, Bardina L, Niggemann B, Wahn U, Sampson HA, Beyer K. Walnut allergy in peanut-allergic patients: significance of sequential epitopes of walnut homologous to linear epitopes of Ara h 1, 2 and 3 in relation to clinical reactivity. Int Arch Allergy Immunol 2011; 157:238-45. [PMID: 22042002 DOI: 10.1159/000327841] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 03/25/2011] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Peanut allergy is a frequent and potentially life-threatening food allergy. Despite the large taxonomic distance between the plants, peanut-allergic patients often react to tree nuts such as walnuts. While the allergens of peanut and walnut have a high degree of homology in their amino-acid sequences, it is unknown whether this similarity is responsible for the observed co-reactivity. Therefore, we analyzed the binding of specific IgE antibodies to sequential epitopes of peanut and walnut in peanut-allergic patients with and without walnut allergy. METHODS The IgE binding to previously described sequential epitopes of peanut and the homologous regions of walnut was assessed in 32 peanut-allergic patients using a peptide microarray technology. Twelve patients had a clinically relevant walnut allergy and 20 were tolerant to walnut. Inhibition assays with peanut peptides and corresponding walnut sequences were performed to show specific binding to sequential epitopes. RESULTS No differences in the recognition of sequential epitopes could be found between peanut-allergic patients with or without walnut allergy. Only a few patients showed IgE binding to walnut sequences that corresponded to sequential epitopes of peanut. In the inhibition assays, no relevant cross-reacting IgE antibodies could be detected for the peptides analyzed. CONCLUSION Our results indicate that although they share a rather high degree of homology with the corresponding regions of walnut allergens, the sequence stretches previously identified as sequential IgE binding epitopes of Ara h 1, Ara h 2 and Ara h 3 have no IgE binding equivalents in walnut allergens.
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Affiliation(s)
- Leonard Rosenfeld
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité, Berlin, Germany
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