From left: principal investigators Cecilia Berin, PhD; and Scott Sicherer, MD; with Supinda Bunyavanich, MD, MPH, leader of the genomic and data-science arm of the project.
When patients are diagnosed with peanut allergy, they often ask two questions: “How much peanut can I eat before I get sick, and how severe will the reaction be?” says Scott Sicherer, MD, Director, Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai. And physicians have another question, he says: “If I recommend a therapy, is it going to work for this patient?” These questions are at the center of research funded by a five-year, $7.6 million grant from the National Institute of Allergy and Infectious Diseases that was recently awarded to a multidisciplinary team at the Icahn School of Medicine.
The research is divided into three projects, which reflect Mount Sinai’s unique strengths in clinical allergy treatment, basic science, and data-driven medicine. Cecilia Berin, PhD, Deputy Director of the Jaffe Food Allergy Institute, and Professor of Pediatrics, and Dr. Sicherer are principal investigators of the National Institutes of Health grant.
The central project is a clinical trial that will focus on a seldom-studied group—people with “high-threshold” peanut allergy, meaning they react only to larger amounts of peanut. This trial of a dietary allergy immunotherapy will be led by Dr. Sicherer, the Elliot and Roslyn Jaffe Professor of Pediatric Allergy and Immunology, and Chief of Pediatric Allergy; and Anna Nowak-Wegrzyn, MD, PhD, Professor of Pediatrics. “Most studies right now are looking at people who are exquisitely allergic—people who react to a fraction as small as a 50th of a peanut,” Dr. Sicherer says. “But a majority of people with peanut allergy do not react to these tiny amounts, and the treatments so far have not really been directed to them. This study is trying to identify those people and then see if an immunotherapy would help them, possibly to a cure.”
Researchers will conduct “food challenges” of about 200 children ages 4 to 14, giving them small doses of peanut. They plan to identify 98 high-threshold children, who will be divided into two groups. One group will simply avoid peanut, and the other will eat small amounts of peanut butter—carefully measured by parents—starting with about 1/8 teaspoon and progressing to larger servings. The aim is to reduce, or even eliminate, their sensitivity to peanut.
Anna Nowak-Wegrzyn, MD, PhD, gave patient Gabriella Evans a small dose of peanut, a therapy that will be further studied in an upcoming clinical trial.
The other two projects will analyze blood samples from all 200 children. “We have developed advanced tools for studying many parameters of the allergic response to peanut using small amounts of blood,” says Dr. Berin. “In my project, the idea is understanding the immune pathways that affect peanut allergy overall and the immune basis of outgrowing peanut allergy in response to allergen immunotherapy.”
The third project will take a genomic and data-science approach, using Mount Sinai’s high-performance computing resources. It is led by Supinda Bunyavanich, MD, MPH, Associate Director of the Jaffe Food Allergy Institute, and Associate Professor of Genetics and Genomic Sciences, and Pediatrics. “We will sequence blood samples from the children participating in this trial and use data science to identify novel biomarkers for peanut-allergy management,” Dr. Bunyavanich says. “Our goal is to find biomarkers that predict reaction threshold and desensitization potential in peanut-allergic individuals. The project will also further our mechanistic understanding of peanut allergy severity.”
Overall, the objective is to develop more effective, personalized immunotherapies for peanut allergy and to determine which patients are the best candidates before any treatment starts. “Peanut allergy is a very common food allergy—it affects about 2 percent of kids,” Dr. Sicherer says, “and this research will have a big impact on how we treat these patients.”