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 Sanchez‐Garcia; 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

doi:10.1111/pai.13517

journal article Apr 27, 2021

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

Carmelo Escudero Rocío Candón Morillo Eva M. Lasa Eva Marchán‐Martín Silvia Sanchez‐Garcia 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 Vol. 32 No. 6 pp. 1287-1295 · Wiley

View at Publisher Save 10.1111/pai.13517

Abstract

AbstractBackgroundOral 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.MethodsOmaBASE was a national, multicenter, open, and observational registry that collected clinical, immunologic, and treatment from patients with food allergy receiving omalizumab.ResultsData 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).ConclusionMilk 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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Details

Published: Apr 27, 2021
Vol/Issue: 32(6)
Pages: 1287-1295
License: View

Authors

M

María Dolores Ibáñez‐Sandín

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

C

Carmelo Escudero

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

R

Rocío Candón Morillo

Department of Allergy Hospital General La Mancha Centro Alcázar de San Juan Spain

E

Eva M. Lasa

Pediatric Allergy Unit Hospital Universitario Donostia San Sebastián Spain

E

Eva Marchán‐Martín

Department of Allergy Complejo Hospitalario Universitario de Toledo Toledo Spain

S

Silvia Sanchez‐Garcia

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

S

Soledad Terrados

Department of Allergy Hospital Universitario Ramón y Cajal Madrid Spain

C

Carlos González Díaz

Pediatric Allergy Unit Basurto University Hospital Biocruces Bizkaia Health Research Institute Bilbao Spain

S

Sonsoles Juste

Department of Allergy Hospital Universitario de Burgos Burgos Spain

A

Antonio Martorell

Department of Allergy University General Hospital Valencia Spain

V

Vanessa Gázquez García

Department of Allergy Hospital Universitari Joan XXIII Universitat Rovira i Virgili Tarragona Spain

A

Antonio Ramírez Jiménez

Food Safety Unit Department of Allergy Hospital Universitario Virgen Macarena Seville Spain

�

Ángel Abellán

Department of Allergy Hospital Universitario Los Arcos del Mar Menor Murcia Spain

M

María D. Martos Calahorro

Department of Allergy Hospital Universitario de Torrevieja Alicante Spain

A

Ana I. Tabar

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

J

Joan Bartra

Department of Allergy Hospital Clinic, IDIBAPS Universitat de Barcelona and ARAdyAL Barcelona Spain

R

Rosa García Rodríguez

Department of Allergy Hospital General Universitario de Ciudad Real Ciudad Real Spain

C

Catalina Gómez Galán

Department of Allergy Althaia, Xarxa Assistencial Universitària de Manresa Barcelona Spain

M

María Flora Martín‐Muñoz

Department of Allergy Hospital Infantil Universitario La Paz Madrid Spain

J

José Meseguer Arce

Department of Allergy Hospital Clínico Universitario Virgen de la Arrixaca Murcia Spain

J

Juan C. Miralles

Department of Allergy Hospital General Universitario Reina Sofía Murcia Spain

A

Ana M. Montoro de Francisco

Department of Allergy Hospital Central de la Defensa Gómez Ulla Madrid Spain

P

Paloma Poza Guedes

Department of Allergy Hospital Universitario de Canarias Santa Cruz de Tenerife Spain

P

Pablo Rodríguez del Río

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

Cite This Article

María Dolores Ibáñez‐Sandín, Carmelo Escudero, Rocío Candón Morillo, et al. (2021). Oral immunotherapy in severe cow’s milk allergic patients treated with omalizumab: Real life survey from a Spanish registry. Pediatric Allergy and Immunology, 32(6), 1287-1295. https://doi.org/10.1111/pai.13517

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

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