The following is a summary of “Distinct trajectories distinguish antigen-specific T cells in peanut-allergic individuals undergoing oral immunotherapy,” published in the JULY 2023 issue of Allergy & Immunology by Calise, et al.

While peanut-allergic (PA) individuals may exhibit similar clinical symptoms, their response to therapeutic interventions can vary significantly. For a study, researchers sought to investigate whether the inherent qualities of cell response at baseline could influence the response to peanut oral immunotherapy (PnOIT).

Ex vivo T-cell profiling was performed on peanut-reactive CD154⁺CD137⁺ T (pTeff) cells from 90 challenge-confirmed PA individuals. A gating strategy was developed to assess the phenotypic distribution of rare pTeff cells across different memory CD4⁺ T-cell subsets to define patient immunotype. Longitudinal samples from 29 PA participants enrolled in the IMPACT trial of PnOIT were analyzed to determine whether the patient immunotype at baseline could influence the response to PnOIT.

The study revealed the heterogeneity of pTeff cell responses in PA participants, classifying them into two mutually exclusive phenotypic entities (CCR6−CRT_H2⁺ and CCR6⁺CRT_H2^–). Based on the proportion of T_H2A pTeff cells, peanut allergy was broadly divided into at least two distinct subtypes, termed immunotypes, each with different immunologic and clinical characteristics. PnOIT led to the elimination of T_H2A pTeff cells during the IMPACT clinical trial. Notably, only one PA patient with low T_H2A pTeff cells at baseline experienced the long-lasting remission benefit after PnOIT discontinuation.

By dividing PA patients according to their peanut-specific T-cell profile, the research suggested that patient stratification in clinical settings based on immunotypes could help identify those who respond best to different therapies.

Source: jacionline.org/article/S0091-6749(23)00372-X/fulltext