Combination of omalizumab with allergen immunotherapy versus immunotherapy alone for allergic diseases: A meta‐analysis of randomized controlled trials

Abstract

BackgroundAllergen immunotherapy (AIT)‐associated adverse events (AEs) limit its usage in the management of allergic diseases. The monoclonal anti‐IgE antibody (omalizumab) and AIT have complementary actions. However, no consensus has been reached on whether their combination could exert superior efficacy and safety.ObjectiveTo evaluate whether the combination of AIT with omalizumab is superior to AIT alone in treating allergic diseases.MethodsThe MEDLINE/PubMed, Embase, Scopus and Cochrane Library databases were searched to identify randomized control trials (RCTs) reporting the outcomes of omalizumab combined with AIT (omalizumab + AIT) versus AIT alone. A random‐effect model was established to estimate outcomes with a 95% confidence interval (CI).ResultsA total of 11 eligible RCTs (involving 901 patients) were screened out for the meta‐analysis. According to a pooled analysis, omalizumab + AIT significantly increased the number of patients achieving the target maintenance dose (TMD) and sustained unresponsiveness (SU) to allergens (odds ratio [OR] = 2.43; 95% CI: 1.33–4.44; p = 0.004; I2 = 35%, and OR = 6.77; 95% CI: 2.10–21.80; p = 0.001; I2 = 36%, respectively). Similarly, individuals receiving the combination therapy reported significantly fewer episodes of severe systemic AEs than AIT alone (OR = 0.32; 95% CI: 0.18–0.59; p = 0.0003; I2 = 0%). Meanwhile, the improvements in symptom severity score (mean difference [MD] = −0.26), rescue medication daily means score (MD = −0.14), and number of patients consuming epinephrine in AIT (OR = 0.20) were all more evident than those in AIT alone.ConclusionOmalizumab + AIT can significantly enhance the efficacy and safety of AIT by increasing TMD and SU to allergens, while decreasing severe systemic AEs.

Allergen immunotherapy in China

“…In addition, several studies have shown that omalizumab combined with SCIT can enhance the efficacy and safety of SCIT, while decreasing adverse event ( 173 – 178 ). For instance, Long found that omalizumab combined with SCIT can achieve complete asthma control faster, with a reduction in the amount of asthma medication used, and a better improvement in lung function.…”

The Multiple Trajectories of the Allergic March

“…The available data shows that Omalizumab may be effective as an add-on to AIT for respiratory allergy and food desensitization, especially to prevent adverse events during the build-up phases. A recent meta-analysis has shown that omalizumab+AIT can significantly enhance the efficacy and safety of AIT by increasing the target maintenance dose and sustained unresponsiveness to allergens while decreasing severe systemic adverse effects [81].…”

“…Although there is currently no cure for atopic diseases, AIT and biologics can modify allergic pathways by acting as true disease-modifying therapies [73][74][75][76][77][78][79][80][81][82][83]. To effectively change the course of the allergic march, future research should resolve the major questions of how, when, and to whom specific treatment should be applied.…”

Omalizumab for the reduction of allergic reactions to foods: a narrative review

“…When used in conjunction with food allergy immunotherapy (AIT), omalizumab can improve the safety and effectiveness of the treatment, lowering severe adverse events and raising tolerance to allergens (30).…”