Epitope-Specific Antibodies in Allergic Disease and Clinical Tolerance.

B-cell epitope specificity on food allergens is highly relevant to understanding both the pathogenesis of IgE and IgG-mediated clinical tolerance after immunotherapy. The molecular binding interactions between the paratopes of antibodies and the epitopes of food allergens drive IgE-crosslinking, the subsequent activation of allergen effector cells, and the symptoms of systemic and life-threatening anaphylaxis. Various characteristics of allergen-specific IgE, such as high affinity and clonal diversity, can contribute to the persistence of food allergy and the severity of anaphylaxis upon allergen exposure. On the other hand, the induction of epitope-specific IgG antibodies in allergic individuals can inhibit IgE binding to food allergens. A subset of these can be neutralizing antibodies that effectively disrupt multiple allergen-IgE interactions to suppress effector responses. This review details the crucial role of epitope specificity and antibody clonality in both the pathogenesis of food allergy and in the development of clinical tolerance.