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Combining Anti-IgE Monoclonal Antibodies and Oral Immunotherapy for the Treatment of Food Allergy

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Abstract

Immunoglobulin E (IgE)-mediated food allergy is a real public health problem worldwide. The prevalence of food allergy is particularly high in children. Patients with food allergy experience high morbidity with a change in quality of life due to the risk of severe anaphylaxis. Current treatment options are poor. Allergen avoidance is widely recommended but exposes patients to accidental ingestion. Oral immunotherapy is also used in patients with food allergies to the most common allergens. Oral immunotherapy consists of a daily administration of small, gradually increasing amounts of allergens to induce desensitisation. This procedure aims at inducing immune tolerance to the ingested food allergens. However, some patients experience adverse reactions and discontinue oral immunotherapy.

Given that IgE plays a crucial role in food allergy and anti-IgE are effective in allergic asthma, the use of anti-IgE therapeutic monoclonal antibodies (mAbs) such as omalizumab has been assessed in food allergy patients. The use of omalizumab as a monotherapy in food allergy has not been extensively studied but looks promising. There is more published evidence regarding the effect of omalizumab and oral immunotherapy in food allergy. Given the promising results of oral immunotherapy regarding sustained tolerance in clinical trials and the potential capacity of omalizumab to reduce symptoms in case of accidental exposure, a strategy combining oral immunotherapy with omalizumab pre-treatment has been suggested as a safer option in patients with severe food allergy compared to isolated therapy. Omalizumab seems useful in ensuring safer administration of oral immunotherapy with the oral immunotherapy maintenance dose being reached more rapidly. Quality-of-life improvement is greater with oral immunotherapy + omalizumab compared to oral immunotherapy alone. Moreover, sustained unresponsiveness is achieved more frequently with omalizumab. Considering that precision medicine and personalised therapy are major goals for allergic diseases, predictive biomarkers are crucial in order to identify food allergy patients more likely to benefit from anti-IgE therapies.

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Authors and Affiliations

  1. Toulouse Institute for Infectious, Inflammatory Diseases (Infinity), Inserm U1291, University of Toulouse, C. H. U. Purpan, CNRS, U5282, Toulouse, France

    Laurent Guilleminault, Marine Michelet & Laurent Lionel Reber

  2. Department of Respiratory Medicine and Allergic Diseases, Toulouse University Hospital Centre, Toulouse, France

    Laurent Guilleminault

  3. Paediatric Pneumo-Allergology Department, Children’s Hospital, Toulouse University Hospital Centre, 330 Avenue de Grande Bretagne, 31300, Toulouse, France

    Marine Michelet

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  1. Laurent Guilleminault
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L.G. has been an investigator in clinical trials for AstraZeneca, MSD, and Novartis and reports grants or fees for consulting from AstraZeneca, GlaxoSmithKline, Novartis, and Sanofi-Regeneron and fees for consulting from Bayer, Chiesi, MSD, not related to the submitted work. M.M. declares no disclosure of interest. L.L.R. reports grants or consulting fees from Neovacs S.A. not related to the work submitted, and patents issued or pending relating to allergy diagnosis or therapy: 63/079,686, PCT/EP2021/060829, WO2019197607 (A1) and WO2019228674 (A1).

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Guilleminault, L., Michelet, M. & Reber, L.L. Combining Anti-IgE Monoclonal Antibodies and Oral Immunotherapy for the Treatment of Food Allergy. Clinic Rev Allerg Immunol 62, 216–231 (2022). https://doi.org/10.1007/s12016-021-08902-0

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