Proteins and Pathway of Peanut Oral Immunotherapy
Peanut oral immunotherapy often results in patients being in a desensitized state. This means that a patient’s allergic response is decreased or stopped while they are regularly ingesting the allergen.
Desensitization is characterized by the shift of the antibody response from an IgE-dominated response, driven by TH2 cells, to an IgG-dominated response, driven by TH1 cells5.
The structures of IgE and IgG can be found here. As the patient is given increasingly larger doses of the allergen, their total concentration of IgE decreases.
Figure 20 – Concentration of peanut IgE in patients over time14
While total IgE decreases over time, the diversity of antigen-binding sites on IgE actually increases over time and its binding affinity does not change5, 22. In addition, the shift from IgE-dominated response to the IgG-dominated response happens especially in Ara h 2.
Figure 18 – Summary of change in IgE and IgG in patients treated for peanut allergies
IgG4 increases over time as well and seems to be connected to the inhibition of IgE binding to B cells12. Both IgE and IgG4 bind at the Fc region of mast cells. Because of this, it makes sense that IgE and IgG4 can compete for the same active site. It has been proven that IgE activates mast cells by binding to FcƐRI, but this can be inhibited by IgG423. Since the activation of mast cells leads to allergic responses, desensitized patients with lower levels of IgE and higher levels of IgG4 will be less likely to have an allergic reaction to peanuts.
Great therapeutic look into how we can treat/desensitize individuals to allergens, especially something as common as a peanut.
I am a little confused by the figure (16) though, as the idea that IgE decreases and IgG increases together lead to loss of allergic sensitivity/reaction from what I can gather. How come the figure shows on the left column side that decreases in IgE lead to an allergic reaction?
Also, would you happen to know how common it is for people to undergo this sort of immunotherapy/desensitization?
I definitely agree with Kenny here. I know plenty of people who are allergic to peanuts but just try to avoid them as much as possible without seeking treatment for the allergy. It would be cool to see if you can find the proportion of people with the allergy that take an oral immunotherapy just to provide a frame of reference.
Desensitization is characterized by the shift of the antibody response
Nice information
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