title: Utility of component analyses in subjects undergoing sublingual immunotherapy for peanut allergy.
abstract: BACKGROUND
  Sublingual immunotherapy (SLIT) with peanut changes clinical and immune responses in most peanut-allergic individuals, but the response is highly variable.
  
  
  OBJECTIVE
  We sought to examine the component-specific effects of peanut SLIT and determine whether peanut component testing could predict the outcome of a double-blind, placebo-controlled food challenge (DBPCFC) after 12 months of peanut SLIT.
  
  
  METHODS
  We included 33 subjects who underwent peanut SLIT with a DBPCFC of 2500 mg of peanut protein performed after 12 months of therapy. Plasma samples from baseline and after 12 months of peanut SLIT were assayed using ImmunoCAP for IgE and IgG4 against whole peanut, Ara h 1, Ara h 2, Ara h 3, Ara h 8, and Ara h 9.
  
  
  RESULTS
  Following 12 months of SLIT, 10 subjects (30%) passed the DBPCFC without symptoms and were considered desensitized. Subjects that failed the DBPCFC tolerated a median of 460 mg peanut protein (range: 10-1710 mg). The desensitized group had significantly lower baseline levels of IgE against peanut (median 40.8 vs. 231 kUA /L, P = 0.0082), Ara h 2 (median 17 vs. 113 kUA /L, P = 0.0082), and Ara h 3 (median 0.3 vs. 8.5 kUA /L, P = 0.0396). ROC curves indicated that baseline IgE against peanut and Ara h 2 were equally effective at discriminating between the two groups (AUC = 0.7957, P = 0.007752 for both).
  
  
  CONCLUSIONS
  In this cohort of subjects undergoing SLIT for peanut allergy, lower baseline levels of IgE against Ara h 2, Ara h 3, and peanut were associated with successful desensitization.
authors.affiliation: Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Burk
authors.affiliation: Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: M
authors.initials: M
authors.lastname: Kulis
authors.affiliation: Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: N
authors.initials: N
authors.lastname: Leung
authors.affiliation: Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: E H
authors.initials: EH
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: A W
authors.initials: AW
authors.lastname: Burks
authors.affiliation: Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: B P
authors.initials: BP
authors.lastname: Vickery
mesh_terms: D055516:2S Albumins, Plant / Q000276:immunology; D000485:Allergens / Q000276:immunology*; D052179:Antigens, Plant / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006023:Glycoproteins / Q000276:immunology; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D008297:Male; D008565:Membrane Proteins; D021183:Peanut Hypersensitivity / Q000276:immunology* / Q000517:prevention & control*; D010940:Plant Proteins / Q000276:immunology; D063729:Sublingual Immunotherapy / Q000379:methods*
chemical_list: D055516:2S Albumins, Plant; D000485:Allergens; D052179:Antigens, Plant; C500889:Ara h 1 protein, Arachis hypogaea; C500890:Ara h 2 allergen, Arachis hypogaea; C549941:Ara h 3 allergen, Arachis hypogea; C000594056:Ara h 8 allergen, peanut; C544631:Ara h 9 allergen, peanut; D006023:Glycoproteins; D007074:Immunoglobulin G; D008565:Membrane Proteins; D010940:Plant Proteins; D007073:Immunoglobulin E
keywords: component resolved diagnosis (CRD); desensitization; peanut allergy; sublingual immunotherapy (SLIT)