The New England Journal of MedicineOmalizumab for the Treatment of Multiple Food Allergies

Addressing the Challenge: Beyond Oral Immunotherapy for Peanut Allergy in the Battle Against Food Allergies

A recent clinical trial has investigated the efficacy and safety of omalizumab, an anti-IgE monoclonal antibody, as a potential treatment for individuals with multiple food allergies. This study marks a significant step in exploring treatment options beyond the existing oral immunotherapy for peanut allergies, potentially broadening the horizons for allergy management.

Study Design:

• Participants: Individuals aged 1 to 55 with allergies to peanuts and at least two other specified foods (cashew, milk, egg, walnut, wheat, hazelnut).
• Inclusion criteria: Reactions to food challenges with 100 mg or less of peanut protein and 300 mg or less of the two other foods.
• Study Process: Randomized 2:1 to receive subcutaneous omalizumab or placebo, based on weight and IgE levels, every 2 to 4 weeks for 16 to 20 weeks.
• Primary Endpoint: Ability to ingest 600 mg or more of peanut protein without dose-limiting symptoms.
• Secondary Endpoints: Ability to consume at least 1000 mg of cashew, milk, and egg each without dose-limiting symptoms.

Key Findings:

• Of the 177 analyzed participants (mostly children and adolescents), 67% receiving omalizumab met the primary endpoint, compared to 7% receiving placebo.
• Secondary endpoint results: cashew (41% vs. 3%), milk (66% vs. 10%), and egg (67% vs. 0%) consumption without dose-limiting symptoms significantly favored omalizumab.
• Safety Profile: Similar between both groups, except for more injection-site reactions in the omalizumab group.

HCN Medical Memo
Omalizumab significantly enhanced the reaction threshold to peanuts and other allergens over 16 weeks in individuals as young as 1 year with multiple food allergies, outperforming placebo.

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