Biomarkers in Food Allergy Immunotherapy

  • LaKeya C. HardyEmail author
  • Johanna M. Smeekens
  • Michael D. Kulis
Food Allergy (E Kim, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Food Allergy


Purpose of Review

Investigational allergen immunotherapies (AITs) including oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT) have proven to increase allergen thresholds required to elicit an allergic reaction in a majority of subjects. However, these studies lack consistent biomarkers to predict therapy outcomes. Here, we will review biomarkers that are currently being investigated for AIT.

Recent Findings

The mechanisms underlying the therapeutic benefit of AIT involve various cell types, including mast cells, basophils, T cells, and B cells. Skin prick and basophil activation tests assess effector cell sensitivity to allergen and are decreased in subjects on AIT. Allergen-specific IgE increases initially and decreases with continued therapy, while allergen-specific IgG and IgA increase throughout therapy. Allergen-induced regulatory T cells (Tregs) increase throughout therapy and were found to be associated with sustained unresponsiveness after OIT. Subjects on OIT and SLIT have decreased Th2 cytokine production during therapy.


Although trends have been reported, a common limitation of these biomarkers is that none are able to reproducibly predict prognosis during AIT. Further studies are needed to expand the currently available biomarker repertoire to provide personalized approaches to AIT.


Food allergy Allergen Immunotherapy Biomarkers Basophils Tregs IgG4 



Allergen immunotherapy


Basophil activation test


Double-blind, placebo-controlled food challenge


Epicutaneous immunotherapy


Mast cell activation test


Oral immunotherapy


Sublingual immunotherapy


Skin prick test


Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • LaKeya C. Hardy
    • 1
    • 2
    Email author
  • Johanna M. Smeekens
    • 2
    • 3
  • Michael D. Kulis
    • 2
    • 3
  1. 1.Department of Microbiology and ImmunologyUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.UNC Food Allergy InitiativeUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Department of PediatricsUniversity of North Carolina at Chapel HillChapel HillUSA

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