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The Use of Biomarkers to Predict Aero-Allergen and Food Immunotherapy Responses

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Abstract

The incidence of allergic conditions has continued to rise over the past several decades, with a growing body of research dedicated toward the treatment of such conditions. By driving a complex range of changes in the underlying immune response, immunotherapy is the only therapy that modulates the immune system with long-term effects and is presently utilized for the treatment of several atopic conditions. Recent efforts have focused on identifying biomarkers associated with these changes that may be of use in predicting patients with the highest likelihood of positive clinical outcomes during allergen immunotherapy (AIT), providing guidance regarding AIT discontinuation, and predicting symptomatic relapse and the need for booster AIT after therapy. The identification of such biomarkers in food allergy has the additional benefit of replacing oral food challenges, which are presently the gold standard for diagnosing food allergies. While several markers have shown early promise, research has yet to identify a marker that can invariably predict clinical response to AIT. Skin prick testing (SPT) and specific IgE have commonly been used as inclusion criteria for the initiation of AIT and prediction of reactions during subsequent allergen challenge; however, existing data suggests that changes in these markers are not always associated with clinical improvement and can be widely variable, reducing their utility in predicting clinical response. Similar findings have been described for the use of allergen-specific functional IgG4 antibodies, basophil activation and histamine release, and type 2 innate lymphoid cells. There appears to be a promising association between changes in the expression of dendritic cell-associated markers, as well as the use of DNA promoter region methylation patterns in the prediction of allergy status following therapy. The cellular and molecular changes brought about by immunotherapy are still under investigation, but major strides in our understanding are being made.

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Acknowledgements

This work was supported by NIH grant U19AI104209, the Bezos Family Foundation, the FARE Center of Excellence, the Myra Reinhard Foundation, and the Sean N. Parker Center for Allergy and Asthma Research at Stanford University.

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  1. Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, 94305, USA

    Sayantani B. Sindher, Andrew Long, Swati Acharya, Vanitha Sampath & Kari C. Nadeau

  2. Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, 94305, USA

    Sayantani B. Sindher, Andrew Long, Swati Acharya, Vanitha Sampath & Kari C. Nadeau

  3. Division of Allergy, Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, CA, 94305, USA

    Kari C. Nadeau

  4. Department of Medicine, Stanford University School of Medicine, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA, 94305-5101, USA

    Kari C. Nadeau

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Sindher, S.B., Long, A., Acharya, S. et al. The Use of Biomarkers to Predict Aero-Allergen and Food Immunotherapy Responses. Clinic Rev Allerg Immunol 55, 190–204 (2018). https://doi.org/10.1007/s12016-018-8678-z

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