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Th108 - Serological Assessment of Patients Undergoing Peanut Oral Immunotherapy: The Role of igg4

Thursday, June 22, 2023
7:30 AM – 7:30 PM  
EISHA AHMED – Research Institute of the McGill University Health Centre, Department of Pediatrics and Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Canada; LIANE BEAUDETTE – Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.; MOSHE BEN-SHOSHAN – Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.; CASEY COHEN – Research Institute of the McGill University Health Centre, Department of Pediatrics and Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Canada; THOMAS EIWEGGER – Division of Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.; DANBING KE – Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.; DUNCAN LEJTENYI – Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.; BRUCE MAZER – Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.; JULIA UPTON – Division of Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.; WENDY ZHAO – Research Institute of the McGill University Health Centre, Department of Pediatrics and Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Canada

  • Diana K. Toscano Rivero

    PhD candidate
    McGill University
    Montreal, Quebec, Canada

  • EA

    EISHA AHMED

    Research Institute of the McGill University Health Centre, Department of Pediatrics and Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Canada

  • LB

    LIANE BEAUDETTE

    Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.

  • MB

    MOSHE BEN-SHOSHAN

    Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.

  • CC

    CASEY G. COHEN

    Research Institute of the McGill University Health Centre, Department of Pediatrics and Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Canada

  • TE

    THOMAS EIWEGGER

    Division of Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

  • DK

    DANBING KE

    Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.

  • DL

    DUNCAN LEJTENYI

    Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.

  • BM

    BRUCE D. MAZER

    Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.

  • JU

    JULIA UPTON

    Division of Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

  • WZ

    WENDY ZHAO

    Research Institute of the McGill University Health Centre, Department of Pediatrics and Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Canada

  • EA

    EISHA AHMED

    Research Institute of the McGill University Health Centre, Department of Pediatrics and Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Canada

  • LB

    LIANE BEAUDETTE

    Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.

  • MB

    MOSHE BEN-SHOSHAN

    Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.

  • CC

    CASEY G. COHEN

    Research Institute of the McGill University Health Centre, Department of Pediatrics and Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Canada

  • TE

    THOMAS EIWEGGER

    Division of Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

  • DK

    DANBING KE

    Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.

  • DL

    DUNCAN LEJTENYI

    Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.

  • BM

    BRUCE D. MAZER

    Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.

  • JU

    JULIA UPTON

    Division of Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

  • WZ

    WENDY ZHAO

    Research Institute of the McGill University Health Centre, Department of Pediatrics and Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Canada

Abstract Text: Peanut oral immunotherapy (OIT) aims to increase the safety of individuals with peanut allergy by gradual exposure to small, measured amounts of peanuts. Many studies use a maintenance dose of 300mg to achieve clinical desensitization. OIT is limited by frequent dose-related adverse reactions, leading to participant withdrawals. Data on immunologic parameters associated with maintenance doses lower than 300mg are limited.
Seventeen peanut-allergic children aged 1 to 17 years were enrolled in a trial (NCT03532360) of low or high-maintenance dose peanut OIT. Patients were randomized to 300mg (N=9) or 30mg (N=8) groups. Blood was drawn at three timepoints: oral food challenge, post-escalation challenge and exit challenge. Serum samples were used for quantitative detection of total peanut- and Arah2-specific immunoglobulin (Ig) E and IgG4 levels by ELISA.
After a median escalation phase of 15 months, peanut-specific-IgG4 significantly increased from a median baseline of 148.55 μg/mL (IQR 68.95-243.41) to 989.09 μg/mL (IQR 392.55-1905.33) (p < 0.05) in the 300mg group and from 58.13 μg/mL (IQR 20.54-303.92) to 277.91 μg/mL (IQR 64.85-634.99) in the 30mg group (p < 0.05). Peanut-specific-IgE did not significantly decrease in either group. The IgG4/IgE ratio significantly increased over the course of peanut OIT in both groups (p < 0.05). From the low-dose and high-dose groups, 6/8 and 6/9 subjects were clinically desensitized respectively.
Both low-dose and high-dose OIT maintenance doses resulted in significant increases in peanut-specific IgG4. Our findings suggest that changes in IgG4, rather than IgE, better reflect clinical desensitization. Large-scale studies are required to establish the role of IgGs versus IgE in OIT.