Oral Food Challenges After Treatment With Omalizumab in the Clinical Setting.

Abstract

Although omalizumab is now approved for the treatment of food allergy, little is known about its use in the clinical setting. To examine the outcome of oral food challenges (OFCs) after treatment with omalizumab. We conducted a retrospective chart review of clinic patients who underwent OFCs after treatment with omalizumab, including cumulative tolerated doses and all adverse events. A total of 51 patients (45% female; median age, 9 [range, 1-23] years; median total IgE, 512 [interquartile range, 285 to 1080] IU/mL) underwent 73 OFCs, with milk (n = 27), egg (n = 23), and wheat (n = 9) accounting for 81% of the OFCs. A reaction history was documented for 95% and all challenged foods had a positive allergen-specific IgE (median, 34 [interquartile range, 12 to >100] kUA/L). OFCs were performed at a median of 7 (range, 4-14) months after starting omalizumab. Among OFCs to any food with a goal dose ≥6000 mg (n = 56), 89% successfully consumed ≥1000 mg, 86% ≥2000 mg, 75% ≥4000 mg, and 66% ≥6000 mg. Allergic reactions occurred in 45% (n = 33) of all OFCs, with 21 treated with antihistamines and 2 treated with epinephrine. Dietary introduction of allergenic foods was permitted following 92% of OFCs. Omalizumab treatment response was associated with higher baseline total IgE, every 2-week dosing versus every 4-week dosing, higher total omalizumab dose per 4 weeks per weight, and lower allergen-specific IgE to total IgE ratio. Omalizumab can be effectively used for the treatment of food allergy in the clinical setting and may enable the introduction of allergenic foods into the diet for most patients.