Can Children With Severe Milk Allergies Use OIT, Omalizumab Safely? Study Says Yes

Oral immunotherapy (OIT) is being studied and used as a treatment for cow’s milk allergy (CMA), but concerns still exist about safety, particularly for individuals with a severe milk allergy.

In an abstract prepared for American Academy of Allergy, Asthma & Immunology (AAAAI) 2020 Annual Meeting, researchers studied milk OIT when given in combination with omalizumab (Xolair) in a small group of patients in order to describe the safety of this combination in those with a severe milk allergy. Few OIT studies include this group of patients, the researchers noted.

OIT involves mixing in an allergenic food into something that the patient would tolerate, like applesauce or a liquid, and increasing the dose in gradually increasing amounts, a period known as the build-up phase.

Neither of the 2 main medical associations for allergists, including AAAAI, have officially endorsed OIT or come up with a standardized protocol for it.

Omalizumab is already approved for asthma and chronic idiopathic urticaria, is given by injection every 2 or 4 weeks, and costs about $2000 a dose. The idea behind it is that it can speed up the OIT process, reduce the adverse effects associated with OIT, and increase the threshold at which someone can eat the food that used to make them sick.

The researchers evaluated 11 patients who had been desensitized to cow’s milk through OIT (CM-OIT) and omalizumab. The patients started with a 150 mg monthly dose 2 months before starting OIT, followed by a 2-month build-up phase.

Their median age was 5.9 years, and all of them had history of anaphylactic reactions and sensitivity to minimum amounts of milk protein. The researchers collected clinical data, levels of immunoglobulin E (IgE) levels, success rate in desensitization, and adverse reactions.

Six patients had specific IgE to cow’s milk and casein proteins above 100kUA/L. However, during the study, none of the 11 patients needed emergency epinephrine and all reactions were mild to moderate and were relieved with antihistamine, corticosteroids, and inhaled beta2-agonists, such as albuterol.

All of the patients reached the 150 mL dose of raw milk.

Ten patients had reactions, with a medium of 1.6 reactions per patient; 56% were mild and 44% moderate, and they primarily were gastrointestinal, urticaria, and respiratory in nature.

Despite the severity of the allergy, the use protocol of milk OIT and omalizumab was performed with satisfactory safety, the researchers concluded.