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

Autor: Ibáñez-Sandín MD; Department of Allergy, Hospital Infantil Universitario Niño Jesús and ARADyAL- RETICs network RD16/0006/0026, Instituto de Salud Carlos III, IIS-P, FibHNJ, Madrid, Spain., Escudero C; Department of Allergy, Hospital Infantil Universitario Niño Jesús and ARADyAL- RETICs network RD16/0006/0026, Instituto de Salud Carlos III, IIS-P, FibHNJ, Madrid, Spain., Candón Morillo R; Department of Allergy, Hospital General La Mancha Centro, Alcázar de San Juan, Spain., Lasa EM; Pediatric Allergy Unit, Hospital Universitario Donostia, San Sebastián, Spain., Marchán-Martín E; Department of Allergy, Complejo Hospitalario Universitario de Toledo, Toledo, Spain., Sánchez-García S; Department of Allergy, Hospital Infantil Universitario Niño Jesús and ARADyAL- RETICs network RD16/0006/0026, Instituto de Salud Carlos III, IIS-P, FibHNJ, Madrid, Spain., Terrados S; Department of Allergy, Hospital Universitario Ramón y Cajal, Madrid, Spain., González Díaz C; Pediatric Allergy Unit, Basurto University Hospital, Biocruces Bizkaia Health Research Institute, Bilbao, Spain., Juste S; Department of Allergy, Hospital Universitario de Burgos, Burgos, Spain., Martorell A; Department of Allergy, University General Hospital, Valencia, Spain., Gázquez García V; Department of Allergy, Hospital Universitari Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain., Ramírez Jiménez A; Food Safety Unit, Department of Allergy, Hospital Universitario Virgen Macarena, Seville, Spain., Abellán Á; Department of Allergy, Hospital Universitario Los Arcos del Mar Menor, Murcia, Spain., Martos Calahorro MD; Department of Allergy, Hospital Universitario de Torrevieja, Alicante, Spain., Tabar AI; Department of Allergy, Hospital Complex of Navarra, Pamplona, Spain.; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.; Cooperative Health Research Thematic Networks (RETICs) for Asthma, Adverse Reactions to drugs and Allergy (ARADYAL) Research Network, Pamplona, Spain., Bartra J; Department of Allergy, Hospital Clinic, IDIBAPS, Universitat de Barcelona and ARAdyAL, Barcelona, Spain., García Rodríguez R; Department of Allergy, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain., Gómez Galán C; Department of Allergy, Althaia, Xarxa Assistencial Universitària de Manresa, Barcelona, Spain., Martín-Muñoz MF; Department of Allergy, Hospital Infantil Universitario La Paz, Madrid, Spain., Meseguer Arce J; Department of Allergy, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain., Miralles JC; Department of Allergy, Hospital General Universitario Reina Sofía, Murcia, Spain., Montoro de Francisco AM; Department of Allergy, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain., Poza Guedes P; Department of Allergy, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain., Rodríguez Del Río P; Department of Allergy, Hospital Infantil Universitario Niño Jesús and ARADyAL- RETICs network RD16/0006/0026, Instituto de Salud Carlos III, IIS-P, FibHNJ, Madrid, Spain.
Jazyk: angličtina
Zdroj: Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology [Pediatr Allergy Immunol] 2021 Aug; Vol. 32 (6), pp. 1287-1295. Date of Electronic Publication: 2021 Apr 27.
DOI: 10.1111/pai.13517
Abstrakt: 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 kU A /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.
(© 2021 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)
Databáze: MEDLINE
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