Systematic review of monotherapy with biologicals for children and adults with IgE‐mediated food allergy

Abstract

Background Biological therapies relieve symptoms in allergic inflammatory diseases so we systematically reviewed the evidence about whether biological monotherapy could benefit people with IgE‐mediated food allergy. Methods We searched six bibliographic databases from 1946 to 30 September 2021 for randomised and non‐randomised controlled trials about biological monotherapy in people with IgE‐mediated food allergy confirmed by oral food challenge. We used the Grading of Recommendations, Assessment, Development and Evaluation approach to narratively summarise findings from three trials with 118 participants. The studies were too heterogeneous and sparse to conduct meta‐analysis. Results We included one randomised trial about etokimab, one about omalizumab and one about the discontinued TNX‐901. All were in people with peanut allergy in the USA, mostly aged 13+ years. There was a trend towards improved tolerance of peanut during treatment, with few side effects. However, we have very low certainty about the evidence due to the small number of trials and participants. No included trial reported on quality of life or cost‐effectiveness. Conclusions There is not yet enough certainty to support offering etokimab or omalizumab widely for food allergy. Clinicians may consider the merits for individuals, but large randomised trials with standardised measures are needed to confirm the safety, efficacy and most suitable candidates, doses and durations of treatment before more universal use.

Pea and lentil 7S globulin crystal structures with comparative immunoglobulin epitope mapping

“…At the same time, the degree to which epitopes cover a significant portion of the surface of trimers and individual monomers is consistent with challenges associated with addressing allergenicity of these proteins in food ( de Silva et al, 2022 ). To gain more insight into epitope coverage across 7S globulins, the Ara h 1 epitopes identified by Cabanos et al and the Gly m 5.01 epitopes listed by Pi et al, were mapped onto the trimeric crystal structure of Ara h 1 ( Fig.…”

Biologicals in IgE-mediated food allergy

“…The study generated promising evidence for the intravenous administration of Etokimab in the treatment of peanut allergy [35]. A systematic review from 2021 compared this study with other biologicals [36 ▪▪ ].…”

Thymic Stromal Lymphopoietin (TSLP), Its Isoforms and the Interplay with the Epithelium in Allergy and Asthma

“…Etokimab, an antagonist of IL-33, has been recently studied for IgE-mediated peanut allergy, while no clinical trials with tezepelumab in food allergy have been reported. Large, randomised trials are needed to assess the safety, efficacy, posology and the most suitable candidates for such treatments [ 92 , 93 ]. The rationale for such studies derived initially from the functional role of TLSP in food allergy revealed in murine model studies [ 94 ].…”