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The Role of Eosinophils in Immunotherapy

  • Food Allergy (E Kim, Section Editor)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to provide a brief discussion on the differential diagnosis for peripheral eosinophilia. We will then focus on targeted immunotherapies for atopic disease, their effects on absolute peripheral eosinophil counts, and use of peripheral eosinophils as a predictor of treatment response.

Recent Findings

In atopic disease, lower absolute peripheral eosinophil counts are typically associated with improved outcomes. Much of the current evidence on eosinophils as a biomarker comes from post hoc analyses in therapeutic immunotherapy. While changes in eosinophilia were not the primary outcome of interest in many studies, some patterns did emerge. Cytolytic monoclonal antibodies AK002 and benralizumab completely reduce peripheral and tissue eosinophil numbers. Dupilumab may have paradoxical transient eosinophilia despite observed clinical efficacy.

Summary

Atopic inflammation is complex largely due to the various cytokines which affect eosinophil activation, proliferation, differentiation, and survival. This demonstrates the challenges of using peripheral eosinophilia alone as a biomarker for atopic disease activity. More attention should spotlight how different immunotherapy modalities affect eosinophil-driven responses.

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Abbreviations

AEC:

Absolute eosinophil count

IL:

Interleukin

GM-CSF:

Granulocyte-macrophage colony-stimulating factor

TSLP:

Thymic stromal lymphopoietin

HES:

Hypereosinophilic syndrome

GI:

Gastrointestinal

AD:

Atopic dermatitis

EoE:

Eosinophilic esophagitis

SCIT:

Subcutaneous allergen immunotherapy

SLIT:

Sublingual aeroallergen immunotherapy

OIT:

Oral immunotherapy

EPIT:

Epicutaneous immunotherapy

EGPA:

Eosinophilic granulomatosis with polyangiitis

IgE:

Immunoglobulin E

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Funding

MAR is funded by National Institutes of Health National Center for Advancing Translational Sciences award number KL2TR001879. JMS is funded by the Stuart Starr Endowed Chair at the Children’s Hospital of Philadelphia. The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Wood Building, 3rd floor, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Joseph Cafone, Melanie A. Ruffner & Jonathan M. Spergel

  2. Institute for Immunology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Melanie A. Ruffner & Jonathan M. Spergel

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  1. Joseph Cafone
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  2. Melanie A. Ruffner
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  3. Jonathan M. Spergel
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Correspondence to Jonathan M. Spergel.

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Conflict of Interest

Dr. Spergel reports grants and personal fees from Regeneron, Sanofi, and Dbv Technologies, grants from NIH, during the conduct of the study; grants from AImmune THerapeutics, personal fees from ACAAI, outside the submitted work. The other authors have no disclosures to report during the conduct of the study.

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Cafone, J., Ruffner, M.A. & Spergel, J.M. The Role of Eosinophils in Immunotherapy. Curr Allergy Asthma Rep 20, 1 (2020). https://doi.org/10.1007/s11882-020-0895-x

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