Omalizumab facilitates rapid oral desensitization for peanut allergy

Food allergy is the leading cause of anaphylaxis, a serious and life-threatening systemic allergic reaction, among American children today.  Although it can be managed by avoidance and supportive management, there are few options for disease modification.  Oral immunotherapy (OIT) whereby increasing doses of an allergen are given, has been a promising investigational treatment, but the high rates of adverse reactions and intolerance of symptoms lead to high drop-out rates. In this month’s issue of JACI, MacGinnitie et al look at the use of omalizumab, an anti-IgE medication used in asthma, in helping to facilitate OIT (J Allergy Clin Immunol 2017; 139(3): 873-881).

To do this, they randomized 37 participants to receive either omalizumab or a placebo for 19 weeks, in addition to oral immunotherapy.  Neither the patients nor the researchers knew the assignment of the groups.  6 weeks after stopping the omalizumab, it was found that a majority (79%) of the omalizumab group was able to achieve the 2000-mg maintenance dose.  Even 12 weeks after stopping the omalizumab, 76% were able to tolerate even higher doses of peanut protein (4000mg).  Even though the reaction rates were not statistically different between the two groups, the omalizumab group was also exposed to higher doses of peanut proteins.

Despite the small number of participants, this is encouraging news for the use of omalizumab as an adjunct for peanut oral desensitization.  The authors suggest that the benefits of omalizumab-enabled OIT may outweigh the downsides of its expense, repeat injections, and risk of hypersensitivity reactions.