Oral immunotherapy in severe cow's milk allergic patients treated with omalizumab: Real life survey from a Spanish registry

María Dolores Ibáñez-Sandín, Carmelo Escudero, Rocío Candón Morillo, Eva M Lasa, Eva Marchán-Martín, Silvia Sánchez-García, Soledad Terrados, Carlos González Díaz, Sonsoles Juste, Antonio Martorell, Vanessa Gázquez García, Antonio Ramírez Jiménez, Ángel Abellán, María D Martos Calahorro, Ana I Tabar, Joan Bartra, Rosa García Rodríguez, Catalina Gómez Galán, María Flora Martín-Muñoz, José Meseguer Arce, Juan C Miralles, Ana M Montoro de Francisco, Paloma Poza Guedes, Pablo Rodríguez Del Río
Pediatric Allergy and Immunology 2021 April 9

BACKGROUND: Oral immunotherapy is a frequent treatment for the management of food allergies, but adverse events (AE) are common. This study assessed the outcome of cow's milk oral immunotherapy (MOIT) in severe cow`s milk-allergic patients treated with omalizumab in a real-life setting.

METHODS: OmaBASE was a national, multicenter, open, and observational registry that collected clinical, immunologic, and treatment from patients with food allergy receiving omalizumab.

RESULTS: Data derived from 58 patients aged 10.3 years (IQR 6.3-13.2) and median milk-specific IgE 100 kUA /L at the start of omalizumab treatment. Most had experienced anaphylaxis by accidental exposures (70.7%) and had asthma (81.0%). Omalizumab in monotherapy induced tolerance to ≥6000 mg of cow's milk protein (CMP) to 34.8% of patients tested by oral food challenge. Omalizumab combined with MOIT conferred desensitization to ≥6000 mg of CMP to 83.0% of patients. Omalizumab withdrawal triggered more AE (P = .013) and anaphylaxis (P = .001) than no discontinuation. Anaphylaxis was observed in 36.4% of patients who discontinued omalizumab, and more in those with sudden (50.0%) rather than progressive (12.5%) discontinuation. At database closure, 40.5% of patients who had completed follow-up tolerated CMP without omalizumab (7.2% 1500-4500 mg; 33.3% ≥6000 mg).

CONCLUSION: Milk oral immunotherapy initiated under omalizumab allows the desensitization of subjects with severe cow's milk allergy even after omalizumab discontinuation. However, discontinuation of omalizumab can lead to severe AE and should be carefully monitored.

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