Omalizumab helps reduce allergic reactions to foods in kids

In young children with multiple food allergies, a treatment course with omalizumab appears to increase tolerance to peanuts and other common food allergens.

A study conducted by a group of US-based researchers showed that significantly more children who received omalizumab vs placebo were able to consume at least 600 mg of peanut protein without triggering dose-limiting reactions (67 percent vs 7 percent; p<0.001). [N Engl J Med 2024;doi: 10.1056/NEJMoa2312382]

Likewise, omalizumab-treated children were more likely to tolerate higher doses (at least 1,000 mg) of foods such as cashew (41 percent vs 3 percent; p<0.001), milk (66 percent vs 10 percent; p<0.001), and egg (68 percent vs 0 percent; p<0.001).

“Patients impacted by food allergies face a daily threat of life-threatening reactions due to accidental exposures,” said lead study author Dr Robert Wood of Johns Hopkins University School of Medicine in Baltimore, Maryland, US.

“The study showed that omalizumab can be a layer of protection against small, accidental exposures,” Wood added.

A total of 177 children (1–17 years of age) with allergic reaction to peanuts (≤100 mg) and at least two other foods (≤300 mg: cashew, milk, egg, walnut, wheat, and hazelnut) were included in the study. These children were randomly assigned to receive omalizumab (n=118) or placebo (n=59), delivered subcutaneously. Medication doses were based on weight and IgE levels, with injections given every 2 to 4 weeks for 16 to 20 weeks.

Wood and colleagues noted that omalizumab was safe, with only minor injection-site reactions documented during the study period.

Multiple benefits

“I’m excited that we have a promising new treatment for multifood allergic patients. This new approach showed really great responses for many of the foods that trigger their allergies,” according to the senior author of the study Dr Sharon Chinthrajah of Stanford University School of Medicine in Palo Alto, California, US.

Chinthrajah went on to emphasize the potential of omalizumab for broader application, noting that a lot of patients with food allergies also struggle with other allergic conditions—such as asthma, hay fever, or eczema—that respond well to the drug. “The possibility of a single medication managing all their allergies is exactly what we’re striving for.”

Omalizumab, according to Chinthrajah, could especially benefit young children with severe food allergies, who are prone to accidentally ingesting allergens.

In addition, the drug offers a safer alternative to oral immunotherapy for physicians managing food allergies, given that omalizumab reduces the potential for dangerous allergic reactions that oral immunotherapy sometimes triggers, she continued. “This is something that our food allergy community has been waiting a long time for. [Omalizumab is] an easy drug regimen to implement in a medical practice, and many allergists are already using this for other allergic conditions.”

Nevertheless, Chinthrajah acknowledged that several key questions remain unanswered regarding omalizumab therapy for food allergies, including the optimal treatment duration, the potential for lasting immune system changes, and factors influencing individual patient responses.

Chinthrajah and Wood, along with the rest of their team, shared that they are actively planning further studies to address such questions and are looking into the development of monitoring methods to track patients’ progress toward meaningful allergy tolerance.