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Oral Food Challenges After Treatment With Omalizumab in the Clinical Setting
Hao Tseng1, Robert A Wood1, Jackie Isola1
1Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
Background:
Although omalizumab is now approved for the treatment of food allergy, little is known about its use in the clinical setting.
Objective:
To examine the outcome of oral food challenges (OFCs) after treatment with omalizumab.
Methods:
We conducted a retrospective chart review of clinic patients who underwent OFCs after treatment with omalizumab, including cumulative tolerated doses and all adverse events.
Results:
A total of 51 patients (45% female; median age, 9 [range, 1-23] years; median total IgE, 512 [interquartile range, 285 to 1080] IU/mL) underwent 73 OFCs, with milk (n = 27), egg (n = 23), and wheat (n = 9) accounting for 81% of the OFCs. A reaction history was documented for 95% and all challenged foods had a positive allergen-specific IgE (median, 34 [interquartile range, 12 to >100] kUA/L). OFCs were performed at a median of 7 (range, 4-14) months after starting omalizumab. Among OFCs to any food with a goal dose ≥6000 mg (n = 56), 89% successfully consumed ≥1000 mg, 86% ≥2000 mg, 75% ≥4000 mg, and 66% ≥6000 mg. Allergic reactions occurred in 45% (n = 33) of all OFCs, with 21 treated with antihistamines and 2 treated with epinephrine. Dietary introduction of allergenic foods was permitted following 92% of OFCs. Omalizumab treatment response was associated with higher baseline total IgE, every 2-week dosing versus every 4-week dosing, higher total omalizumab dose per 4 weeks per weight, and lower allergen-specific IgE to total IgE ratio.
Conclusions:
Omalizumab can be effectively used for the treatment of food allergy in the clinical setting and may enable the introduction of allergenic foods into the diet for most patients.
Insights
Omalizumab treatment enables successful oral food challenges (OFCs) for most patients with food allergy (FA). This approach facilitates the dietary introduction of allergenic foods, improving patient outcomes.
Area of Science:
- Immunology
- Allergy and Immunology
- Clinical Medicine
Background:
- Omalizumab is approved for food allergy (FA) treatment.
- Clinical effectiveness and outcomes of omalizumab in FA require further investigation.
Purpose of the Study:
- To evaluate the outcomes of oral food challenges (OFCs) in patients with FA undergoing treatment with omalizumab.
- To assess the safety and efficacy of omalizumab in a clinical setting for FA management.
Main Methods:
- Retrospective chart review of patients with FA undergoing OFCs post-omalizumab treatment.
- Analysis of cumulative tolerated food doses and adverse events during OFCs.
Main Results:
- 73 OFCs were performed on 51 patients (median age 9 years) for milk, egg, and wheat allergies.
- 66% of patients successfully consumed ≥6000 mg of the target allergen during OFCs.
- Allergic reactions occurred in 45% of OFCs, managed with antihistamines or epinephrine.
- Dietary introduction of allergenic foods was permitted in 92% of cases post-OFC.
Conclusions:
- Omalizumab is effective for treating FA in a clinical setting.
- Omalizumab facilitates the introduction of allergenic foods into the diet for the majority of FA patients.
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