Q&A With Dr. Erik Wambre, FARE Investigator in Food Allergy

Erik Wambre, PhD, is on the faculty of the Benaroya Research Institute at Virginia Mason, located in Seattle, WA. He received a 2015 Mid-Career FARE Investigator in Food Allergy Award for his research to understand immune cell responses in peanut allergy. In August 2017, Dr. Wambre’s lab published in Science Translational Medicine the discovery of a specific cell type that is present in allergic individuals and absent in people who don’t have allergies. He will be presenting an update on this work at the 2018 FARE Research Retreat, which will be held April 13-14 in McLean, VA.

What first attracted you to food allergy research?

While allergy testing provides robust and reliable diagnosis for pollen or dander allergy, current tests can’t differentiate between a true food allergy and cross-reactivity. The methods we have aren’t sensitive enough for foolproof prediction of the onset of food allergy disease. Consequently, some parents never suspect a food allergy until their child ends up in the emergency room. Or if the child initially has mild symptoms, like eczema, parents may not realize the cause is a food allergy. Among allergic diseases, food allergies tend to be most feared, and their prevalence is increasing. This represents a constant stress not only for the patient but for the family, too. As a father of two young kids, I have become increasingly interested in developing new testing methods for predicting and determining the presence of food allergy and the likelihood that an allergy will resolve.

What has sustained your interest?

My lab started focusing on the identification of immunological signatures, or biomarkers, for allergic disease. A biomarker is a measurable substance whose presence indicates disease, symptoms, or treatment effects. Biomarker discovery requires carefully documented biological samples from patients. For this reason, we are collaborating with various biotech and pharma companies that have ongoing clinical trials, so that we have access to coded samples from a variety of therapeutic interventions in food allergy. These samples allow the identification and measurement of biomarkers that may predict treatment outcomes. A better understanding of disease mechanisms is crucial in this respect. I feel fortunate that funds from FARE have allowed my lab to move into this field of research.

What experimental finding has surprised you the most, and why?

Accumulating evidence suggests that immune-system cells called CD4+ T helper cells play a significant role in the development of allergic disease. Our research project began by trying to distinguish the “bad” T cells that cause allergy from the “good” T cells that fight infections. One thing that surprised me is that the T cells involved in pollen, cat dander, or dust mite allergies shared exactly the same features as the T cells triggering peanut, milk or egg allergy. Interestingly, we identified a new subset of Type 2 helper T cells (TH2) found only in patients with allergic disease; we named these allergy-associated cells TH2A. We also observed that TH2A cells decrease as patients become desensitized during allergen immunotherapy. We now expect that using TH2A cells as a therapeutic target has the potential to improve allergy diagnosis and guide the development of more effective treatments.

How might your research supported by FARE affect patient care in the future?

Despite advances in food allergen immunotherapy, some patients don't benefit from immunotherapy, and some experience adverse reactions during the treatment protocol. I have become increasingly interested in determining the cellular and molecular mechanisms associated with variation in peanut allergic responses. Our research indicates that the magnitude and quality of specific CD4+ T cell responses vary from patient to patient and may dictate the outcome of clinical allergic response. Instead of seeing confusion in such diversity, I see an opportunity to identify a group of patients with shared biological characteristics so that physicians can select the optimal management for those patients and achieve the best possible treatment outcome.

What unresolved question relating to food allergies would you most like to see answered?

The mechanisms of food allergen immunotherapy are not yet understood. So far our research supports a model in which the presence of a disease-causing CD4+ T cell subset might be sufficient for the development of allergic disease regardless of the other T helper subsets. To develop more effective food allergen immunotherapy, we would like to understand the processes responsible for producing and maintaining pro-allergic TH2A cells, so that we can figure out how to stop them.