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J Allergy Clin Immunol. 2012 Nov;130(5):1130-1135.e5. doi: 10.1016/j.jaci.2012.05.038. Epub 2012 Jul 15.

Suppression of the basophil response to allergen during treatment with omalizumab is dependent on 2 competing factors.

Author information

1
Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA. dmacglas@jhmi.edu

Abstract

BACKGROUND:

A recent study of subjects with peanut allergy treated with omalizumab generated some results that were concordant with a study of subjects with cat allergy treated with omalizumab. However, there were differences that provided additional insight into the nature of the cellular responses in allergic subjects.

OBJECTIVE:

We sought to determine the cause for failure to suppress the allergen-induced basophil response during treatment with omalizumab.

METHODS:

Patients with peanut allergy were treated with omalizumab. Clinical, serologic, and cellular indices relevant to the response of the subjects and their peripheral blood basophil values (specific/total IgE ratio, cell-surface FcεRI expression, and histamine release responses to anti-IgE antibody or peanut allergen) were obtained at 3 times.

RESULTS:

After treatment, approximately 60% of the subjects' basophil responses to peanut allergen did not significantly decrease. In 40% of cases, the in vitro basophil response to peanut allergen increased 2- to 7-fold. The increases were associated with 2 primary factors: a high (>10%) specific/total IgE ratio and an increase in the intrinsic response of the basophil to IgE-mediated stimulation. The extent to which the basophil response to peanut allergen increased was inversely correlated with improvement in the patient's ability to tolerate ingestion of peanut.

CONCLUSION:

The basophil response during treatment with omalizumab is a consequence of 2 competing factors: suppression of allergen-specific IgE on the cell surface versus increased intrinsic sensitivity to IgE-mediated stimulation. In subjects with peanut allergy, the basophil response appears to mitigate against the ability of omalizumab to improve the patient's tolerance of oral allergen.

PMID:
22800400
PMCID:
PMC3488135
DOI:
10.1016/j.jaci.2012.05.038
[Indexed for MEDLINE]
Free PMC Article
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