Successful Oral Immunotherapy (OIT) Due to Anti-IgE Protection

Area of Science:

• Allergy and Immunology
• Clinical Therapeutics

Background:

• Oral immunotherapy (OIT) for peanut allergy is challenging for highly reactive patients.
• Omalizumab (anti-IgE monoclonal antibody) shows promise as an adjunctive therapy for OIT initiation.

Purpose of the Study:

• To evaluate the safety and efficacy of omalizumab premedication for initiating peanut OIT in highly reactive children.
• To assess the impact of omalizumab on anaphylaxis and time to reach maintenance dose.

Main Methods:

• Retrospective case series involving three children with failed OIT initiation.
• Off-label insurance approval obtained for omalizumab premedication prior to a second OIT attempt.
• Patients received omalizumab before restarting OIT with peanut protein powder.

Main Results:

• All patients successfully restarted OIT under omalizumab protection without anaphylactic reactions.
• Patients tolerated escalating doses and reached the maintenance dose within the protocol.
• Omalizumab significantly reduced side effects, particularly anaphylaxis, during OIT initiation.

Conclusions:

• Omalizumab premedication is a safe and effective strategy for initiating peanut OIT in select highly reactive patients.
• This approach mitigates anaphylactic risks and accelerates desensitization to maintenance levels.
• Further research is warranted, especially given the lack of EMA approval for food allergy treatment with omalizumab.