Omalizumab reduces anaphylactic reactions and allows food introduction in food-allergic in children with severe asthma: An observational study

• Published in: Allergy (Copenhagen) 2024-09
• Main Authors: Arasi, Stefania, Cafarotti, Arianna, Galletta, Francesca, Panetta, Valentina, Riccardi, Carla, Calandrelli, Veronica, Fierro, Vincenzo, Dahdah, Lamia, Artesani, Maria Cristina, Valluzzi, Rocco Luigi, Pecora, Valentina, Tallarico, Valeria, Dinardo, Giulio, Scalzo, Lucia Lo, Fiocchi, Alessandro
• Format: Article
• Language: English
• ISSN: 1398-9995; 1398-9995
• DOI: 10.1111/all.16314

In Europe, Omalizumab (anti-IgE) is indicated for the treatment of moderate to severe asthma, but not for IgE-mediated food allergy (FA). We assessed the impact of Omalizumab on efficacy, safety, and quality of life (FA-QoL) in patients with moderate to severe asthma and who have a history of anaphylaxis to peanut, tree nuts, fish, egg, milk, and/or wheat. Food-allergic children (6-18 years) with moderate to severe asthma underwent oral food challenges (OFCs) to establish the threshold of reaction to the culprit food(s) at baseline (T0) and at 4-month intervals (T1, T2, and T3) during their first year of treatment with Omalizumab. We recorded the number and severity of food-allergic reactions, Asthma Control Test (ACT) scores, FA-QoL, and total IgE levels. In 65 patients allergic to 107 foods, the No Observed Adverse Events Level (NOAEL) at T1 increased: 243- and 488-fold for fresh and baked milk, respectively; 172- and 134-fold for raw and baked egg; 245-fold for hazelnut; 55-fold for peanut; 31-fold for wheat; and 10-fold for fish. Full tolerance was achieved in 66.4% of OFCs at T1, 58.3% at T2, and 75% at T3. Ninety-five foods were liberalized in the diet of 55 patients; the remaining 12 were introduced by 10 patients at least in traces. Throughout the study, 40 out of 65 were able to get a free diet. ACT increased from 17 (Q1-Q3: 15-17) to 23.6 (Q1-Q3: 23-25). The FA-QoL score in children ≤12 years decreased from 4.63 ± 0.74 to 2.02 ± 1.13, and in adolescents from 4.68 ± 0.92 to 1.90 ± 1.50. During Omalizumab therapy, a safe reintroduction of allergenic foods is feasible. ClinicalTrials.gov, NCT06316414.