Abstract
This review summarises recent advances in characterising the transcriptional pathways associated with outcomes following Oral Immunotherapy.
Recent technological advances including single-cell sequencing are transforming the ways in which the transcriptional landscape is understood. The application of these technologies is still in its infancy in food allergy but here we summarise current understanding of gene expression changes following oral immunotherapy for food allergy and specific signatures underpinning the different clinical outcomes of desensitisation and remission (sustained unresponsiveness).
T helper 2A cells have been identified as a cell type which correlates with disease activity and is modified by treatment. Molecular features at study entry may differentiate individuals who achieve more positive outcomes during OIT. Recent findings point to T cell anergy and Type 1 interferon pathways as potential mechanisms supporting redirection of the allergen-specific immune response away from allergy towards remission.
Despite these developments in our understanding of immune mechanisms following OIT, there are still significant gaps. Additional studies examining immune signatures associated with long term and well-defined clinical outcomes are required to gain a more complete understanding of the pathways leading to remission of allergy, in order to optimise treatments and gain improved outcomes for patients.
Key words : Food allergy; Transcriptomics; Systems biology; Oral Immunotherapy; Gene expression; Remission; Desensitisation
Key Message: This review summarises the current understanding of immune changes associated with food oral immunotherapy (OIT), focusing on new discoveries gained from state of the art transcriptomic approaches. Recent computational and technological advances have transformed our understanding of immune mechanisms driving food allergy, desensitisation and remission of food allergy. There is compelling evidence that T cell anergy and type I interferons play important roles in determining clinical outcomes following OIT. Future studies with larger sample sizes, from individuals with well-defined clinical outcomes and longitudinal sampling are needed to provide high quality evidence of key mechanisms and further elucidate novel biomarkers of treatment response.