IgE-Immunoadsorption for severe allergy to multiple foods: a case series of five children

Abstract

Background: Children with severe atopic status may present high risk of fatal or near fatal anaphylaxis and a highly impaired quality of life. Omalizumab has been shown to be a promising approach as monotherapy for severe allergy to multiple foods. However, very high serum total IgE levels may limit its use. Objective: To assess the efficacy of selective IgE-immunoadsorption (IgE-IA) on total IgE levels and threshold of reactivity to the culprit foods in children with history of severe anaphylaxis due to multiple foods and allergic comorbidities. Methods: In this single-center, prospective, open-label efficacy study we evaluated children with severe asthma, allergy to 2+foods and total IgE levels >2,300 kUI/L. To establish the food reactivity threshold, each patient underwent oral food challenges (OFCs) before and after IgE-IA. Results: Five patients (4 males; age, 10.9±5 years, mean±SD), underwent an average of three (range 2–5) sessions of IgE-IA. Each session reduced IgE levels by a mean of 1,958.87 kUI/L. After the IgE-IA cycle, serum total IgE dropped from 3,948±1,652.7 (mean±SD) to 360.8±71.89 kUI/L (-10.94 folds; p=0.01). The threshold of reactivity (No Observed Adverse Effect Level, NOAEL) tested at OFCs for the culprit foods (4baked-milk+2baked-egg+1lentil+2hazelnut+1wheat) increased overall from 21.51 (median, IQR 1.49-82.62) protein milligrams to 1,114.99 (837.2-4,222.8) milligrams (p<.001), ie. up to 51.8 times higher than baseline. 8/10 OFCs were negative after IgE-IA. Conclusions: IgE-IA increased food threshold quickly. It can be considered in well-selected patients with severe food allergies and high IgE-levels especially if otherwise eligible to anti – IgE treatments.