Impact of Omalizumab on Food Allergy in Patients Treated for Asthma: A Real-Life Study

Publication date: Available online 20 February 2019

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Alessandro Fiocchi, Maria Cristina Artesani, Carla Riccardi, Maurizio Mennini, Valentina Pecora, Vincenzo Fierro, Veronica Calandrelli, Lamia Dahdah, Rocco Luigi Valluzzi

Background

The effects of omalizumab on food allergy thresholds have been little studied.

Objective

To assess the real-life effects of omalizumab on food threshold tolerability in children treated for severe asthma.

Methods

In this observational, real-life, efficacy study, we reviewed the food allergen thresholds of patients with severe asthma, as well as their immediate reactions to 2+ foods before and after a 4-month treatment with omalizumab. We also evaluated their control of asthma and their quality of life, as measured by Pediatric Quality of Life Inventory (PedsQL).

Results

Fifteen children, allergic to 37 foods, were evaluated. Omalizumab induced an increase in the allergen threshold for milk, egg, wheat, and hazelnut from a mean 1012.6 ± 1464.5 mg protein to 8727 ± 6463.3 eliciting dose (P < .001). A total of 70.4% of subjects tolerated the complete challenge dose after 4 months of treatment with omalizumab. These foods were reintroduced in the patients' diet without the need for any oral immunotherapy procedures. The remaining foods were partially tolerated. The number of reactions to the unintended ingestion of allergenic foods over 4 months dropped from 47 to 2. The PedsQL increased from 61 ± 5.32 to 87 ± 7.33 (parental judgment; P < .001) and from 65 ± 7.39 to 90 ± 4.54 (patients' judgment; P < .001). The mean cost of omalizumab was €1311.63 per month.

Conclusions

During treatment with omalizumab for severe uncontrolled asthma, the food allergen threshold increases to 8.6 times its original value. The quality of life of patients also increased, due to a better asthma control and a reduction in dietary restrictions. The cost/benefit ratio of such treatment for selected cases of food allergy remains to be evaluated.

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