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Omalizumab - a potential treatment approach for IgE-mediated food allergy patients

Published: December 16, 2022

Globally, food allergy (FA), an immune-mediated adverse reaction to dietary proteins (allergens), is on the rise with prevalence estimates of 0.2 to >10%. FA negatively impacts the quality of life (QoL) of patients and caregivers, especially in patients allergic to multiple foods. The current management of FA involves strict allergen avoidance, immediate treatment in the event of an allergic reaction, and oral immunotherapy (OIT) to increase allergen reaction threshold and decrease FA symptoms. Despite this, the treatment of FA remains a challenge for many patients owing to accidental exposures to allergens. Omalizumab (OMA), an anti-IgE monoclonal antibody, has been shown to prevent allergic responses and may have clinical applications in the treatment of FA. Indeed, several individual studies have demonstrated that OMA increases allergen threshold when given as monotherapy or as an adjunct to OIT and can also prevent systemic reactions to OIT.

In a recent analysis by Zuberbier, et al, published in The Journal of Allergy and Clinical Immunology: In Practice, the efficacy and safety of OMA and OMA+OIT in patients with IgE-mediated FA was evaluated. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, the authors assessed data regarding an increase in the amount of allergen that does not cause severe or unacceptable adverse effects (tolerated dose), clinical nonreactivity upon persistent allergen exposure (desensitization), consumption of food without requiring any treatment (sustained unresponsiveness), levels of immunological biomarkers, QoL, and severity of allergic reactions to food following treatment with OMA and OMA+OIT.

The authors searched multiple databases and included data from 36 studies in children and adults with clinician diagnosed IgE-mediated FA. OMA monotherapy significantly increased the threshold tolerated dose for multiple foods such as milk, egg, wheat, and baked milk, improved patients’ QoL, and reduced food-induced allergic reactions versus pre-OMA therapy (P<0.01). Similarly, compared to placebo and pre-OMA, OMA+OIT significantly increased the tolerated dose of multiple foods, resulting in desensitization (P<0.01). OMA+OIT also improved patients’ QoL, and increased immunoglobulin G4 levels versus pre-OMA therapy (P<0.01). No major safety concerns were noted. These results imply that OMA is beneficial and can represent a potential treatment option for patients with IgE-mediated FA. The ongoing Phase III OUtMATCH study may help understand the long-term safety and efficacy of OMA and OMA+OIT in patients with allergy to multiple foods.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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