Omalizumab & OIT Show Similar Food Allergy Desensitization Rates

Philadelphia – New data presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting suggest that children with multiple food allergies achieve similar success in consuming allergenic foods whether treated with omalizumab in combination with oral immunotherapy (OIT) or omalizumab alone. The findings, stemming from the phase 3 OUtMATCH study, offer a potentially simpler path to managing food allergies, reducing the burden of multi-allergen OIT for patients and families.

Study Details and Findings

The OUtMATCH study, led by R. Sharon Chinthrajah, MD, FAAAI, of Stanford University, involved 80 children with allergies to up to three foods. All participants had a peanut allergy, with other common allergens including cashew, egg, milk, walnut, hazelnut, and wheat. After 12 months of treatment – either omalizumab plus multi-food OIT or omalizumab plus a placebo OIT – participants who qualified for dietary consumption were followed for an additional year. The study assessed the ability of children to incorporate allergenic foods into their daily diets.

Researchers found no statistically significant difference in allergen consumption rates between the two groups. A median of 300 mg of allergenic food was consumed daily, based on patient diaries and evaluations by the study team. At 3 months, 77% of the omalizumab plus OIT group and 66% of the omalizumab alone group were consuming their allergens. These rates remained comparable at 6 months (65% vs. 63%, respectively). Detailed results were published in the Journal of Allergy and Clinical Immunology.

The study also examined consumption rates for individual allergens. For those with peanut allergies, 77% of the omalizumab plus OIT group and 67% of the omalizumab alone group were consuming peanut at 3 months, with rates of 65% and 60% respectively at 6 months. These findings reinforce the consistency of outcomes across different allergens.

Omalizumab and the Changing Landscape of Food Allergy Treatment

Omalizumab, an anti-IgE antibody, has recently emerged as a promising treatment for food allergies. Approved by the FDA in February 2024, it works by reducing the allergic response, potentially allowing patients to tolerate small amounts of their trigger foods. OIT, involves gradually increasing exposure to allergens to build tolerance. Yet, OIT can be burdensome, requiring strict adherence to a dosing schedule and carrying the risk of allergic reactions.

“Really, there’s no difference in the ability to introduce foods into the diet, which is great,” Chinthrajah told Healio. “You can be on multi-allergen oral immunotherapy for a year, or you could be on omalizumab for a year, and you have equal success.” This suggests that omalizumab may offer a less intensive, yet equally effective, approach to food allergy management.

Safety Considerations

The study also assessed the safety of both treatment approaches. Adverse events were reported in both groups, with 86% of patients in the omalizumab plus OIT group reporting 86 events and 93% of those in the omalizumab alone group reporting 125 events. These differences were not considered statistically significant. Three patients in the omalizumab alone group experienced adverse events meeting criteria for anaphylaxis, while none were reported in the omalizumab plus OIT group. Two patients in the OIT group experienced serious adverse events related to open feedings, including one case of eosinophilic esophagitis.

While adverse events occurred in both groups, the overall safety profile appeared comparable, and no significant differences were observed. This is reassuring for clinicians and patients considering these treatment options.

Implications for Clinical Practice and Future Research

The OUtMATCH study findings have significant implications for clinical practice. The ability to achieve similar outcomes with omalizumab alone could simplify treatment for many patients, reducing the logistical challenges and potential risks associated with multi-allergen OIT. This is particularly relevant for families seeking a more manageable approach to food allergy management.

Chinthrajah emphasized the importance of personalized treatment plans. “If one treatment option doesn’t sense right, becomes burdensome, you have too many side effects, we can switch pathways and still go towards treating a chronic disease with a different approach,” she said.

Looking ahead, Chinthrajah highlighted the need for better biomarkers to predict which patients will respond best to specific therapies. Her team at Stanford is maintaining a registry to collect data and identify potential predictors of treatment success. Further research is also needed to understand the complex interplay between environmental factors and food allergies, as highlighted in recent studies exploring the link between planetary health and allergic disease.

The findings also underscore the importance of ongoing monitoring and education for patients and families. While treatment can improve tolerance, it’s crucial to remain vigilant for allergic reactions and exercise caution when consuming allergenic foods.

R. Sharon Chinthrajah, MD, FAAAAI, can be reached at [email protected].