Frequent occurrence of T cell–mediated late reactions revealed by atopy patch testing with hypoallergenic rBet v 1 fragments Raffaela Campana, PhD, Katharina.

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Frequent occurrence of T cell–mediated late reactions revealed by atopy patch testing with hypoallergenic rBet v 1 fragments Raffaela Campana, PhD, Katharina Moritz, MD, Katharina Marth, MD, Angela Neubauer, PhD, Hans Huber, PhD, Rainer Henning, PhD, Katharina Blatt, PhD, Gregor Hoermann, MD, PhD, Tess M. Brodie, PhD, Alexandra Kaider, MSc, Peter Valent, MD, Federica Sallusto, PhD, Stefan Wöhrl, MD, MSc, Rudolf Valenta, MD Journal of Allergy and Clinical Immunology Volume 137, Issue 2, Pages 601-609.e8 (February 2016) DOI: 10.1016/j.jaci.2015.08.042 Copyright © 2015 The Authors Terms and Conditions

Fig 1 Study design. Four groups of subjects, group 1 (patients with birch pollen allergy with AD, n = 15), group 2 (patients with birch pollen allergy with rhinoconjunctivitis without AD, n = 5), group 3 (allergic patients without birch pollen allergy and without AD, n = 5), and group 4 (nonallergic subjects, n = 5), were subjected to SPTs and APTs. Journal of Allergy and Clinical Immunology 2016 137, 601-609.e8DOI: (10.1016/j.jaci.2015.08.042) Copyright © 2015 The Authors Terms and Conditions

Fig 2 T-cell proliferation toward rBet v 1 or F1+F2. Shown are PBMC proliferations (y-axes: stimulation indices as box-and-whisker plots showing minimum, quartiles, median, and maximum values) in response to rBet v 1 or the rBet v 1 fragments (F1+F2) for study groups 1 to 4 (upper panel) and (lower panel) for patients with birch pollen allergy with positive APT reactions (group A), patients with birch pollen allergy with negative APT reactions (group B), and subjects without birch pollen allergy with negative APT reactions (group C). Significant differences between the groups are indicated. Journal of Allergy and Clinical Immunology 2016 137, 601-609.e8DOI: (10.1016/j.jaci.2015.08.042) Copyright © 2015 The Authors Terms and Conditions

Fig 3 Activation of CLA+ or CCR4+CD3+ cells by rBet v 1 or F1+F2 with carboxyfluorescein diacetate succinimidyl ester staining. A and B, Shown are the stimulation indices as box-and-whisker plots showing minimum, quartiles, median, and maximum values in response to rBet v 1 (Fig 3, A) or to the rBet v 1 fragment mix (F1+F2; Fig 3, B) for study groups 1 to 4. C and D, Results for patients with birch pollen allergy with positive APT reactions (Fig 3, A), patients with birch pollen allergy with negative APT reactions (Fig 3, B), and subjects without birch pollen allergy with negative APT reactions (Fig 3, C) in response to rBet v 1 and F1+F2, respectively. Significant differences between the groups are indicated. The horizontal dashed line represents the cutoff for positive proliferation (stimulation index > 1). Journal of Allergy and Clinical Immunology 2016 137, 601-609.e8DOI: (10.1016/j.jaci.2015.08.042) Copyright © 2015 The Authors Terms and Conditions

Fig E1 IgE reactivity to rBet v 1 and rBet v 1 fragments. Dot-blotted purified recombinant antigens (rBet v 1, rBet v 1 fragments F1 and F2, an rBet v 1 fragment mix [F1+F2], and BSA) were incubated with sera from the study subjects from groups 1 to 4 (1-30) or with buffer alone as a negative control (NC). Bound IgE antibodies were detected with iodine 125–labeled anti-human IgE antibodies and visualized by means of autoradiography. Journal of Allergy and Clinical Immunology 2016 137, 601-609.e8DOI: (10.1016/j.jaci.2015.08.042) Copyright © 2015 The Authors Terms and Conditions

Fig E2 Immediate-type skin reactions to rBet v 1 and rBet v 1 fragments in subjects with residual IgE reactivity to the F1+F2 mix in RAST-based dot blotting assay. SPTs were performed with birch pollen extract (1), rBet v 1 (2 and 3), and the mix of rBet v 1 fragments F1+F2 (4 and 5). SPTs were performed with antigen concentrations of 20 μg/mL (2 and 4) or 40 μg/mL (3 and 5). Journal of Allergy and Clinical Immunology 2016 137, 601-609.e8DOI: (10.1016/j.jaci.2015.08.042) Copyright © 2015 The Authors Terms and Conditions

Fig E3 Delayed-type skin reactions to rBet v 1 and rBet v 1 fragments in selected subjects. Shown are APT reactions to rBet v 1 and the rBet v 1 fragment mix (F1+F2) in patients from study groups 1 to 4 (group 1, subjects 26 and 19; group 2, subjects 13 and 11; group 3, subject 4; and group 4, subject 16). APTs were performed with 160 μg of rBet v 1 and a mix containing 80 μg of each rBet v 1 fragment (F1+F2). Journal of Allergy and Clinical Immunology 2016 137, 601-609.e8DOI: (10.1016/j.jaci.2015.08.042) Copyright © 2015 The Authors Terms and Conditions

Fig E4 Cytokine levels measured in PBMC cultures on stimulation with rBet v 1 shortly before SPTs and APTs. Shown are cytokine levels (in picograms per milliliter) determined for triplicate cultures as box-and-whisker plots showing minimum, quartiles, median, and maximum values (y-axes) for APT-positive patients with birch pollen allergy with positive APT reactions (A), patients with birch pollen allergy with negative APT reactions (B), and subjects without birch pollen allergy with negative APT reactions (C; x-axes). Statistically significant differences (P < .05) are indicated. G-CSF, Granulocyte colony-stimulating factor; MCP-1, monocyte chemoattractant protein 1; MIP-1b, macrophage inflammatory protein 1. Journal of Allergy and Clinical Immunology 2016 137, 601-609.e8DOI: (10.1016/j.jaci.2015.08.042) Copyright © 2015 The Authors Terms and Conditions

Fig E5 Cytokine levels measured in PBMC cultures on stimulation with the F1+F2 mix shortly before SPTs and APTs. Shown are cytokine levels (in picograms per milliliter) determined for triplicate cultures as box-and-whisker plots showing minimum, quartiles, median, and maximum values (y-axes) for APT-positive patients with birch pollen allergy with positive APT reactions (A), patients with birch pollen allergy with negative APT reactions (B), and subjects without birch pollen allergy with negative APT reactions (C; x-axes). Statistically significant differences (P < .05) are indicated. G-CSF, Granulocyte colony-stimulating factor; MCP-1, monocyte chemoattractant protein 1; MIP-1b, macrophage inflammatory protein 1. Journal of Allergy and Clinical Immunology 2016 137, 601-609.e8DOI: (10.1016/j.jaci.2015.08.042) Copyright © 2015 The Authors Terms and Conditions