Asthma Medication with Oral Immunotherapy Can Help Children Fight Food Allergies

Highlights:

• In a study conducted on children, an asthma medication accelerated the treatment protocol that comprised of the children consuming small quantities of several allergic foods orally.
• The medication, omalizumab is a monoclonal antibody that was originally designed to reduce sensitivity to allergens.
• In the current study, more number of children could tolerate at least 2 grams of two different food allergens when omalizumab was taken when compared to children who did not receive the medication.

Researchers at the Stanford University School of Medicine showed that an asthma medication increased the speed and safety of a protocol used to treat children for several food allergies at once in a randomized, controlled phase-2 clinical trial. This study was published in The Lancet Gastroenterology & Hepatology.

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Oral immunotherapy

Oral immunotherapy (OIT) is an allergy treatment where patients are given minute doses of the particular foods that cause the allergic reaction in them. Starting at very small amounts, the doses of the foods are then increased slowly over time until a point where the patients can actually tolerate the regular or normal quantities of the food consumed.

In this new trial, oral immunotherapy was combined with the antibody medication, omalizumab. This drug reduces the activities of the immunoglobulin E (IgE) antibodies that are involved in allergic reactions. As a result, the allergic response that occurs gets slowed down.

The OIT differed according to the patients’ individual allergies, with each child being treated for two to five of their food allergens. Major allergens that were tested were almond, cashew, egg, hazelnut, milk, peanut, sesame, soy, walnut and wheat.

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Does omalizumab make it safer and faster for children to receive oral immunotherapy to desensitize them to multiple foods simultaneously?

There were a total of 48 children in this study who were between 4 to 15 years of age. Among them, 38 children were randomly assigned to receive omalizumab while 12 children received placebo or no drug during OIT. The trial started by giving children the drug or placebo for eight weeks before OIT began, that was continued to be given for the first eight weeks of OIT. The medication or placebo was stopped for the next 20 weeks while immunotherapy was continued.

The patients continued to eat each food daily even after the study was completed so as to maintain the success of the treatment.

The results of the study were as follows at the end of the nine-month trial:

• Eighty three percent of children who received omalizumab could tolerate at least 2 grams of two different food allergens compared to only thirty three percent receiving placebo.
• Children taking omalizumab were desensitized significantly faster than those dosed with placebo
• Twenty-two percent of oral immunotherapy doses in omalizumab patients and 54 percent of doses for placebo patients caused gastrointestinal side effects making the number of children who took the drug have lesser nausea and abdominal pain.
• Zero and 1 percent of doses caused respiratory side effects in the omalizumab and placebo groups, respectively making the number of children who took the drug tolerate the OIT better.

Anaphylactic shock, a serious side effect was not experienced by patients in both groups.

"We were excited to see the clinical efficacy of this combination approach using omalizumab and multiple foods," said Sharon Chinthrajah, MD, director of the Clinical Translational Research Unit at the Sean N. Parker Center for Allergy and Asthma Research at Stanford University. "This could be a very promising way to decrease the burden of living with food allergies."

"The study showed significant efficacy and safety improvements in multi-allergic patients treated with omalizumab and food immunotherapy," said co-author Kari Nadeau, MD, PhD, director of the Parker Center and professor of medicine and of pediatrics. "Multi-allergic patients are at much higher risk for anaphylactic reactions since they are allergic to more foods, and omalizumab can help change the course of therapy by making it safer and faster."

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Outcome of the study

Having a child with multiple food allergies puts a huge social and economic burden on the families. About 30 percent of people who have food allergies are allergic to more than one food. They are strictly advised never to eat foods that trigger their allergies as the consequences can be deadly.

The current study can make a big difference in the lives of children who participated in the trial. Overall, the patients continued to be able to eat the foods safely after the completion of the trial.

These children will be able to broaden their food variety and participate in more social activities (like sitting at the same table with their friends) without fear of a bad allergic reaction.

The next step would be to conduct a larger and longer clinical trial to understand how tolerance develops after someone stops eating the food every day and what makes the benefits of treatment last.

Reference:

1. Drug increases speed, safety of treatment for multiple food allergies - (http://med.stanford.edu/news/all-news/2017/12/drug-increases-speed-safety-of-treatment-for-multiple-food-allergies.html)

Source-Medindia