Biologics in IgE-mediated food allergy: where are we know?

This review summarizes current evidence on emerging biologics and their evolving role in IgE-mediated food allergy management. The goal is to assess the pros and cons of currently available and under evaluation biologicals.

Anti-IgE therapies remain central to biologic-based approaches. Omalizumab improves desensitization rates as monotherapy or when combined with oral immunotherapy (OIT), whose enhances safety and accelerates desensitization efficacy. Next-generation anti-IgE antibodies, including UB-221, show increased potency and promising early results. Less encouraging are data on Dupilumab, targeting IL-4/IL1-3 receptor, in IgE-mediated food allergy. Biologics targeting epithelial alarmins, such as anti-IL-33 (etokimab) and anti-TSLP (tezepelumab), demonstrate encouraging preliminary immunologic and clinical effects, with early success noted in peanut allergy trials. Further research focus is devoted to small molecules and vaccines.

Biologics offer a meaningful advance in food allergy treatment by targeting key immune pathways with an agnostic approach, therefore, independent on the specific antigen-specificity. This may offer the benefit of targeting multiple food allergies and also, eventually, further co-morbidities. There is broad evidence for an excellent safety profile for omalizumab. Studies are ongoing on other biologicals to explore the efficacy alongside the safety. A new era is also opened by the introduction of biosimilar on the market, by dramatically amortizing the economic burden. With the availability of multiple therapeutic options, the challenge for clinicians is to provide a personalized approach, shaped on the specific patient's need.