Modified oral food challenge used with sensitization biomarkers provides more real-life clinical thresholds for peanut allergy Katharina Blumchen, MD,

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Presentation transcript:

Modified oral food challenge used with sensitization biomarkers provides more real-life clinical thresholds for peanut allergy Katharina Blumchen, MD, Alena Beder, John Beschorner, MD, Frank Ahrens, MD, Armin Gruebl, MD, Eckard Hamelmann, MD, Gesine Hansen, MD, Andrea Heinzmann, MD, Katja Nemat, MD, Bodo Niggemann, MD, Ulrich Wahn, MD, Kirsten Beyer, MD Journal of Allergy and Clinical Immunology Volume 134, Issue 2, Pages 390-398.e4 (August 2014) DOI: 10.1016/j.jaci.2014.03.035 Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Log-normal probability distribution model of individual peanut thresholds (in milligrams of whole peanut) for patients with peanut allergy tested in this study. Distribution is based on lowest observed adverse effect levels and no observed adverse effect levels for objective symptoms only. Journal of Allergy and Clinical Immunology 2014 134, 390-398.e4DOI: (10.1016/j.jaci.2014.03.035) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Correlation of the severity of allergic reactions (grade I-V) with the ED (12-18,000 mg of whole peanut) at oral challenge in children with peanut allergy. There is no correlation between the ED at oral peanut challenge and the severity of reactions at challenge. n, Number of patients reacting to an individual ED/experiencing an individual grade of severity at challenge. Journal of Allergy and Clinical Immunology 2014 134, 390-398.e4DOI: (10.1016/j.jaci.2014.03.035) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Correlation of laboratory markers for sensitization, BA, and T-cell activation with the ED of the allergic reaction at oral challenge. There is a correlation between the individual eliciting dose of the allergic reaction at oral challenge (12-18,000 mg of whole peanut) and markers for peanut-specific sensitization (ED [in milligrams] vs peanut-specific IgE [in kilounits of allergen per liter, A]; ED [in milligrams] vs Ara h 2–specific IgE [in kilounits of allergen per liter, B]; and ED [in milligrams] vs peanut-specific wheal size in SPTs [in millimeters, C]). There is a correlation between the individual ED of the allergic reaction at oral challenge (in milligrams) and BA after in vitro stimulation with 5 × 10−2 μg/mL peanut extract (D) and basophil sensitivity (E) and IL-5 production (F; in picograms per milliliter) by PBMCs after in vitro stimulation with peanut extract. Journal of Allergy and Clinical Immunology 2014 134, 390-398.e4DOI: (10.1016/j.jaci.2014.03.035) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 Correlation of laboratory markers for sensitization, BA, and T-cell activation with severity of allergic reactions at oral challenge. There is no correlation of the individual severity of the allergic reaction at oral challenge (grade I-V) with markers for peanut-specific sensitization (peanut-specific IgE [in kilounits of allergen per liter, A]; Ara h 2–specfifc IgE [in kilounits of allergen per liter, B]; and peanut-specific wheal size in SPTs [in millimeters, C]), markers for BA (BA after in vitro stimulation with 5 × 10−2 μg/mL peanut extract [D]; basophil sensitivity [E]), and markers for TH2-cell activation (IL-5 production [in picograms per milliliter (F)] after in vitro stimulation with peanut extract). Journal of Allergy and Clinical Immunology 2014 134, 390-398.e4DOI: (10.1016/j.jaci.2014.03.035) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions