Saliva antibody profiles are associated with reaction threshold and severity of peanut allergic reactions - 06/07/24

Doi : 10.1016/j.jaci.2024.05.020

Hsi-en Ho, MD ^a, Zoe Arditi, BA ^b, Lin Radigan, MD ^a, Galina Grishina, MS ^c, Lingdi Zhang, PhD ^b, Yoojin Chun, MS ^b, Tracy Lo, RN ^c, Julie Wang, MD ^c, Scott Sicherer, MD ^c, Supinda Bunyavanich, MD, MPH, MPhil ^b,^c,^⁎
^a Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
^b Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
^c Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY

^∗Corresponding author: Supinda Bunyavanich, MD, MPH, MPhil, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue #1498, New York, NY 10029.Icahn School of Medicine at Mount Sinai1425 Madison Avenue #1498New YorkNY10029

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 06 July 2024

Graphical abstract

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Abstract

Background

Reaction threshold and severity in food allergy are difficult to predict, and noninvasive predictors are lacking.

Objective

We sought to determine the relationships between pre-challenge levels of peanut (PN)-specific antibodies in saliva and reaction threshold, severity, and organ-specific symptoms during PN allergic reactions.

Methods

We measured PN-specific antibody levels in saliva collected from 127 children with suspected PN allergy before double-blind, placebo-controlled PN challenges in which reaction threshold, severity, and symptoms were rigorously characterized. Low threshold (LT) PN allergy was defined as reaction to <300 mg of PN protein cumulatively consumed. A consensus severity grading system was used to grade severity. We analyzed associations between antibody levels and reaction threshold, severity, and organ-specific symptoms.

Results

Among the 127 children, those with high pre-challenge saliva PN IgE had higher odds of LT PN allergy (odds ratio [OR] 3.9, 95% CI 1.6-9.5), while those with high saliva PN IgA:PN IgE ratio or PN IgG₄:PN IgE ratio had lower odds of LT PN allergy (OR 0.3, 95% CI 0.1-0.8; OR 0.4, 95% CI 0.2-0.9). Children with high pre-challenge saliva PN IgG₄ had lower odds of severe PN reactions (OR 0.4, 95% CI 0.2-0.9). Children with high saliva PN IgE had higher odds of respiratory symptoms (OR 8.0, 95% CI 2.2-26.8). Saliva PN IgE modestly correlated with serum PN IgE levels (Pearson r = 0.31, P = .0004). High and low saliva PN IgE levels further distinguished reaction threshold and severity in participants stratified by serum PN IgE, suggesting endotypes.