Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, 116 Manning Dr., Mary Ellen Jones Building Rm 3310, Chapel Hill, NC, 27599, USA.
UNC Food Allergy Initiative, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
Curr Allergy Asthma Rep. 2019 Dec 4;19(12):61. doi: 10.1007/s11882-019-0894-y.
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.
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.
研究性变应原免疫疗法（AIT），包括口服免疫疗法（OIT）、舌下免疫疗法（SLIT）和经皮免疫疗法（EPIT），已被证明可提高大多数患者引发过敏反应所需的变应原阈值。然而，这些研究缺乏一致的生物标志物来预测治疗效果。在这里，我们将回顾目前正在研究用于 AIT 的生物标志物。
AIT 治疗益处的机制涉及多种细胞类型，包括肥大细胞、嗜碱性粒细胞、T 细胞和 B 细胞。皮肤点刺和嗜碱性粒细胞活化试验评估效应细胞对过敏原的敏感性，在接受 AIT 的患者中减少。过敏原特异性 IgE 最初增加，随着继续治疗而减少，而过敏原特异性 IgG 和 IgA 则在整个治疗过程中增加。过敏原诱导的调节性 T 细胞（Tregs）在整个治疗过程中增加，并发现与 OIT 后的持续无反应相关。接受 OIT 和 SLIT 的患者在治疗期间 Th2 细胞因子的产生减少。尽管已经报道了一些趋势，但这些生物标志物的一个共同局限性是，没有一种能够在 AIT 期间可重复地预测预后。需要进一步的研究来扩大目前可用的生物标志物谱，为 AIT 提供个性化的方法。
