Focus on omalizumab in food allergy

Food allergy is a common disease that particularly affects children, and is associated with high morbidity and mortality. To date, there is no therapeutic option approved for food allergy. Allergen avoidance is recommended, but this strategy has many limitations including exposure to hidden allergens. Oral immunotherapy (OIT) consists of daily administration of small, gradually increasing amounts of allergen. It is an effective strategy for food allergy but with some limitations. Validated protocols are not available for all allergens. Moreover, some patients are not eligible because the threshold of reactivity is too low. Monoclonal antibodies directed against immunoglobulins E (IgE) are an interesting therapeutic option. The therapeutic anti-IgE antibody omalizumab is not validated (yet) for food allergy, but has been tested in several clinical trials. Very few studies have assessed the effect of omalizumab alone in food allergies. However, several studies have now concluded that a combination of omalizumab and OIT appears to be promising for the treatment of food allergy. The combination of omalizumab and OIT leads to an increase in the amount of allergens more rapidly than OIT alone. Fewer side effects have also been described when combining omalizumab to with OIT. Biomarkers are needed for the selection of patients who may be treated with the combination of omalizumab/OIT. (C) 2021 Elsevier Masson SAS. All rights reserved.

Automated summary

Food allergy is a common disease with high morbidity and mortality, for which there is currently no approved therapeutic option. Oral immunotherapy (OIT) and monoclonal antibodies directed against IgE are potential strategies for treatment. Combining omalizumab with OIT appears to have promising results in increasing allergen tolerance and reducing side effects in food allergy patients.