Short-term ibrutinib therapy suppresses skin test responses and eliminates IgE-mediated basophil activation in adults with peanut or tree nut allergy

[...]IgE-mediated BAT responses began to recover within days after cessation of ibrutinib treatment, and all were back to baseline within 1 week for all subjects, suggesting that ibrutinib's suppressive effects last longer in mast cells than in basophils in vivo.Because the lifespan of tissue mast cells is long compared with that of basophils, ibrutinib's varied duration of action is likely due to differing rates of BTK turnover and de novo synthesis in mast cells and basophils.Absolute lymphocyte count was increased on days 2 (P = .02) and 7 (P = .03) of ibrutinib treatment compared with baseline, but not on other days, and total bilirubin was increased (but remained within normal ranges) on days 2 (P = .03) and 4 (P = .02) only (see Fig E4 in this article's Online Repository at www.jacionline.org) and was entirely reversible after cessation of treatment.[...]the clinical significance of these changes is likely minimal, because both these parameters were reversible and always remained within the normal range for adults.[...]SPTs and BAT are imperfect surrogate indicators of clinical reactivity to foods.[...]we have demonstrated that short-term ibrutinib therapy (as few as 2 doses) is well tolerated and can eliminate or drastically reduce mast cell and basophil reactivity to food allergens.