Predicting probability of tolerating discrete amounts of peanut protein in allergic children using epitope-specific IgE antibody profiling.

Autor: Suprun M; Icahn School of Medicine at Mount Sinai, New York, New York, USA., Kearney P; AllerGenis LLC, Hatfield, Pennsylvania, USA., Hayward C; AllerGenis LLC, Hatfield, Pennsylvania, USA., Butler H; AllerGenis LLC, Hatfield, Pennsylvania, USA., Getts R; AllerGenis LLC, Hatfield, Pennsylvania, USA., Sicherer SH; Icahn School of Medicine at Mount Sinai, New York, New York, USA., Turner PJ; National Heart & Lung Institute, Imperial College London, England, UK., Campbell DE; The University of Sydney, Sydney, New South Wales, Australia., Sampson HA; Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Jazyk: angličtina
Zdroj: Allergy [Allergy] 2022 Oct; Vol. 77 (10), pp. 3061-3069. Date of Electronic Publication: 2022 Aug 17.
DOI: 10.1111/all.15477
Abstrakt: Background: IgE-epitope profiling can accurately diagnose clinical peanut allergy.
Objective: We sought to determine whether sequential (linear) epitope-specific IgE (ses-IgE) profiling can provide probabilities of tolerating discrete doses of peanut protein in allergic subjects undergoing double-blind, placebo-controlled food challenges utilizing PRACTALL dosing.
Methods: Sixty four ses-IgE antibodies were quantified in blood samples using a bead-based epitope assay. A pair of ses-IgEs that predicts Cumulative Tolerated Dose (CTD) was determined using regression in 75 subjects from the discovery cohort. This epitope-based predictor was validated on 331 subjects from five independent cohorts (ages 4-25 years). Subjects were grouped based on their predicted values and probabilities of reactions at each CTD threshold were calculated.
Results: In discovery, an algorithm using two ses-IgE antibodies was correlated with CTDs (rho = 0.61, p < .05); this correlation was 0.51 (p < .05) in validation. Using the ses-IgE-based predictor, subjects were assigned into "high," "moderate," or "low" dose-reactivity groups. On average, subjects in the "high" group were four times more likely to tolerate a specific dose, compared with the "low" group. For example, predicted probabilities of tolerating 4, 14, 44, and 144 or 444 mg in the "low" group were 92%, 77%, 53%, 29%, and 10% compared with 98%, 95%, 94%, 88%, and 73% in the "high" group.
Conclusions: Accurate predictions of food challenge thresholds are complex due to factors including limited responder sample sizes at each dose and variations in study-specific challenge protocols. Despite these limitations, an epitope-based predictor was able to accurately identify CTDs and may provide a useful surrogate for peanut challenges.
(© 2022 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)
Databáze: MEDLINE
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