title: Individually dosed omalizumab: an effective treatment for severe peanut allergy.
abstract: BACKGROUND
  Treatment with omalizumab has shown a positive effect on food allergies, but no dosages are established. Basophil allergen threshold sensitivity (CD-sens) can be used to objectively measure omalizumab treatment efficacy and correlates with the outcome of double-blind placebo-controlled food challenge to peanut.
  
  
  OBJECTIVE
  To evaluate whether individualized omalizumab treatment monitored by CD-sens could be an effective intervention for suppression of allergic reactions to peanut.
  
  
  METHODS
  Severely peanut allergic adolescents (n = 23) were treated with omalizumab for 8 weeks, and CD-sens was analysed before and after. Based on whether CD-sens was suppressed after 8 weeks, the patients either were subject to a peanut challenge or received eight more weeks with increased dose of omalizumab, followed by peanut challenge or another 8-week cycle of omalizumab. IgE and IgE-antibodies to peanut and its components were analysed before treatment.
  
  
  RESULTS
  After individualized omalizumab treatment (8-24 weeks), all patients continued with an open peanut challenge with no (n = 18) or mild (n = 5) objective allergic symptoms. Patients (n = 15) needing an elevated omalizumab dose (ED) to suppress CD-sens had significantly higher CD-sens values at baseline 1.49 (0.44-20.5) compared to those (n = 8) who managed with normal dose (ND) 0.32 (0.24-5.5) (P < 0.01). Median ratios for Ara h 2 IgE-ab/IgE were significantly higher in the ED group (17%) compared to the ND group (11%).
  
  
  CONCLUSIONS
  Individually dosed omalizumab, monitored by CD-sens, is an effective and safe treatment for severe peanut allergy. The ratio of IgE-ab to storage protein Ara h 2/IgE as well as CD-sens to peanut may predict the need of a higher omalizumab dose. Clinical trials numbers: EudraCT; 2012-005625-78, ClinicalTrials.gov; NCT02402231.
authors.affiliation: Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.|Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Brandström
authors.affiliation: Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.|Center for Allergy Research, Karolinska Institutet, Stockholm, Sweden.|Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Vetander
authors.affiliation: Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.|Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Lilja
authors.affiliation: Department of Medicine, Immunology and Allergy Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: S G O
authors.initials: SG
authors.lastname: Johansson
authors.affiliation: Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.|Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
authors.forename: A-C
authors.initials: AC
authors.lastname: Sundqvist
authors.affiliation: Department of Medicine, Immunology and Allergy Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.|Division of Proteomics and Nanobiotechnology, School of Biotechnology, Royal Institute of Technology, Stockholm, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Kalm
authors.affiliation: Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.|Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.|Center for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Nilsson
authors.affiliation: Department of Medicine, Immunology and Allergy Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Nopp
mesh_terms: D000293:Adolescent; D000485:Allergens / Q000276:immunology; D000707:Anaphylaxis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D018926:Anti-Allergic Agents / Q000008:administration & dosage*; D010367:Arachis / Q000276:immunology; D001491:Basophils / Q000276:immunology; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D008297:Male; D000069444:Omalizumab / Q000008:administration & dosage*; D021183:Peanut Hypersensitivity / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D057285:Precision Medicine; D012372:ROC Curve; D012720:Severity of Illness Index; D012882:Skin Tests; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000485:Allergens; D018926:Anti-Allergic Agents; D000069444:Omalizumab; D007073:Immunoglobulin E
keywords: CD-sens; IgE; basophil; food allergy; immunotherapy and tolerance induction; omalizumab (or anti-IgE)