Food oral immunotherapy: Any distinguishing factors predicting the need of anti-IgE?
Main Article Content
Keywords
allergic reactions, food allergy, food challenge test, omalizumab, oral immunotherapy
Abstract
Oral immunotherapy (OIT) has gained popularity recently for IgE-mediated food allergy. Omalizumab (OMZ) has been used in patients (10–20%) who have too severe/frequent allergic reactions (AR) to continue OIT, to reduce these reactions. In this study, it was aimed to compare two groups of patients who completed OIT with and without OMZ and to seek determinants predicting the need of this treatment. It was also aimed to share the clinical findings regarding the long-term use of OMZ and the withdrawal process. Forty-one patients were started OIT and 93% could be desensitized. Two groups were similar in means of demographic characteristics, and clinical and laboratory findings. The patients who needed OMZ during OIT had also lower reaction doses during oral challenge (p = 0.037). Higher AR rate in this group declined after starting OMZ (p < 0.001). The injection intervals of OMZ were gradually extended. Most patients were able to discontinue OMZ (81%). There were no severe reactions during drug withdrawal attempts. The low reaction thresholds during oral food challenge may give a clue about OMZ requirement during OIT. It may be an option to start the treatment before OIT if reaction was seen in the first few steps of the oral food challenge. For the sake of safety, extension of injection intervals should be preferred instead of abruptly stopping OMZ.
References
2. Clark AT, Ewan PW. Food allergy in childhood. Arch Dis Child. 2003;88(1):79–81. 10.1136/adc.88.1.79
3. Longo G, Barbi E, Berti I, Meneghetti R, Pittalis A, Ronfani L, et al. Specific oral tolerance induction in children with very severe cow’s milk-induced reactions. J. Allergy Clin. Immunol. 2008;121(2):343–47. 10.1016/j.jaci.2007.10.029
4. Navinés-Ferrer A, Serrano-Candelas E, Molina-Molina GJ, Martín M. IgE-Related Chronic Diseases and Anti-IgE-Based Treat-ments. J Immunol Res. 2016;2016:8163803. 10.1155/2016/8163803
5. Dantzer JA, Wood RA. Anti-immunoglobulin E for food allergy. Ann Allergy Asthma Immunol. 2023;131(1):11–22. 10.1016/j.anai.2023.03.030
6. Yu L, Zhang H, Pan J, Ye L. Pediatric usage of Omalizumab: A promising one. World Allergy Organ J. 2021;14(12):100614. 10.1016/j.waojou.2021.100614
7. Martorell-Calatayud C, Michavila-Gómez A, Martorell-Aragonés A, Molini-Menchón N, Cerdá-Mir JC, Félix-Toledo R, et al. Anti-IgE-assisted desensitization to egg and cow’s milk in patients refractory to conventional oral immunotherapy. Pediatric allergy and immunology: official publication of the European Society of Pediatric Allergy and Immunol. 2016;27(5):544–46. 10.1111/pai.12567
8. Wood RA, Kim JS, Lindblad R, Nadeau K, Henning AK, Dawson P, et al. A randomized, double-blind, placebo-controlled study of omalizumab combined with oral immunotherapy for the treatment of cow’s milk allergy. J. Allergy Clin. Immunol. 2016;137(4):1103–10.e11. 10.1016/j.jaci.2015.10.005
9. Nadeau KC, Schneider LC, Hoyte L, Borras I, Umetsu DT. Rapid oral desensitization in combination with omalizumab therapy in patients with cow’s milk allergy. J. Allergy Clin. Immunol. 2011;127(6):1622–4. 10.1016/j.jaci.2011.04.009
10. Takahashi M, Soejima K, Taniuchi S, et al. Oral immunotherapy combined with omalizumab for high-risk cow’s milk allergy: a randomized controlled trial. Sci. Rep. 2017;7:17453. 10.1038/s41598-017-16730-6
11. Azzano P, Paquin M, Langlois A, Morin C, Parizeault G, Lacombe-Barrios J, et al. Determinants of omalizumab dose-related efficacy in oral immunotherapy: Evidence from a cohort of 181 patients. J. Allergy Clin. Immunol. 2021;147(1):233–43. 10.1016/j.jaci.2020.08.039
12. Kawakami T, Blank U. From IgE to Omalizumab. Journal of immunology (Baltimore, Md: 1950). 2016;197(11):4187–192. 10.4049/jimmunol.1601476
13. Pajno GB, Fernandez-Rivas M, Arasi S, Roberts G, Akdis CA, Alvaro-Lozano M, et al. EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy. Allergy. 2018;73(4):799´815. 10.1111/all.13319
14. Dello Iacono I, Tripodi S, Calvani M, Panetta V, Verga MC, Miceli Sopo S. Specific oral tolerance induction with raw hen’s egg in children with very severe egg allergy: a randomized controlled trial. Pediatric allergy and immunology: official publication of the European Society of Pediatric Allergy and Immunol. 2013;24(1):66–74. 10.1111/j.1399-3038.2012.01349.x
15. Duman Senol H, Topyildiz E, Ulusoy Severcan E, Eren Akercan S, Cigerci Gunaydin N, Gulen F, et al. Could Age and Oral Challenge Outcomes Identify High-Risk Patients During Cow’s Milk Oral Immunotherapy? Pediatric Allergy, Immunol, and Pulmonol. 2022;35(2):95–101. 10.1089/ped.2022.0003
16. Jagdis A, Berlin N, Barron C, Giruparajah M, Leader N, Maclachlan S, et al. Effect of ketotifen premedication on adverse reactions during peanut oral immunotherapy. Allergy, asthma, and clinical immunology: official journal of the Canadian Society of Allergy and Clin. Immunol. 2014;10(1):36. 10.1186/1710-1492-10-36
17. Asaumi T, Ebisawa M. How to manage food dependent exercise induced anaphylaxis (FDEIA). Current opinion in allergy and clinical immunology. 2018;18(3):243–7. 10.1097/ACI.0000000000000442
18. Xolair® (Omalizumab). Prescribing Information for US Healthcare Professionals (Revised: 08/2023). #x00A9;2023 Genentech USA, Inc. and Novartis Pharmaceuticals Corporation. https://www.xolair.com/
19. Andorf S, Purington N, Block WM, Long AJ, Tupa D, Brittain E, et al. Anti-IgE treatment with oral immunotherapy in multifood allergic participants: a double-blind, randomised, controlled trial. Lancet Gastroenterol & Hepatol. 2018;3(2):85–94. 10.1016/S2468-1253(17)30392-8
20. Ayats-Vidal R, Riera-Rubió S, Valdesoiro-Navarrete L, García-González M, Larramona-Carrera H, Cruz OA, et al. Long-term outcome of omalizumab-assisted desensitisation to cow’s milk and eggs in patients refractory to conventional oral immunotherapy: real-life study. Allergol Immunopathol. 2022;50(3): 1–7. 10.15586/aei.v50i3.537
21. Ibáñez-Sandín MD, Escudero C, Candón Morillo R, Lasa EM, Marchán-Martín E, Sánchez-García S, et al. Oral immunotherapy in severe cow’s milk allergic patients treated with omalizumab: Real life survey from a Spanish registry. Pediatric allergy and immunology: official publication of the European Society of Pediatric Allergy and Immunology. 2021;32(6): 1287–95. 10.1111/pai.13517
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.