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Individually dosed omalizumab facilitates peanut oral immunotherapy in peanut allergic adolescents
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Number of Authors: 92019 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 10, p. 1328-1341Article in journal (Refereed) Published
Abstract [en]

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 CD-sens to peanut were significantly lower among successfully treated patients and IgG4-ab 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.

Place, publisher, year, edition, pages
2019. Vol. 49, no 10, p. 1328-1341
Keywords [en]
anaphylaxis, basophil, food allergy, omalizumab, oral immunotherapy, paediatrics
National Category
Respiratory Medicine and Allergy Pharmacology and Toxicology
Identifiers
URN: urn:nbn:se:su:diva-173144DOI: 10.1111/cea.13469ISI: 000481251400001PubMedID: 31329313OAI: oai:DiVA.org:su-173144DiVA, id: diva2:1354587
Available from: 2019-09-25 Created: 2019-09-25 Last updated: 2019-12-07Bibliographically approved

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Sverremark-Ekström, EvaNopp, Anna
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Department of Molecular Biosciences, The Wenner-Gren Institute
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