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Suppression of the basophil response to allergen during treatment with omalizumab is dependent on 2 competing factors.

AbstractBACKGROUND:
A recent study of subjects with peanut allergy treated with omalizumab generated some results that were concordant with a study of subjects with cat allergy treated with omalizumab. However, there were differences that provided additional insight into the nature of the cellular responses in allergic subjects.
OBJECTIVE:
We sought to determine the cause for failure to suppress the allergen-induced basophil response during treatment with omalizumab.
METHODS:
Patients with peanut allergy were treated with omalizumab. Clinical, serologic, and cellular indices relevant to the response of the subjects and their peripheral blood basophil values (specific/total IgE ratio, cell-surface FcεRI expression, and histamine release responses to anti-IgE antibody or peanut allergen) were obtained at 3 times.
RESULTS:
After treatment, approximately 60% of the subjects' basophil responses to peanut allergen did not significantly decrease. In 40% of cases, the in vitro basophil response to peanut allergen increased 2- to 7-fold. The increases were associated with 2 primary factors: a high (>10%) specific/total IgE ratio and an increase in the intrinsic response of the basophil to IgE-mediated stimulation. The extent to which the basophil response to peanut allergen increased was inversely correlated with improvement in the patient's ability to tolerate ingestion of peanut.
CONCLUSION:
The basophil response during treatment with omalizumab is a consequence of 2 competing factors: suppression of allergen-specific IgE on the cell surface versus increased intrinsic sensitivity to IgE-mediated stimulation. In subjects with peanut allergy, the basophil response appears to mitigate against the ability of omalizumab to improve the patient's tolerance of oral allergen.
AuthorsDonald W MacGlashan Jr, Jessica H Savage, Robert A Wood, Sarbjit S Saini
JournalThe Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 130 Issue 5 Pg. 1130-1135.e5 (Nov 2012) ISSN: 1097-6825 [Electronic] United States
PMID22800400 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
CopyrightCopyright © 2012 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
Chemical References
  • Allergens
  • Anti-Allergic Agents
  • Antibodies, Anti-Idiotypic
  • Antibodies, Monoclonal, Humanized
  • FcepsilonRI alpha-chain, human
  • Receptors, IgE
  • Omalizumab
  • Immunoglobulin E
  • Histamine
Topics
  • Adult
  • Allergens (immunology)
  • Animals
  • Anti-Allergic Agents (administration & dosage, adverse effects)
  • Antibodies, Anti-Idiotypic (administration & dosage, adverse effects)
  • Antibodies, Monoclonal, Humanized (administration & dosage, adverse effects)
  • Cells, Cultured
  • Female
  • Follow-Up Studies
  • Histamine (metabolism)
  • Humans
  • Immunoglobulin E (blood)
  • Male
  • Omalizumab
  • Peanut Hypersensitivity (immunology, therapy)
  • Receptors, IgE (metabolism)
  • Treatment Outcome

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