Omalizumab Shows Promise in Reducing Severe Food Allergy Reactions in Children

Omalizumab, marketed as Xolair, has shown promise in reducing severe food allergy reactions in children. A recent study published in the New England Journal of Medicine found that regular use of omalizumab could protect children from severe allergic responses to small quantities of food they are allergic to. The study included 177 children with multiple food allergies, and after receiving omalizumab injections over four months, a significant percentage could safely consume small amounts of their allergy-triggering foods.

What is Omalizumab?

Omalizumab, sold under the brand name Xolair, is a medication used to treat various allergic conditions, including:

Allergic asthma: In people whose asthma symptoms are not well controlled with inhaled corticosteroids.
Chronic rhinosinusitis with nasal polyps (CRSwNP): A condition that causes inflammation in the lining of the nose and sinuses, along with nasal polyps (growths in the nose).

Food allergy: To reduce the risk of allergic reactions, including anaphylaxis, in adults and children aged 1 year and older with food allergies mediated by immunoglobulin E (IgE).

Chronic hives (urticaria): A condition that causes itchy welts on the skin that come and go over time.
It works by binding to and inactivating a protein called immunoglobulin E (IgE), which plays a key role in the allergic response. By blocking IgE, omalizumab reduces the release of inflammatory substances in the body, thereby lessening allergy symptoms.

About the study

The research conducted at Stanford School of Medicine revealed that 69% of patients could consume small amounts of two allergenic foods, and 47% could eat small amounts of all three allergenic foods after receiving omalizumab injections. The drug was found to be safe with minimal side effects, primarily minor reactions at the injection site. This study marks the first time the safety of omalizumab has been assessed in children as young as 1 year old.

The study also highlighted the potential of omalizumab to provide protection against accidental exposures for patients with severe food allergies, especially young children who may not fully comprehend the dangers posed by their allergies. Omalizumab binds to and inactivates antibodies that cause various allergic diseases, making it a promising treatment for individuals with food allergies and other allergic conditions like asthma, allergic rhinitis, and eczema.

Key Findings:

Omalizumab injections significantly increased the amount of allergy-triggering foods children could safely tolerate compared to a placebo.

Two-thirds of participants taking omalizumab could tolerate at least 600 mg of peanut protein (equivalent to 2-3 peanuts), compared to only 6.8% in the placebo group.

The drug appeared safe and well-tolerated, with no serious side effects reported.
This is the first study to assess the safety of omalizumab in children as young as 1 year old.

Food allergies affect millions of children worldwide, causing constant anxiety and posing a risk of life-threatening reactions. While current treatments like oral immunotherapy (OIT) can help build tolerance, they are time-consuming, can trigger allergic reactions themselves, and are not suitable for everyone with multiple allergies.

This study suggests omalizumab could offer several advantages:

Broader effect: It appears effective against multiple food allergies simultaneously, unlike OIT which usually focuses on one allergy at a time.

Safer: It does not trigger allergic reactions like OIT sometimes can.

Faster acting: It may provide a quicker layer of protection compared to OIT, which can take months or years to build tolerance.

Further research is needed to understand the long-term effects of omalizumab on the immune system, the duration of treatment needed, and factors predicting individual responses. Despite these unanswered questions, omalizumab presents a significant advancement in managing severe food allergies in children and adults.

What are the alternatives to omalizumab for treating allergic asthma?

Omalizumab is not the only treatment option for allergic asthma. Other biological drugs have emerged as alternative options for patients with severe asthma who do not achieve adequate symptom control with omalizumab. One example is mepolizumab, which is effective in patients with severe eosinophilic asthma that remains uncontrolled despite treatment with omalizumab.

Another option is benralizumab, which is indicated for patients aged 12 years and older with severe asthma characterized by elevated blood eosinophil counts.

These alternative treatments target different aspects of the asthmatic pathway, offering additional therapeutic choices for patients with severe asthma.

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