Peer-reviewed article
Longitudinal basophil activation testing for assessing response to low-dose initiation, slow-escalation peanut oral immunotherapy in patients with high Ara h 2-sIgE
Jinguo Chen, J. Joanna Yu, Jing Yu, Lili Wan, Joseph Chiao et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study followed 32 children with peanut allergy who received peanut oral immunotherapy, a treatment that gives gradually increasing amounts of peanut protein. Sixteen children had high Ara h 2-sIgE (a blood marker linked to harder-to-treat allergy) and 16 had lower levels. All started at a low dose and increased slowly, and they were followed for up to 36 months. About two thirds in each group reached effective desensitization (tolerating at least 300 mg peanut protein), with one severe adverse event in each group and no treatment-related discontinuations. The authors also tested blood markers (basophil activation and the sIgE/sIgG4 ratio) as possible ways to track response, and they say these need further validation.
Key points
- Effective desensitization (≥300 mg peanut protein) was reached by 68.8% of the high-sIgE group and 62.5% of the lower-sIgE group.
- One severe adverse event occurred in each subgroup, and no one stopped treatment because of the therapy.
- Peanut-specific sIgE rose temporarily and then declined, while sIgG4 rose early, so the sIgE/sIgG4 ratio fell. A ratio below 50 was linked to effective desensitization.
- Baseline basophil activation and sIgE did not predict desensitization. A basophil activation AUC below 100 was associated with it (ROC AUC 0.784, 95% CI 0.536–0.983).
- Time-lagged analyses did not show that the markers could predict outcomes in advance.
Limitations
The sample is very small (32 children) with wide confidence intervals, and there is no untreated or standard-care comparison group. The biomarker findings are exploratory and not validated prospectively. The abstract does not name the study country, so no country is recorded.
Abstract
Background Peanut oral immunotherapy (pOIT) can achieve desensitization, yet patients with high peanut-sIgE may experience more adverse reactions and treatment failure. We evaluated a conservative pOIT protocol in children with high Ara h 2-sIgE (≥40 kU/L) and examined longitudinal basophil activation test (BAT) and sIgE/sIgG4 trajectories as candidate biomarkers. Methods Thirty-two peanut-allergic children underwent pOIT, including 16 with high and 16 with lower Ara h 2-sIgE. All received low-dose initiation and slow up-dosing. Clinical outcomes, safety, and immunologic markers were evaluated longitudinally for up to 36 months. Results Effective desensitization (≥300 mg peanut protein) was achieved in 68.8% of high-sIgE and 62.5% of lower-sIgE participants. One severe adverse event occurred in each subgroup, with no treatment-related discontinuations. Peanut and Ara h 2/6-sIgE levels rose transiently before gradually declining, whereas sIgG4 increased early, leading to a reduced sIgE/sIgG4 ratio. A ratio <50 was associated with effective desensitization. BAT responses initially increased and subsequently declined, with progressive increase in the activation threshold. Baseline BAT and sIgE were not associated with desensitization. However, BAT area under the curve (AUC) <100 was significantly associated with effective desensitization with ROC AUC of 0.784 (bootstrap 95% CI 0.536–0.983). Exploratory time-lagged analyses did not establish prospective predictive utility. Conclusions Low-dose initiation, slow-escalation pOIT achieved effective desensitization in patients with high Ara h 2-sIgE, without treatment-related discontinuations. Longitudinal reductions in BAT and sIgE/sIgG4 ratio were associated with increased ingested dose. These exploratory biomarkers may provide adjunctive information during pOIT, but prospective validation is required.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Peanut oral immunotherapy with low-dose initiation and slow up-dosing, with longitudinal monitoring of basophil activation and sIgE/sIgG4 as possible biomarkers
- Population
- 32 peanut-allergic children: 16 with high Ara h 2-sIgE (≥40 kU/L) and 16 with lower Ara h 2-sIgE
Key finding
Effective desensitization was achieved in 68.8% of the high-sIgE group and 62.5% of the lower-sIgE group.
Chen et al. · OpenAlex - Early Childhood · 7 Oct 2026