At this year’s AAAAI annual meeting, Dr. Sharon Chinthrajah discussed how alterations in IgE lead to the development of gastrointestinal symptoms during oral immunotherapy for food allergy. This presentation highlighted the extensive gastrointestinal and mechanistic studies in the POISED clinical trial, one of the largest clinical trials for using oral immunotherapy (OIT) for the treatment of peanut allergy. The development of esophageal eosinophilia (EoE) is a rare but very concerning risk during OIT which is characterized by increased eosinophil counts in the esophagus with pathological abnormalities.

Esophageal eosinophilia is often used as a criteria for exclusion from OIT, however not all individuals with esophageal eosinophilia show symptoms of EoE and it was not clear whether OIT should be discontinued in these individuals. Dr. Chinthrajah showed how results from the POISED study demonstrated that transient asymptomatic eosinophilia is common during OIT and does not influence the development of gastrointestinal symptoms. For these individuals with asymptomatic eosinophilia, OIT was able to be completed safely and effectively. In addition, Dr. Chinthrajah discussed mechanisms that do contribute to gastrointestinal symptoms during OIT including studies tracking IgE+ B cell clones and γδ T cells throughout the course of OIT.