Allergenic immunotherapy (AIT) is currently the only curative treatment for allergic disease. Whereas efficacy of this treatment is well established, its mechanisms of action are not clearly understood and predictive as well as surrogate biomarkers are needed to further support AIT development. We focused on allergen specific CD4 T cells, highly involved in allergic inflammation, and monitored their responses both in normal and pathologic conditions, or during AIT. Using MHC class II tetramers, we highlighted distinct patterns of polarization between seasonal and perennial allergen-specific CD4 T cells as well as between healthy and allergic individuals. Then, allergen-specific CD4 T cell responses were monitored during 2 double-blind placebo-controlled sublingual AIT clinical trials. After short term AIT (4 months), we observed a decrease of Th2A cells, a newly define subset, thought to contain most allergen-specific CD4+ T cells. IFN-γ production was increased after one year of treatment. However, these variations were not related to AIT clinical efficacy. We further compared the expression of various activation markers and MHC class II tetramer staining following in vitro stimulation in order to circumvent inherent limitation of tetramers. No correlation could be established between tetramer staining and the expression of multiple activation markers in allergen-stimulated CD4 T cells. Combining these methods helps understanding patient heterogeneity regarding CD4 T cell responses. Moreover, Th2A cells detection is likely a promising approach to identify allergen-specific CD4 T cell during long-term AIT.
