A pilot study towards the immunological effects of omalizumab treatment used to facilitate oral immunotherapy in peanut allergic adolescents.

Anti-IgE treatments, such as omalizumab, have shown promising effects in allergy treatment. Our previous work has shown that individualized omalizumab treatment (OT) allows a safe initiation and rapid up-dosing of peanut oral immunotherapy (OIT) in peanut allergic adolescents. However, the broader immunological effects of this OT are incompletely understood. In this pilot study, we longitudinally followed the total B- and T-cell immunity during OT, using flow cytometry, ELISpot and ELISA. Peripheral blood mononuclear cells (PBMCs) and plasma were collected from participants (n=17) at several timepoints during treatment; before starting OT (baseline), prior to starting OIT during OT (start OIT), and at maintenance dose OIT prior to OT reduction (maintenance). OT did not affect the total B-cell compartment over treatment time, but our results suggest an association between the OT dosage scheme and the B cell compartment. Further, in vitro polyclonal T cell-activation at the different timepoints suggests a cytokine skewing towards the Th1 phenotype at the expense of Th2 and Th9 related cytokines during treatment. No differences in the frequencies or phenotype of regulatory T-cells (Tregs) over treatment time were observed. Finally, plasma chemokine levels were stable over treatment time, but suggest elevated gut homing immune responses in treatment successes during the treatment as compared to treatment failures. The novel and explorative results of this pilot study help to improve our understanding on the immunological effects of OT used to facilitate OIT and provide guidance for future immunological investigation in large clinical trials.