A practical guide for implementing omalizumab therapy for food allergy

Abstract

The recent approval of omalizumab for the treatment of IgE-mediated food allergy is an important step forward for the millions of food allergy patients in the US. Through the depletion of circulating IgE and the subsequent reduction of FCεR1 on key effector cells, patients increase their tolerance to food allergens. However, omalizumab does not permit patients to eat foods that they are allergic to with impunity. Rather, it protects them from most accidental exposures. In addition, omalizumab does not cure food allergy and has not demonstrated true immunomodulation. Thus, omalizumab might be a lifelong therapy for some patients. Furthermore, there are many important questions and issues surrounding the appropriate use of omalizumab for food allergy which this paper discusses. Managing patients that fall outside of the dosing range, assessing treatment response/nonresponse, appropriateness for patients older than 55 and determining whether immunotherapy plus omalizumab provides any advantage over omalizumab alone needs to be examined. Identifying appropriate patients for this therapy is critical given the cost of biologics. Indeed, not all food allergy patients are good candidates for this therapy. Also, when, and how to stop omalizumab for patients that may have outgrown their food allergy needs to be elucidated. Thus, although providing a good option for patients with food allergies, much information is needed to determine how best to use this therapy. This paper addresses many of these unanswered questions and issues. Hopefully, this will provide the clinician with some practical guidance on the implementation of this therapy for their patients.