Clinica Pediatrica, Institute for Maternal and Child Health - "IRCCS Burlo Garofolo", Trieste, Italy.
Department of Medical Sciences, University of Trieste, Trieste, Italy.
Immun Inflamm Dis. 2022 Jan;10(1):117-120. doi: 10.1002/iid3.542. Epub 2021 Oct 8.
Some studies addressed the issue of omalizumab (OML) effectiveness in children starting their first oral immunotherapy (OIT) attempt but no study investigated the possible role of OML in the setting of patients with persisting milk allergy after a failed OIT attempt.
Single-center, prospective, observational study in a selected group of patients with a persisting and severe cow milk (CM) allergy associated with moderate allergic asthma, in which a previous OIT attempt had already failed. We performed an open oral food challenge (OFC) to identify patients who tolerated less than 173 mg of cow's milk protein. At the end of the recruitment, we have found four patients with a mean age of 16.25 years (8-24) who had suspended a previous OIT attempt and still reacted to an amount of CM equal or below 173 mg. Enrolled patients, after an 8-week course of OML along with a CM avoiding diet, underwent again an open OFC with CM to re-evaluate their threshold. Eventually, a new OIT course was started using the same OIT protocol of the previous attempt, maintaining cotreatment with OML for the first 12 months. For each patient, we documented: the threshold of CM at OFC, level of specific immunoglobulin E (IgE) and IgG4 for milk, and quality of life (QoL).
During OIT the four patients experienced no reactions or extremely mild ones (oral itching, transient mild abdominal pain). All increased their threshold of CM in OML if compared with the baseline and maintained it long after that biologic therapy had discontinued. Specific milk proteins IgG4 levels significantly increased in all.
In this series, OML was effective in patients with severe CM allergy who had previously failed OIT, allowing milk intake without adverse reactions and improving the QoL.
一些研究探讨了奥马珠单抗（OML）在开始首次口服免疫治疗（OIT）尝试的儿童中的有效性，但没有研究调查 OML 在 OIT 尝试失败后持续牛奶过敏患者中的可能作用。
在一组选择的患者中进行单中心、前瞻性、观察性研究，这些患者患有与中度过敏性哮喘相关的持续且严重的牛奶（CM）过敏，此前的 OIT 尝试已经失败。我们进行了开放口服食物挑战（OFC），以确定对少于 173mg 牛奶蛋白耐受的患者。在招募结束时，我们发现了 4 名平均年龄为 16.25 岁（8-24 岁）的患者，他们暂停了之前的 OIT 尝试，仍然对等于或低于 173mg 的 CM 有反应。入组患者在接受 OML 治疗 8 周和避免食用 CM 饮食后，再次进行 CM 开放 OFC 以重新评估其阈值。最终，使用与之前尝试相同的 OIT 方案开始了新的 OIT 课程，并在前 12 个月内维持 OML 的联合治疗。对于每个患者，我们记录了：OFC 中 CM 的阈值、牛奶特异性免疫球蛋白 E（IgE）和 IgG4 的水平以及生活质量（QoL）。
在 OIT 期间，四名患者均未出现反应或仅出现极轻微的反应（口腔瘙痒、短暂轻度腹痛）。所有患者在接受 OML 治疗时，CM 阈值均较基线有所增加，并且在停止该生物治疗后很久仍保持该阈值。所有患者的牛奶特异性蛋白 IgG4 水平均显著增加。
在本系列中，OML 对先前 OIT 失败的严重 CM 过敏患者有效，允许摄入牛奶而无不良反应，并改善了 QoL。
