Omalizumab in children with severe allergic disease: a case series

Abstract

BackgroundCurrently, severe allergic asthma and food allergy in children represent an important public health problem with medical, psychosocial and economic impacts. Omalizumab is a humanized monoclonal anti-IgE antibody, approved for refractory allergic asthma and chronic urticaria. It has been widely used in clinical practice as add-on therapy in patients with severe uncontrolled allergic asthma. In recent years there has seen the emergence of an allergic epidemic with increasing food allergy, which represents the main cause of anaphylaxis in children. The standard of care for food allergy is strictly dietary allergen avoidance and emergency treatment, but recent clinical trials have suggested that omalizumab may have a role to play as an adjuvant to oral immunotherapy (OIT). We present a case series of patients treated at our institution with omalizumab for severe allergic asthma and food allergy.MethodsPatients received omalizumab according to a standard reference nomogram after failing standard therapies. In children with comorbid severe food allergy, omalizumab was administered in conjunction with an oral immunotherapy protocol.ResultsOmalizumab was effective in controlling symptoms of allergic asthma, allergic rhinitis and rhinosinusitis, but not eosinophilic esophagitis, while aiding successful oral desensitization of comorbid severe food allergies.ConclusionsOmalizumab appears to be an excellent therapeutic option in children with inadequately controlled severe allergic asthma, allergic rhinitis and rhinosinusitis, with or without food allergy.

Biologics for atopic diseases: Indication, side effect management, and new developments

“…Another therapeutic approach is to reduce the rate of side effects or to enable a faster dosage of the food allergen by administering anti-IgE during oral immunotherapy. Again, the study results show efficacy of omalizumab in peanut-allergic children [ 82 ] as well as in patients with multiple food allergies compared to placebo-treated patients [ 83 , 84 ].…”

Allergen immunotherapy for IgE‐mediated food allergy: There is a measure in everything to a proper proportion of therapy

“…However, safety issues are still unsolved. In this perspective, adjunctive therapies such as omalizumab have been investigated with quite promising results . Nevertheless, a shared grading and homogenous reporting system of adverse reactions is currently missing.…”

“…In this perspective, adjunctive therapies such as omalizumab have been investigated with quite promising results. 28,84 Nevertheless, a shared grading and homogenous reporting system of adverse reactions is currently missing. This makes it difficult to compare the real occurrence and severity of specific type of adverse reactions among trials.…”

Advances in paediatrics in 2019: current practices and challenges in allergy, endocrinology, gastroenterology, public health, neonatology, nutrition, nephrology, neurology, respiratory diseases and rheumatic diseases

“…Furthermore, the frequency of adverse events is high and duration of effectiveness unclear. Crisafulli G et al [2] investigated the efficacy of add-on therapy with omalizumab a monoclonal anti-IgE antibody during OIT in 5 children with cow's milk allergy. A combination treatment (OIT plus omalizumab) preceded by a pretreatment with omalizumab in 3 cases, was beneficial in most children and tolerability was good.…”

“…Omalizumab is that has been approved for the treatment of severe persistent allergic uncontrolled asthma and spontaneous chronic urticaria. It has also been shown to be successful in chronic rhinosinusitis [2,3]. Among allergies with a mixed (IgE and cell-mediated) pathophysiology, omalizumab could be helpful in improving atopic dermatitis [4] that shares with asthma, inflammatory mediators [5] and the response to allergen immunotherapy [6] but it did not improve eosinophilic esophagitis [2].…”