Abstract | BACKGROUND: 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.
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Authors | Donald W MacGlashan Jr, Jessica H Savage, Robert A Wood, Sarbjit S Saini |
Journal | The 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 |
PMID | 22800400
(Publication Type: Journal Article, Research Support, N.I.H., Extramural)
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Copyright | Copyright © 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
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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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