{Reference Type}: Journal Article
{Title}: Fecal IgE Analyses Reveal a Role for Stratifying Peanut-Allergic Patients.
{Author}: Czolk R;Codreanu-Morel F;de Nies L;Busi SB;Halder R;Hunewald O;Boehm TM;Hefeng FQ;De Beaufort C;Wilmes P;Ollert M;Kuehn A;
{Journal}: J Investig Allergol Clin Immunol
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jul 26
{Factor}: 8.185
{DOI}: 10.18176/jiaci.1008
{Abstract}: <B>UNASSIGNED: </B>Peanut allergy (PA) is an IgE-mediated food allergy with variable clinical outcomes. Mild-to-severe symptoms affect various organs and, often, the gastrointestinal tract. The role of intestine-derived IgE antibodies in astrointestinal PA symptoms is poorly understood. This study aimed to examine fecal IgE responses in PA as a novel approach to patient endotyping.<BR><B>METHODS: </B>Feces and serum samples were collected from peanut-allergic and healthy children (n=26) to identify IgE and cytokines using multiplex assays. Shotgun metagenomics DNA sequencing and allergen database comparisons made it possible to identify microbial peptides with homology to known allergens.<BR><B>RESULTS: </B>Compared to controls, fecal IgE signatures showed broad diversity and increased levels for 13 allergens, including food, venom, contact, and respiratory allergens (P<.01-.0001). Overall, fecal IgE patterns were negatively correlated compared to sera IgE patterns in PA patients, with the greatest differences recorded for peanut allergens (P<.0001). For 83% of the allergens recognized by fecal IgE, we found bacterial homologs from PA patients' gut microbiome (eg, thaumatin-like protein Acinetobacter baumannii vs Act d 2, 109/124 aa identical). Compared to controls, PA patients had higher levels of fecal IgA, IL-22, and auto-IgE binding to their own fecal proteins (P<.001). Finally, levels of fecal IgE correlated with abdominal pain scores (P<.0001), suggesting a link between local IgE production and clinical outcomes.<BR><B>CONCLUSIONS: </B>Fecal IgE release from the intestinal mucosa could be an underlying mechanism of severe abdominal pain through the association between leaky gut epithelia and anticommensal TH2 responses in PA.