Omalizumab facilitates rapid oral desensitization for peanut allergy.
BACKGROUND
Peanut oral immunotherapy is a promising approach to peanut allergy, but reactions are frequent, and some patients cannot be desensitized. The anti-IgE medication omalizumab (Xolair; Genentech, South San Francisco, Calif) might allow more rapid peanut updosing and decrease reactions.


OBJECTIVE
We sought to evaluate whether omalizumab facilitated rapid peanut desensitization in highly allergic patients.


METHODS
Thirty-seven subjects were randomized to omalizumab (n = 29) or placebo (n = 8). After 12 weeks of treatment, subjects underwent a rapid 1-day desensitization of up to 250 mg of peanut protein, followed by weekly increases up to 2000 mg. Omalizumab was then discontinued, and subjects continued on 2000 mg of peanut protein. Subjects underwent an open challenge to 4000 mg of peanut protein 12 weeks after stopping study drug. If tolerated, subjects continued on 4000 mg of peanut protein daily.


RESULTS
The median peanut dose tolerated on the initial desensitization day was 250 mg for omalizumab-treated subjects versus 22.5 mg for placebo-treated subject. Subsequently, 23 (79%) of 29 subjects randomized to omalizumab tolerated 2000 mg of peanut protein 6 weeks after stopping omalizumab versus 1 (12%) of 8 receiving placebo (P < .01). Twenty-three subjects receiving omalizumab versus 1 subject receiving placebo passed the 4000-mg food challenge. Overall reaction rates were not significantly lower in omalizumab-treated versus placebo-treated subjects (odds ratio, 0.57; P = .15), although omalizumab-treated subjects were exposed to much higher peanut doses.


CONCLUSIONS
Omalizumab allows subjects with peanut allergy to be rapidly desensitized over as little as 8 weeks of peanut oral immunotherapy. In the majority of subjects, this desensitization is sustained after omalizumab is discontinued. Additional studies will help clarify which patients would benefit most from this approach.
Division of Immunology, Boston Children's Hospital, Boston, Mass.
Andrew J
AJ
MacGinnitie
Division of Immunology, Boston Children's Hospital, Boston, Mass.
Rima
R
Rachid
Clinical Research Center, Boston Children's Hospital, Boston, Mass.
Hana
H
Gragg
Division of Immunology, Boston Children's Hospital, Boston, Mass.
Sara V
SV
Little
Clinical Research Center, Boston Children's Hospital, Boston, Mass.
Paul
P
Lakin
Division of Allergy, Children's Hospital of Philadelphia, Philadelphia, Pa.
Antonella
A
Cianferoni
Division of Allergy, Children's Hospital of Philadelphia, Philadelphia, Pa.
Jennifer
J
Heimall
Allergy Division, the Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
Melanie
M
Makhija
Allergy Division, the Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
Rachel
R
Robison
Division of Allergy, Immunology, and Rheumatology, Lucille Packard Children's Hospital, Palo Alto, Calif.
R Sharon
RS
Chinthrajah
Division of Immunology, Boston Children's Hospital, Boston, Mass.
John
J
Lee
Division of Immunology, Boston Children's Hospital, Boston, Mass.
Jennifer
J
Lebovidge
Division of Allergy, Immunology, and Rheumatology, Lucille Packard Children's Hospital, Palo Alto, Calif.
Tina
T
Dominguez
Division of Allergy, Children's Hospital of Philadelphia, Philadelphia, Pa.
Courtney
C
Rooney
Division of Allergy, Children's Hospital of Philadelphia, Philadelphia, Pa.
Megan Ott
MO
Lewis
Allergy Division, the Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
Jennifer
J
Koss
Division of Immunology, Boston Children's Hospital, Boston, Mass.
Elizabeth
E
Burke-Roberts
Clinical Research Center, Boston Children's Hospital, Boston, Mass.
Kimberly
K
Chin
Clinical Research Center, Boston Children's Hospital, Boston, Mass.
Tanya
T
Logvinenko
Allergy Division, the Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
Jacqueline A
JA
Pongracic
Genentech, South San Francisco, Calif.
Dale T
DT
Umetsu
Division of Allergy, Children's Hospital of Philadelphia, Philadelphia, Pa.
Jonathan
J
Spergel
Division of Allergy, Immunology, and Rheumatology, Lucille Packard Children's Hospital, Palo Alto, Calif.
Kari C
KC
Nadeau
Division of Immunology, Boston Children's Hospital, Boston, Mass. Electronic address: Lynda.Schneider@childrens.harvard.edu.
Lynda C
LC
Schneider
D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000276:immunology; D018926:Anti-Allergic Agents / Q000627:therapeutic use*; D010367:Arachis / Q000276:immunology; D002648:Child; D003888:Desensitization, Immunologic; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D000069444:Omalizumab / Q000627:therapeutic use*; D021183:Peanut Hypersensitivity / Q000188:drug therapy* / Q000628:therapy*; D012882:Skin Tests; D055815:Young Adult
D000485:Allergens; D018926:Anti-Allergic Agents; D000069444:Omalizumab; D007073:Immunoglobulin E
Peanut allergy; desensitization; food allergy; omalizumab