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Use of Omalizumab in the Treatment of Food Allergy and Anaphylaxis

  • ANAPHYLAXIS AND DRUG ALLERGY (P LIEBERMAN AND S SPECTOR, SECTION EDITORS)
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Abstract

Omalizumab is a humanized monoclonal anti-IgE antibody that is currently FDA-approved for allergic asthma. Given its mechanism of action, recent reports have suggested its possible clinical use for food allergy and some forms of anaphylaxis. Omalizumab exerts its action by binding to circulating IgE, reducing IgE receptor expression, and decreasing mediator release from mast cells and basophils. Clinical trials using omalizumab in patients with food allergy resulted in achieving tolerance to higher amounts of the allergen in some patients. When used as an adjunct therapy during immunotherapy trials in patients with food allergy and anaphylaxis, omalizumab allowed more rapid and higher doses of immunotherapy to be given. Omalizumab has also been reported to be effective in a few patients with idiopathic anaphylaxis and mast cell disorders. Large multi-center trials are needed to confirm the above findings, and to identify subsets of patients that would benefit the most from omalizumab.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Johansson SG, Bieber T, Dahl R, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004;113:832–6.

    Article  PubMed  CAS  Google Scholar 

  2. Sampson HA, Munoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report – Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium. J Allergy Clin Immunol. 2006;117:391–7.

    Article  PubMed  Google Scholar 

  3. Lieberman PL, et al. Anaphylaxis. In: Adkinson NF, editor. Middleton’s allergy: principles and practice. 7th ed. Philadelphia: Mosby Elsevier; 2009. p. 1027–51.

    Chapter  Google Scholar 

  4. • Simons FE. Anaphylaxis. J Allergy Clin Immunol. 2010;125:S161–81. Comprehensive review of anaphylaxis: pathogenesis, diagnosis and management.

    Article  PubMed  Google Scholar 

  5. Brownwell J, Casale TB. Anti-IgE therapy. Immunol Allergy Clin North Am. 2004;24:551–68.

    Article  Google Scholar 

  6. Liu J, Lester P, Builder S, et al. Characterization of complex formation by humanized anti-E monoclonal antibody and monoclonal human IgE. Biochemistry. 1995;34:10474–82.

    Article  PubMed  CAS  Google Scholar 

  7. MacGlashan Jr DW, Bochner BS, Adelman DC, et al. Down-regulation of Fc(epsilon)RI expression on human basophils during in vivo treatment of atopic patients with anti-IgE antibody. J Immunol. 1997;158:1438–45.

    PubMed  CAS  Google Scholar 

  8. Korn S, Haasler I, Fliedner F, et al. Monitoring free serum IgE in severe asthma patients treated with omalizumab. Respir Med 2012 Aug 9 [Epub ahead of print].

  9. MacGlashan Jr DW, Bochner BS, Adelman DC, et al. Serum IgE level drives basophil and mast cell IgE receptor display. Int Arch Allergy Immunol. 1997;113:45–7.

    Article  PubMed  CAS  Google Scholar 

  10. Beck LA, Marcotte GV, MacGlashan D, Togias A, Saini S. Omalizumab-induced reductions in mast cell Fc epsilon RI expression and function. J Allergy Clin Immunol. 2004;114:527–30.

    Article  PubMed  CAS  Google Scholar 

  11. Djukanović R, Wilson SJ, Kraft M, et al. Effects of treatment with anti-immunoglobulin E antibody omalizumab on airway inflammation in allergic asthma. Am J Respir Crit Care Med. 2004;170:583–93.

    Article  PubMed  Google Scholar 

  12. Lin H, Boesel KM, Griffith DT, et al. Omalizumab rapidly decreases nasal allergic response and FcepsilonRI on basophils. J Allergy Clin Immunol. 2004;113:297–302.

    Article  PubMed  CAS  Google Scholar 

  13. Gomez G, Jogie-Brahim S, Shima M, Schwartz LB. Omalizumab reverses the phenotypic and functional effects of IgE-enhanced Fc epsilonRI on human skin mast cells. J Immunol. 2007;179:1353–61.

    PubMed  CAS  Google Scholar 

  14. Prussin C, Griffith DT, Boesel KM, et al. Omalizumab treatment downregulates dendritic cell FcepsilonRI expression. J Allergy Clin Immunol. 2003;112:1147–54.

    Article  PubMed  CAS  Google Scholar 

  15. Schroeder JT, Bieneman AP, Chichester KL, et al. Decreases in human dendritic cell-dependent T(H)2-like responses after acute in vivo IgE neutralization. J Allergy Clin Immunol. 2010;125:896–901.

    Article  PubMed  CAS  Google Scholar 

  16. Foster B, Foroughi S, Yin Y, Prussin C. Effect of anti-IgE therapy on food allergen specific T cell responses in eosinophil associated gastrointestinal disorders. Clin Mol Allergy. 2011;9:7.

    Article  PubMed  CAS  Google Scholar 

  17. Noga O, Hanf G, Kunkel G, Kleine-Tebbe J. Basophil histamine release decreases during omalizumab therapy in allergic asthmatics. Int Arch Allergy Immunol. 2008;146:66–70.

    Article  PubMed  CAS  Google Scholar 

  18. Eckman JA, Sterba PM, Kelly D. Effects of omalizumab on basophil and mast cell responses using an intranasal cat allergen challenge. J Allergy Clin Immunol. 2010;125:889–95.

    Article  PubMed  CAS  Google Scholar 

  19. Savage JH, Courneya JP, Sterba PM. Kinetics of mast cell, basophil, and oral food challenge responses in omalizumab-treated adults with peanut allergy. J Allergy Clin Immunol 2012 [Epub ahead of print].

  20. MacGlashan DW Jr, Savage J, Wood R, Saini S. Suppression of the basophil response to allergen during treatment with omalizumab is dependent on 2 competing factors. J Allergy Clin Immunol 2012 Jul 14 [Epub ahead of print].

  21. Leung DY, Sampson HA, Yunginger JW, et al. Effect of anti-IgE therapy in patients with peanut allergy. N Engl J Med. 2003;348:986–93.

    Article  PubMed  CAS  Google Scholar 

  22. • Sampson HA, Leung DY, Burks AW, et al. A phase II, randomized, double-blind, parallel-group, placebo-controlled oral food challenge trial of Xolair (omalizumab) in peanut allergy. J Allergy Clin Immunol. 2011;127:1309–10. Study confirming that omalizumab can be used as a monotherapy in patients with peanut allergy.

    Article  PubMed  CAS  Google Scholar 

  23. Varshney P, Jones SM, Scurlock AM, et al. A randomized controlled study of peanut oral immunotherapy: clinical desensitization and modulation of the allergic response. J Allergy Clin Immunol. 2011;127:654–60.

    Article  PubMed  CAS  Google Scholar 

  24. Burks AW, Jones SM, Wood RA, et al. Oral immunotherapy for treatment of egg allergy in children. N Engl J Med. 2012;367:233–43.

    Article  PubMed  CAS  Google Scholar 

  25. • Nadeau KC, Schneider LC, Hoyte L, Borras I, Umetsu DT. Rapid oral desensitization in combination with omalizumab therapy in patients with cow’s milk allergy. J Allergy Clin Immunol. 2011;127:1622–4. Pilot study demonstrating a possible role for omalizumab therapy as an adjunct to oral immunotherapy in food allergic patients.

    Article  PubMed  Google Scholar 

  26. Foroughi S, Foster B, Kim N, et al. Anti-IgE treatment of eosinophil-associated gastrointestinal disorders. J Allergy Clin Immunol. 2007;120:594–601.

    Article  PubMed  CAS  Google Scholar 

  27. Rocha R, Vitor AB, Trindade E, et al. Omalizumab in the treatment of eosinophilic esophagitis and food allergy. Eur J Pediatr. 2011;170:1471–4.

    Article  PubMed  CAS  Google Scholar 

  28. Kuehr J, Brauburger J, Zielen S, et al. Efficacy of combination treatment with anti-IgE plus specific immunotherapy in polysensitized children and adolescents with seasonal allergic rhinitis. J Allergy Clin Immunol. 2002;109:274–80.

    Article  PubMed  CAS  Google Scholar 

  29. Casale TB, Busse WW, Kline JN, et al. Omalizumab pretreatment decreases acute reactions after rush immunotherapy for ragweed-induced seasonal allergic rhinitis. J Allergy Clin Immunol. 2006;117:134–40.

    Article  PubMed  CAS  Google Scholar 

  30. Massanari M, Nelson H, Casale T, et al. Effect of pretreatment with omalizumab on the tolerability of specific immunotherapy in allergic asthma. J Allergy Clin Immunol. 2010;125:383–9.

    Article  PubMed  CAS  Google Scholar 

  31. Kontou-Fili K. High omalizumab dose controls recurrent reactions to venom immunotherapy in indolent systemic mastocytosis. Allergy. 2008;63:376–8.

    Article  PubMed  CAS  Google Scholar 

  32. Galera C, Soohun N, Zankar N, et al. Severe anaphylaxis to bee venom immunotherapy: efficacy of pretreatment and concurrent treatment with omalizumab. J Investig Allergol Clin Immunol. 2009;19:225–9.

    PubMed  CAS  Google Scholar 

  33. Jones JD, Marney Jr SR, Fahrenholz JM. Idiopathic anaphylaxis successfully treated with omalizumab. Ann Allergy Asthma Immunol. 2008;101:550–1.

    Article  PubMed  Google Scholar 

  34. Warrier P, Casale TB. Omalizumab in idiopathic anaphylaxis. Ann Allergy Asthma Immunol. 2009;102:257–8.

    Article  PubMed  Google Scholar 

  35. Demirturk M, Gelincik A, Colakoglu B, Dal M, Buyukozturk S. Promising option in the prevention of idiopathic anaphylaxis: omalizumab. J Dermatol. 2012;39:552–4.

    Article  PubMed  CAS  Google Scholar 

  36. Carter MC, Robyn JA, Bressler PB, et al. Omalizumab for the treatment of unprovoked anaphylaxis in patients with systemic mastocytosis. J Allergy Clin Immunol. 2007;119:1550–1.

    Article  PubMed  CAS  Google Scholar 

  37. Douglass JA, Carroll K, Voskamp A, et al. Omalizumab is effective in treating systemic mastocytosis in a nonatopic patient. Allergy. 2010;65:926–7.

    Article  PubMed  CAS  Google Scholar 

  38. Kontou-Fili K, Filis CI, Voulgari C, Panayiotidis PG. Omalizumab monotherapy for bee sting and unprovoked “anaphylaxis” in a patient with systemic mastocytosis and undetectable specific IgE. Ann Allergy Asthma Immunol. 2010;104:537–9.

    Article  PubMed  Google Scholar 

  39. Pitt TJ, Cisneros N, Kalicinsky C, Becker AB. Successful treatment of idiopathic anaphylaxis in an adolescent. J Allergy Clin Immunol. 2010;126:415–6.

    Article  PubMed  Google Scholar 

  40. Molderings GJ, Raithel M, Kratz F, et al. Omalizumab treatment of systemic mast cell activation disease: experiences from four cases. Intern Med. 2011;50:611–5.

    Article  PubMed  CAS  Google Scholar 

  41. Bell MC, Jackson DJ. Prevention of anaphylaxis related to mast cell activation syndrome with omalizumab. Ann Allergy Asthma Immunol. 2012;108:383–4.

    Article  PubMed  CAS  Google Scholar 

  42. Bray SM, Fajt ML, and Petrov AA. Successful treatment of exercise-induced anaphylaxis with omalizumab. Ann Allergy Asthma Immunol 2012 Aug 17 [Epub ahead of print].

  43. Tartibi HM, Majmundar AR, Khan DA. Successful use of omalizumab for prevention of fire ant anaphylaxis. J Allergy Clin Immunol. 2010;126:664–5.

    Article  PubMed  Google Scholar 

  44. Cox L, Platts-Mills TA, Finegold I, et al. American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma and Immunology Joint Task Force Report on omalizumab-associated anaphylaxis. J Allergy Clin Immunol. 2007;120:1373–7.

    Article  PubMed  CAS  Google Scholar 

  45. Cox L, Lieberman P, Wallace D, et al. American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma & Immunology Omalizumab-Associated Anaphylaxis Joint Task Force follow-up report. J Allergy Clin Immunol. 2011;128:210–2.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Lebonheur Hospital, Division of Allergy and Immunology, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, USA

    Jay A. Lieberman

  2. Mount Sinai Center for Eosinophilic Disorders, Jaffe Food Allergy Institute, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1198, New York, NY, 10029, USA

    Mirna Chehade

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  1. Jay A. Lieberman
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Correspondence to Mirna Chehade.

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Lieberman, J.A., Chehade, M. Use of Omalizumab in the Treatment of Food Allergy and Anaphylaxis. Curr Allergy Asthma Rep 13, 78–84 (2013). https://doi.org/10.1007/s11882-012-0316-x

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  • DOI: https://doi.org/10.1007/s11882-012-0316-x

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