0
0
January 7, 2025 – New findings in food allergy treatment have brought attention to an unexpected player: bile acids. In a breakthrough study, bile acids were identified as key components influencing immune responses in children with food allergies and their reaction to oral immunotherapy (OIT).
The rising prevalence of potentially life-threatening food allergies has sparked the urgent need for better therapies. One of the few treatments available, oral immunotherapy (OIT), involves gradually introducing allergens to help the body build tolerance. However, the success of OIT varies significantly among patients, and understanding the mechanisms behind this discrepancy is vital for improving treatment strategies.
A recent study led by Dr. Yamini Virkud, associate professor of pediatrics at the University of North Carolina (UNC) and director of Bioinformatics at the UNC Food Allergy Institute, sought to uncover the role of metabolites—small molecules involved in numerous biological processes—in food allergies. Through a comprehensive analysis of metabolomic profiles, Virkud’s team discovered that bile acids, which are traditionally known for aiding digestion, play a crucial role in immune system regulation.
The study, published in Pediatric Allergy and Immunology, compared metabolite levels in children with food allergies to those without. It found that children with food allergies had higher bile acid levels, while those without allergies had lower concentrations. This key discovery was further explored in children undergoing OIT treatment, with the researchers examining the differences in responses to the therapy.
Notably, children who maintained their protection from OIT after a month-long hiatus showed higher levels of specific bile acids called lithocholates. On the other hand, those who lost their protection exhibited generally higher bile acid levels but lacked the beneficial lithocholates.
Dr. Virkud explains, “While bile acids are essential for digestion, emerging research has shown that they also play a significant role in immune cell regulation. Our findings suggest that the profile of bile acids could be a predictor of how well a patient responds to OIT, offering us a potential avenue to personalize treatments.”
The study also found significant differences in other metabolites, such as histidines and poly-unsaturated fatty acids, which are known to affect the immune system. These findings open the door to further research on how metabolic pathways influence allergic responses and OIT outcomes.
Virkud’s team worked with multiethnic cohorts from several studies, including the Genetics of Asthma in Costa Rica (GACRS) and the Vitamin D Antenatal Asthma Reduction Trial (VDAART), along with participants from the Peanut Oral Immunotherapy (PNOIT) trial. By studying repeated samples from the same individuals, the team gained insights into how metabolomic profiles evolved during OIT and how they correlated with long-term therapeutic success.
The discovery that bile acids are linked to immune regulation in food allergies represents a novel area of exploration. According to Dr. Virkud, “Clinical allergists typically don’t focus on bile acids, and it was only recently—around 2019 to 2020—that studies began uncovering the relationship between these metabolites and immune cells. Our research ties those findings to food allergies and opens up new possibilities for treatment.”
As a result, the research team is optimistic that further studies into bile acids and other immunomodulatory metabolites could not only help identify patients most likely to benefit from OIT but also guide the development of new therapeutic approaches for food allergies.
This groundbreaking work underscores the growing importance of metabolomics in understanding the intricate relationship between diet, immune function, and disease. The hope is that, as this field progresses, therapies can be developed that not only manage but potentially cure food allergies, improving the lives of millions of people worldwide.
For more information, the full study, titled Immunomodulatory metabolites in IgE‐mediated food allergy and oral immunotherapy outcomes based on metabolomic profiling, can be accessed in Pediatric Allergy and Immunology (2024).
