Targeting IgE to facilitate oral immunotherapy for food allergy: a potential new role for anti-IgE therapy?

Abstract

Food allergy is a major public health problem without satisfactory treatment options. Of several new treatments being studied, oral immunotherapy (OIT) appears to be the most promising. Unfortunately, OIT is associated with an unacceptably high frequency of allergic reactions. However, recent studies suggest that OIT might be made safer and faster when performed in conjunction with anti-IgE monoclonal antibody as an adjunctive treatment.

Keywords::

• desensitization
• food allergy
• milk allergy
• oral immunotherapy
• peanut allergy

Financial & competing interests disclosure

DT Umetsu is an employee of Genentech. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Food allergy is a major public health problem that is increasing in prevalence and that lacks satisfactory treatment options.

• Oral immunotherapy (OIT) appears to be the most promising new treatment for food allergy being studied, but OIT is associated with significant allergic reactions that reduce its appeal.

• Combining anti-IgE monoclonal antibody (mAb) treatment with OIT appears to greatly improve the safety of OIT and may permit faster and more effective OIT.

• Future larger, placebo-controlled studies are required to confirm recent findings and to optimize the treatment protocol.

• Successful Phase II and III studies could lead to health authority (e.g., US FDA) approval of anti-IgE mAb (e.g., omalizumab) for food allergy.

• Widespread community acceptance of a safe OIT treatment protocol for food allergy facilitated with anti-IgE mAb could significantly improve treatment options available for patients with food allergy.

• Additional studies of anti-IgE facilitated OIT will need to address: the development of immunological tolerance/remission from food allergy following OIT; the length of the maintenance treatment period for OIT; occasional late occurring allergic reactions; defining the specific characteristics of food-allergic patients best suited for OIT with omalizumab; and the treatment of patients with multiple food allergies.