Healthy Living

Got Food Allergies? Omalizumab is a Game Changer in Preventing Severe Reactions

Apr. 26, 2024
People who are highly at-risk now have more tools at their disposal

When your child is allergic to peanuts, every birthday party or meal out is stressful. Will there be peanuts in the cake or cookies? What menu options are peanut free? What if she accidentally eats something she shouldn’t?

Finally, some relief has arrived with the drug omalizumab (brand name Xolair), commonly used to treat asthma, nasal polyps, and hives. A study published in the New England Journal of Medicine found that the drug also prevented severe reactions in people with food allergies.

It’s a game changer, according to Golisano Children’s Hospital and Strong Memorial Hospital allergy clinical directors Dr. Katherine Tuttle and Dr. Emily Weis. They shared the pros, cons, and potential long-term effects of this treatment.

Preventing life-threatening reactions

Approximately 8 percent of US children and 10 percent of adults live with food allergies. For the tens of millions of people who live with this condition, omalizumab expands the toolbox of available treatments.

Allergy stats

Prior to this finding, food avoidance was the main option.

“Allergen avoidance is incredibly difficult, no matter how common or rare the allergen is,” said Tuttle. “We ask patients and families to take on an incredible load to avoid their allergens.”

By taking omalizumab every two or four weeks, many patients had significant protection against allergic reactions from food allergen contamination, particularly life-threatening conditions like anaphylactic shock. In the trial, 79 of the 118 participants who received omalizumab (67%) were able to consume a single dose of at least 600 mg of peanut protein – the equivalent of two peanuts – without allergic reaction symptoms during the post-treatment challenge, as compared with 4 of the 59 participants who received placebo (7%)—demonstrating significant benefit for the treatment group.

Does this mean that someone with a peanut allergy can eat a peanut butter and jelly sandwich?

No, but it does open up a world of options for patients with severe allergies. Many may have the opportunity now to go to restaurants with decreased fear of severe reactions if there’s cross-contamination. Certain patient populations, including school-age children with multiple food allergies, are another group who can potentially benefit.

“The authors of this study were able to demonstrate the benefit of omalizumab in preventing life threatening allergic reactions resulting from lower dose exposure to multiple food allergens for many patients,” said Weis.

Essentially, omalizumab’s primary benefit is to prevent the negative effects of accidental ingestion. Those with food allergies will still need to avoid directly consuming the foods they are allergic to, and tools to control potentially life-threatening symptoms—like intramuscular epinephrine (epi-pens)—will still be needed on hand.

How does omalizumab work, and are there downsides?

When a person has a food allergy, the body mistakenly recognizes a substance as harmful, and produces antibodies that set off an allergic reaction when exposed to that food. Omalizumab acts essentially as a sponge and picks up the allergy antibodies in the blood that would be directed toward ordinarily harmless foods to reduce the risk of having an allergic reaction.

Xolair will help with peanut allergies

Omalizumab will be taken in standard intervals, every 2-to-4 weeks, which will vary based on the patient’s allergy levels and weight. Adherence to this dosing schedule will be critical for omalizumab’s effectiveness.

Also, while omalizumab is very effective, not every patient in the study had an increased threshold, and the study did not determine what made those patients different.

Additional studies will be conducted to account for this difference, and this is why people with allergies will still need to remain careful about being exposed to foods they are allergic to.

What are the next steps for patients and families?

Omalizumab is already available for the public, since it is an existing treatment for other allergic disorders. The URMC allergy team began working with clinical staff and pharmacy even before the study was officially published to make sure processes are in place and to foster equitable access to treatment. Currently, patients aged 1 and over at risk for immediate allergic reactions and anaphylaxis are potential candidates for this medication. The process to prescribe it will be a shared decision between families and clinicians, based on the level of risk and commitment to the long-term dosing schedule.

“We were already getting questions from our patients leading up to the publication of this landmark study. Our entire allergy team is very excited to be able to have this treatment available to our patients,” said Weis.

People with food allergies and their families should reach out to their primary care provider or allergist with questions.