Individually dosed omalizumab: an effective treatment for severe peanut allergy

Brändström, Josef; Vetander, Mirja; Lilja, G.; Johansson, S. G. O.; Sundqvist, Ann-Charlotte; Kalm, Frida; Nilsson, Caroline; Nopp, Anna

doi:10.1111/cea.12862

Cited by 65 publications

(65 citation statements)

References 32 publications

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Section: Methodsmentioning

confidence: 99%

“…Briefly, in the first part 26 23 peanut allergic adolescents, with positive peanut CD-sens, were treated with omalizumab at the recommended doses for allergic asthma for 8 weeks, and the omalizumab doses were then increased, if needed, until CD-sens to peanut was suppressed. 26 As a control, subjects also had an allergy to pollen or pets with clinical symptoms, positive SPT, IgE sensitization and positive CD-sens. 26 Inclusion criteria for this study were severe peanut allergy with a history of systemic reactions (convincing history of anaphylaxis or anaphylaxis or symptoms indicating an impending anaphylaxis at food challenge), IgE sensitization, positive skin prick test (SPT) and CD-sens to peanut and after individualized omalizumab treatment for 8-32 weeks tolerating >1 g of peanut (280 mg peanut protein) at the open challenge marking the end of the first part of this two-step study.…”

Section: Methodsmentioning

confidence: 99%

“…Most subjects experience AEs; although mostly mild, severe reactions occur, thus preventing patients from reaching effective doses and forcing patients to stop treatment. [24][25][26] SCIT and OIT stimulate production of allergen blocking factors, including IgG4ab. 17,19,20 Omalizumab, a humanized anti-IgE antibody mainly used in allergic asthma, decreased peanut allergic subjects' sensitivity to peanut.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Individually dosed omalizumab facilitates peanut oral immunotherapy in peanut allergic adolescents

Brändström

Vetander

Sundqvist

et al. 2019

Clin Experimental Allergy

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Background: Peanut oral immunotherapy (pOIT) has showed good short-term outcomes, but allergic reactions may prevent effective up-dosing and is a major cause of stopping OIT. In placebo-controlled trials, omalizumab has been shown to facilitate allergen immunotherapy and increase tolerance to peanut.Objective: We hypothesized that by combining omalizumab with pOIT, and monitor treatment effects with basophil allergen threshold sensitivity tests (CD-sens), peanut allergic patients could safely initiate pOIT and thereafter slowly withdraw omalizumab.Methods: This is the 2nd part of a one-armed open phase-2 study where peanut allergic adolescents (n = 23) started pOIT after an individualized omalizumab treatment. The pOIT dose was increased from 280 to 2800 mg peanut protein in 8 weeks followed by an individualized step-wise withdrawal of omalizumab, based on clinical symptoms and CD-sens levels. pOIT continued for 12 weeks followed by an open peanut challenge. Peanut CD-sens and allergen-binding activity (ABA) and IgE-ab, IgG-ab and IgG4-ab to peanut and its components were measured during the study.Results: All 23 patients successfully reached the 2800 mg maintenance dose. Moderate/ systemic allergic reactions were rare while receiving full-dose omalizumab. Eleven of 23 (48%) successfully continued with pOIT after omalizumab was stopped. Compared to treatment failures, median baseline IgE-ab to peanut components Ara h 1-3 and CDsens to peanut were significantly lower among successfully treated patients and IgG4ab to peanut, Ara h 2 and 6 increased significantly more during treatment. Conclusions and clinical relevance:This study indicates that omalizumab is an effective adjunctive therapy for initiation and rapid up-dosing of pOIT; however, adverse events from pOIT become more frequent as omalizumab doses are decreased.Clinical trials registration: ClinicalTrials.gov; NCT02402231. EudraCT; 2012-005625-78. K E Y W O R D Sanaphylaxis, basophil, food allergy, omalizumab, oral immunotherapy, paediatrics | 1329 BRANDSTRÖM eT Al.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Individually dosed omalizumab facilitates peanut oral immunotherapy in peanut allergic adolescents

Brändström

Vetander

Sundqvist

et al. 2019

Clin Experimental Allergy

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“…A popular approach is to initiate patients with cow's milk or egg allergy on baked milk or baked egg, respectively. 42 Specific immunotherapy is another option although serious adverse events are not infrequent. 41 A potential treatment strategy is omalizumab, and Vetander and colleagues publish data to suggest that an individualized dosing can prevent reactions in patients with food allergy.…”

Section: Food Allergymentioning

confidence: 99%

Developments in the field of allergy in 2017 through the eyes of Clinical and Experimental Allergy

Roberts

Almqvist

Boyle

et al. 2018

Clin Experimental Allergy

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“…As noted above, recent work indicates that blood basophil phenotype and function analyzed in vitro may be able to distinguish between peanut-sensitized children who have clinical allergy, in contrast to those who are sensitized but tolerant to peanut[19]. Basophil assays also are under investigation for monitoring the efficacy of IT for SAR[83] or omalizumab treatment for severe peanut allergy[84]. …”

Section: Therapy Selection and Monitoringmentioning

confidence: 99%

Immune monitoring for precision medicine in allergy and asthma

Boyd

Hoh

Galli

2017

Current Opinion in Immunology

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“Precision Medicine” embodies the analyses of extensive data collected from patients and their environments to identify and apply patient-specific prophylactic strategies and medical treatments to improve clinical outcomes and healthcare cost-effectiveness. Many new methods have been developed for evaluating the activity of the human immune system. Such “immune monitoring” approaches are now being used in studies of allergy and asthma in the hope of identifying better correlates of disease status, predictors of therapeutic outcomes, and potential side-effects of treatment. Together with analyses of family histories, genetic and other biometric data, and measurements of exposures to environmental and other risk factors for developing or exacerbating disease, immune monitoring approaches promise to enable “Precision Medicine” for allergic diseases and asthma.

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Individually dosed omalizumab: an effective treatment for severe peanut allergy

Cited by 65 publications

References 32 publications

Individually dosed omalizumab facilitates peanut oral immunotherapy in peanut allergic adolescents

Individually dosed omalizumab facilitates peanut oral immunotherapy in peanut allergic adolescents

Developments in the field of allergy in 2017 through the eyes of Clinical and Experimental Allergy

Immune monitoring for precision medicine in allergy and asthma

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