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.