Long-term outcome of omalizumab-assisted desensitisation to cow’s milk and eggs in patients refractory to conventional oral immunotherapy: real-life study

Abstract

Background: Oral immunotherapy (OIT) is a promising approach to cow’s milk and egg allergies, but reactions are frequent and some patients cannot be desensitized. Objective: To evaluate long-term OIT outcomes with omalizumab (OMZ) in paediatric patients with severe egg and/or milk allergies. Methods: This retrospective real-life study analysed findings in children with Immunoglobulin E-mediated allergy to cow’s milk and/or hen eggs refractory to conventional OIT, who underwent OIT with OMZ in our department between 1 January 2010 and 31 December 2015. Results: In all, 41 patients were included (median age: 7 years; interquartile range [IQR]: 5.5–9.5); 26/41 (63.4%) underwent OIT for milk, 8/41 (19.5%) for egg and 7/41 (17.1%) for both. The median time between initiation of OMZ and OIT was 27 weeks (IQR: 22–33). Forty (97.56%) patients reached the maintenance phase (200 mL of cow’s milk and 30 mL of raw egg or 1 cooked egg) in a median time of 27 weeks (IQR: 18–37). The median total time with OMZ was 117 weeks (IQR: 88–144). During the OMZ period, 2.44% (1/41) of patients presented anaphylaxis. After discontinuation of OMZ, 29.3% (12/41) presented anaphylaxis, 50% of them had a poor adherence to daily ingestion. One patient (2.44%) was diagnosed with eosinophilic esophagitis after 2 years of discontinuation of OMZ. Currently, after a median time of 9 years (IQR: 7–10) since the initiation of OMZ, 75.6% (31/41) are desensitized (27/31 without OMZ). Conclusions: Omalizumab allows desensitisation of children with severe allergies to cow’s milk and/or egg without developing severe reactions while receiving this treatment. However, discontinuation of OMZ leads to severe allergic reactions, and hence must be monitored carefully.

Oral immunotherapy for Immunoglobulin E‐mediated cow's milk allergy in children: A systematic review and meta analysis

“…OMB binds to the heavy chain constant CH3 domain of the free IgE molecule and prevents IgE from binding to FceRI effector cells. There were several studies of OMB with milk OIT, 20,[31][32][33][34] including two RCTs (one compared with milk avoidance and the other compared with OIT alone). F I G U R E 5 Summary of findings table for a question-Should oral immunotherapy be used in children with IgE-mediated cow's milk allergy OIT with OMB may allow a shorter build-up phase or higher median tolerated dose, but adverse reactions, including the need for epinephrine, still occurred.…”

The Impact of Processing and Extraction Methods on the Allergenicity of Targeted Protein Quantification as Well as Bioactive Peptides Derived from Egg

“…Especially in children, it often develops during the first year of life. However, many children will outgrow their egg allergy by the time they reach school age [ 16 , 17 , 18 ]. The prevalence of egg allergy varies widely across different populations and geographical regions, likely due to differences in dietary habits, genetic factors, and environmental exposures.…”

The origins and longevity of IgE responses as indicated by serological and cellular studies in mice and humans

“… 29 Omalizumab can further reduce the time taken to reach maintenance immunotherapy dose. 30 Sustained nonresponsiveness, or tolerance is achieved with anti‐IgE plus immunotherapy in some individuals 31 ; however, symptoms in many individuals return after cessation of the cotherapy, 32 suggesting sustained nonresponsiveness, or tolerance mediated by T cells, 33 , 34 is not instated in many cases. Recently it has been acknowledged that glycosylation state of the IgE Fc region influences the interaction of omalizumab with free IgE, 35 while glycosylation profiles of IgE antibodies differ by individual, 36 so IgE glycosylation state might be relevant for sensitivity to such drugs.…”