IgE Immunoadsorption Knocks Down the Risk of Food-Related Anaphylaxis

Abstract

The effects of an immunoadsorption procedure, specifically designed to remove immunoglobulin E (IgE), on food-induced anaphylaxis have never been evaluated. We evaluate the effects of IgE removal on the allergic thresholds to foods. A 6-year-old boy with anaphylaxis to multiple foods and steroid-resistant unstable allergic asthma displayed serum IgE levels of 2800 to 3500 kU/L. To lower IgE serum concentrations, which could be overridden by a high dose of omalizumab, 1.5 plasma volumes were exchanged in 8 apheresis sessions. During the procedure, serum IgE levels fell to 309 kU/L. After the procedure, the threshold of reactivity to baked milk increased from 0.125 to 5 g of milk protein (full tolerance) after the first session, and the threshold of reactivity to hazelnut increased from 0.037 to 0.142 g of protein after the first session, 0.377 g after the eighth, and 1.067 g (full tolerance) after the first administration of omalizumab. Immediately after the sixth IgE immunoadsorption, we started omalizumab therapy. In the next 40 days, the threshold of reactivity to hazelnut increased to 7.730 (full tolerance). Asthma control was obtained, treatment with montelukast was stopped, and fluticasone was tapered from 500 to 175 μg/day. The boy became partially or fully tolerant to all the tested foods, and quality of life was improved. IgE immunoadsorption, used to establish the starting basis for omalizumab administration, is able to increase the tolerance threshold to foods.

Threshold of Reactivity and Tolerance to Precautionary Allergen-Labelled Biscuits of Baked Milk- And Egg-Allergic Children

“…In these highly selected patients, we found thresholds of 116.3 and 128.3 mg protein for milk and egg at DBPCFC. As in previous studies these thresholds ranged between 0.6 and 150 mg for milk and between 0.65 and 200 mg for egg [27], our patients severely allergic to baked foods do not present thresholds inferior to those allergic to milk/egg, confirming previous data [13,28,29].…”

Targeting IgE Antibodies by Immunoadsorption in Atopic Dermatitis

“…In the recent years, immunoadsorption (IA) has evolved as an alternative anti-IgE treatment for patients with severe AD displaying high total serum IgE ( 4 – 9 ). In addition, it has been reported that IA can increase the threshold of IgE immunoreactivity to different food allergens and thus reduce the risk of anaphylaxis in multiple food allergy ( 10 , 11 ). Most recently, a pilot study indicated that IA may also be used to treat patients with allergic asthma ( 12 ).…”

Extracorporeal IgE Immunoadsorption in Allergic Asthma: Safety and Efficacy

“…An equivalent strategy already was successfully applied in a child suffering from severe asthma (Kerzel et al, 2011), in patients with severe atopic dermatitis (Zink et al, 2016) and in a case of life-threatening food allergy (Dahdah et al, 2015). However, reduction of total IgE-levels in these patients was achieved either by plasma exchange (Kerzel et al, 2011), a very cumbersome and unspecific treatment, by using an adsorber non-specifically removing antibodies of all isotypes (Zink et al, 2016) or by an IgE-specific adsorber that also reduced IgG, IgM and IgA by approximately 40% (Dahdah et al, 2015). In contrast, IgE-depletion with IgEnio would facilitate Omalizumab administration after fewer desorptions and without alteration of other plasma components than IgE which would allow to use IgEnio also in children.…”