The use of omalizumab in allergen immunotherapy

Abstract

Although omalizumab (anti-IgE) is currently only approved for the treatment of asthma and chronic idiopathic urticaria, it has also been studied as an off-label treatment for numerous allergic conditions, including use as an adjunct to allergen immunotherapy in the treatment of allergic rhinitis, asthma, venom hypersensitivity and food allergy. We conducted a review of publications involving the use of omalizumab with allergen immunotherapy, by searching PubMed with key search terms of "omalizumab" and "immunotherapy." Omalizumab has been used in combination with inhalant allergen immunotherapy for the treatment of seasonal allergic rhinitis and comorbid asthma. While there have been no randomized controlled trials evaluating the addition of omalizumab to venom IT, several case reports and small patient series have been published on the use of omalizumab with venom IT. Omalizumab has been used in conjunction with oral immunotherapy for the treatment of milk, peanut and egg, as well as other foods in multi-allergen protocols. In conclusion, omalizumab used in conjunction with immunotherapy has shown promising results, especially in the reduction of adverse reactions. At this stage, larger, randomized, placebo-controlled trials are needed to better identify those patients who would benefit the most from the addition of omalizumab to immunotherapy, as well as optimal dosing strategies and duration of treatment.

Mechanisms of gastrointestinal allergic disorders

“…Omalizumab treatment with allergen immunotherapy helps to potentiate increases in Treg activity by reversing the Th2 cell-like program (156). Using allergen OIT with anti-IgE antibodies in clinical studies showed promise, although not in all studies (157)(158)(159)(160). Anti-IL-5 antibodies (mepolizumab, reslizumab) have been FDA-approved for treating eosinophilic asthma (161), and several clinical trials support their effectiveness for EoE, although while esophageal eosinophilia improved, clinical symptoms were only modestly improved compared with typical improvements seen with topical glucocorticoids or dietary elimination therapy (162)(163)(164).…”

Development of subcutaneous allergen immunotherapy (part 2): preventive aspects and innovations

“…Premedication with omalizumab in patients with recurrent intolerance reactions under venom immunotherapy improved tolerance in many cases [30][31][32][33][34][35]. However, uncertainty remains regarding the necessary duration and dose of omalizumab.…”

Targeting IgE in allergic disease

“…More recently, it has been authorized for the use in patients with chronic spontaneous urticaria [27]. Additionally, off-label use of Omalizumab has revealed its efficacy in facilitating allergen updosing and desensitization in allergen-specific immunotherapy [28,29]. Omalizumab binds IgE with high affinity (K D~ 7 x 10 -9 M) [30].…”