Thank you for the question. We sought the expert answer from Dr. Thomas Casale below.
Below are three references that in part address this issue. There have been no double-blind, placebo-controlled trials to examine the added efficacy and safety of omalizumab plus allergen immunotherapy. The Massanari study does show that pretreatment with omalizumab imparts safety to allergen immunotherapy in patients with asthma. The other two studies are open label studies not controlled but do show added safety and efficacy of the combination. My personal opinion is that the omalizumab should be given for 8 to 16 weeks to make sure that asthma is under reasonable control before starting allergen immunotherapy. There are no data to show if you can stop the omalizumab treatment once a patient reaches maintenance immunotherapy. Again, my opinion would be to continue both.
Key considerations for clinical trials of dietary interventions for primary prevention of allergy and asthma in children (pages 730–732) Bright I. Nwaru, Suvi M. Virtanen and Aziz Sheikh, Pediatric Allergy and Immunology 25 (2015) 817–837
Children with severe asthma can start allergen immunotherapy after controlling asthma with omalizumab: a case series from Poland, Iwona Stelmach1, Paweł Majak, Joanna Jerzyńska, Magdalena Bojo, Łukasz Cichalewski, Katarzyna Smejda, Arch Med Sci 2015; 11, 4: 901–904
Effect of pretreatment with omalizumab on the tolerability of specific immunotherapy in allergic asthma Marc Massanari, PharmD, Harold Nelson, MD, Thomas Casale, MD, William Busse, MD, Farid Kianifard, PhD, Gregory P. Geba, MD, MPH, and Robert K. Zeldin, MD. J Allergy Clin Immunol 2010;125:383-9.
We hope this helps.
Patricia McNally, MD, FAAAAI