Real life study of the use of omalizumab for pediatric patients with multiple food allergies

Abstract

Background: Multiple food allergies (MFAs) affect 30% of the child population with food allergy. The current treatment is the exclusion diet, which frequently affects the quality of life for these patients. The objective of the study was to describe the effect of omalizumab treatment in children diagnosed with MFAs who experienced frequent anaphylactic reactions and the impact on their quality of life.Material and methods: A descriptive observational study. Patients with severe food restrictions and high-risk due to multiple episodes of anaphylaxis were included. The allergy was confirmed by compatible clinical, skin tests, positive specific IgE and oral food challenges (OFCs). Omalizumab treatment was initiated and the impact on the life quality of patients and their families was assessed using the validated Food Allergy Quality of Life Questionnaire-Parent Form.Results: Five patients with an average age at diagnosis of 3.58 years (range between 1.5–7.9 years), were diagnosed with MFAs. All patients presented with anaphylaxis. All patients were treated with omalizumab between 2013 and 2019. Omalizumab treatment was initiated at a mean age of 6.05 years (range between 4.5–8.25 years). All patients have undergone OFC to reintroduce food successfully. 2 patients had their dose of omalizumab reduced by half, and 1 patient has had the time interval extended between administrations due to the maintenance of food tolerance. No immediate local or systemic adverse reactions were documented. Two patients have commenced omalizumab administration at home without incident.Conclusions: Children with MFAs who are treated with omalizumab do not show reactions in response to most of the foods to which they previously had anaphylaxis. Consequently, these patients were able to significantly expand the variety of their diet, improving the life quality and avoid anaphylaxis following the inadvertent intake of these foods.

Systematic review of monotherapy with biologicals for children and adults with IgE‐mediated food allergy

“…Claims of effectiveness have been made based largely on observational studies, descriptive reviews or small clinical trials 7–10 . These therapies can be costly and can be burdensome for patients, so we wanted to compile the most robust research about biologicals to inform Global Allergy and Asthma European Network (GA 2 LEN) guidelines 11 .…”

“…Claims of effectiveness have been made based largely on observational studies, descriptive reviews or small clinical trials. 7 , 8 , 9 , 10 These therapies can be costly and can be burdensome for patients, so we wanted to compile the most robust research about biologicals to inform Global Allergy and Asthma European Network (GA 2 LEN) guidelines. 11 A recent systematic review explored the potential mechanisms of action of biologicals in food allergy, 12 but we did not identify any systematic reviews of randomised trials of safety or effectiveness.…”

Title: Current options in the management of tree nut allergy, focusing on, but not limited to immunotherapy: A systematic review.

“…The same might account for the trials using omalizumab or dupilumab without OIT in multi-allergic patients, in which tree nut allergy seems to be a manifestation of the LTP-syndrome 29,30,36 .…”

“…1 and Table 1). Of them, five were randomized, double-blinded, placebo-controlled (RDBPC) studies [12][13][14][15][16] , one non-randomized, placebocontrolled 17 , eight prospective cohorts, including two conference abstracts [18][19][20][21][22][23][24][25] , five observational studies [26][27][28][29][30] , three retrospective studies [31][32][33] , one follow-up study 34 , and three case reports [35][36][37] .…”

“…The Parent Form of the "Food Allergy Quality of Life Questionnaire" (FAQLQ-PF) was used by Crespo et al 29 . After two years on omalizumab, parents perceived an improvement in the health status of their children.…”