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The following is a summary of “Baseline Epitope-Specific IgE Profiles are Predictive of Sustained Unresponsiveness or High Threshold One-Year Post OIT in the POISED Trial,” published in the November 2024 issue of Allergy and Immunology by Suprun et al. 

Discontinuation of peanut oral immunotherapy (OIT) may heighten the risk of regaining clinical reactivity to peanuts, as indicated by results from the POISED trial. 

Researchers conducted a retrospective study to analyze baseline IgE profiles in patients achieving sustained unresponsiveness (SU) or sustained high threshold (SHT) compared to transient desensitization (TD). 

Subjects in the POISED trial (NCT02103270) were randomized to receive peanut (n=95) or placebo (n=25) for 24 months. Following this, OIT-desensitized subjects were assigned to no peanut (PN-0, n=51) or 300 mg (PN-300, n=30) for 12 months. SU and SHT were determined by passing a 4000 mg peanut oral challenge. Specific IgE and IgG4 levels to peanut, Ara h 1-3 proteins, and 64 allergenic epitopes were measured, and machine learning glmnet models were developed using baseline data to predict SU/SHT. 

The results showed that 80 (84%) subjects were desensitized to peanuts. Among them, 13% (n=8) in PN-0 and 37% (n=13) in PN-300 achieved SU or SHT. They noted decreases in IgE and increases in IgG4 levels during 2 years of OIT. Patients with SU in PN-0 had lower IgE levels than the TD group. A machine-learning model using 12 baseline epitope-specific IgEs and age predicted SU/SHT with 94% accuracy, AUC of 0.97, sensitivity of 1.00, and specificity of 0.91. 

The study concluded that patients with SU or SHT had distinct baseline IgE profiles compared to those with TD. 

Source: jacionline.org/article/S0091-6749(24)01161-8/abstract