Oral Immunotherapy for Food Allergy

Wood, Robert A.

doi:10.18176/jiaci.0143

Cited by 89 publications

(77 citation statements)

References 65 publications

(90 reference statements)

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“…5,18,20,37 The 26% drop-out rate was quite high in our study, but this can at least partially be explained by the long treatment duration. 5,18,20,37 The 26% drop-out rate was quite high in our study, but this can at least partially be explained by the long treatment duration.…”

Section: Discussionmentioning

confidence: 52%

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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: Discussionmentioning

confidence: 52%

“…37 Omalizumab has been shown to facilitate OIT and to reduce AEs. 37 Omalizumab has been shown to facilitate OIT and to reduce AEs.…”

Section: Discussionmentioning

confidence: 99%

Individually dosed omalizumab facilitates peanut oral immunotherapy in peanut allergic adolescents

Brändström

Vetander

Sundqvist

et al. 2019

Clin Experimental Allergy

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“…19 Thus, rice grains are advantageous in terms of enabling efficient delivery to the gut-associated lymphoid tissue. 23 The most effective administration route of allergens expressed in TG-rice seeds for the treatment of JC pollinosis should be investigated. 5 The sneezing frequency and infiltration of inflammatory cells, such as eosinophils and neutrophils, were also significantly reduced in the nasal tissue, 5 suggesting that oral administration of TG-rice seeds induces immune tolerance against JC pollinosis.…”

Section: Discussionmentioning

confidence: 99%

T‐cell activation by transgenic rice seeds expressing the genetically modified Japanese cedar pollen allergens

et al. 2019

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Summary Transgenic rice seeds that contain genetically modified Cry j 1 and Cry j 2, the two major allergens of Cryptomeria japonica (Japanese cedar; JC), have been developed as immunotherapeutic candidates for JC pollinosis. Because the transgenic rice (TG‐rice) seeds express allergens containing whole amino acid sequences of Cry j 1 and Cry j 2 in the endosperm tissue (edible part of rice grain), they can potentially target all Cry j 1‐ and Cry j 2‐specific T‐cells. However, it was unknown whether antigenicity of Cry j 1 and Cry j 2 could be completely preserved in TG‐rice seeds. We verified the antigenicity of TG‐rice seeds to T‐cells through the analysis of the proliferative responses of T‐cells in Cry j 1‐ or Cry j 2‐immunized mice or T‐cell lines to TG‐rice seed extract. First, four mouse strains were immunized with Cry j 1 or Cry j 2. T‐cells in the immunized mice proliferated on treatment with TG‐rice seed extract, but not non‐transgenic wild‐type rice (WT‐rice) seed extract. Furthermore, T‐cell lines were established from the spleen cells of the immunized mice. Each T‐cell line resulted in a proliferative response to TG‐rice seed extract, but not to WT‐rice seed extract, suggesting that TG‐rice seeds certainly express T‐cell epitopes corresponding to T‐cell lines. Considering the modified amino acid sequences of Cry j 1 and Cry j 2 in TG‐rice seeds, the expression of specific T‐cell epitopes suggested that TG‐rice seeds express all possible T‐cell epitope repertoires of Cry j 1 and Cry j 2.

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“…This treatment has the advantage of triggering immunologic changes that can lead to long‐term benefits, even when therapy is complete . Over the past century, AIT has become an effective treatment for allergic rhinitis, asthma and venom hypersensitivity and is an emerging treatment option for food allergy . However, the use of AIT has been limited by potential adverse reactions and poor patient compliance due to the extended duration of treatment .…”

Section: Allergen Immunotherapy Overviewmentioning

confidence: 99%

“…Current treatment options include avoidance and emergency medications for treatment of reactions. Effective therapies for food allergies are needed . In the 1990s, subcutaneous immunotherapy for peanut allergy was attempted, but had an unacceptably high rate of systemic reactions .…”

Section: Food Allergen Immunotherapy + Omalizumabmentioning

confidence: 99%

The use of omalizumab in allergen immunotherapy

Dantzer

Wood

2018

Clin Experimental Allergy

104

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Although omalizumab (anti-IgE) is currently only approved for the treatment of asthma and chronic idiopathic urticaria, it has also been studied as an off-label treatment for numerous allergic conditions, including use as an adjunct to allergen immunotherapy in the treatment of allergic rhinitis, asthma, venom hypersensitivity and food allergy. We conducted a review of publications involving the use of omalizumab with allergen immunotherapy, by searching PubMed with key search terms of "omalizumab" and "immunotherapy." Omalizumab has been used in combination with inhalant allergen immunotherapy for the treatment of seasonal allergic rhinitis and comorbid asthma. While there have been no randomized controlled trials evaluating the addition of omalizumab to venom IT, several case reports and small patient series have been published on the use of omalizumab with venom IT. Omalizumab has been used in conjunction with oral immunotherapy for the treatment of milk, peanut and egg, as well as other foods in multi-allergen protocols. In conclusion, omalizumab used in conjunction with immunotherapy has shown promising results, especially in the reduction of adverse reactions. At this stage, larger, randomized, placebo-controlled trials are needed to better identify those patients who would benefit the most from the addition of omalizumab to immunotherapy, as well as optimal dosing strategies and duration of treatment.

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Oral Immunotherapy for Food Allergy

Cited by 89 publications

References 65 publications

Individually dosed omalizumab facilitates peanut oral immunotherapy in peanut allergic adolescents

Individually dosed omalizumab facilitates peanut oral immunotherapy in peanut allergic adolescents

T‐cell activation by transgenic rice seeds expressing the genetically modified Japanese cedar pollen allergens

The use of omalizumab in allergen immunotherapy

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