奥马珠单抗辅助脱敏治疗对常规口服免疫治疗抵抗的牛奶和鸡蛋过敏患者的长期疗效：真实研究。

Long-term outcome of omalizumab-assisted desensitisation to cow's milk and eggs in patients refractory to conventional oral immunotherapy: real-life study.

机构信息

Paediatric Allergies, Immunology and Pneumology Unit, Paediatric Medicine Service, Parc Tauli Hospital Universitari. Institut d'Investigació i Innovació Parc Tauli (I3PT). Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain;

出版信息

Allergol Immunopathol (Madr). 2022 May 1;50(3):1-7. doi: 10.15586/aei.v50i3.537. eCollection 2022.

DOI:10.15586/aei.v50i3.537

PMID:35527650

Abstract

BACKGROUND

Oral immunotherapy (OIT) is a promising approach to cow's milk and egg allergies, but reactions are frequent and some patients cannot be desensitized.

OBJECTIVE

To evaluate long-term OIT outcomes with omalizumab (OMZ) in paediatric patients with severe egg and/or milk allergies.

METHODS

This retrospective real-life study analysed findings in children with Immunoglobulin E-mediated allergy to cow's milk and/or hen eggs refractory to conventional OIT, who underwent OIT with OMZ in our department between 1 January 2010 and 31 December 2015.

RESULTS

In all, 41 patients were included (median age: 7 years; interquartile range [IQR]: 5.5-9.5); 26/41 (63.4%) underwent OIT for milk, 8/41 (19.5%) for egg and 7/41 (17.1%) for both. The median time between initiation of OMZ and OIT was 27 weeks (IQR: 22-33). Forty (97.56%) patients reached the maintenance phase (200 mL of cow's milk and 30 mL of raw egg or 1 cooked egg) in a median time of 27 weeks (IQR: 18-37). The median total time with OMZ was 117 weeks (IQR: 88-144). During the OMZ period, 2.44% (1/41) of patients presented anaphylaxis. After discontinuation of OMZ, 29.3% (12/41) presented anaphylaxis, 50% of them had a poor adherence to daily ingestion. One patient (2.44%) was diagnosed with eosinophilic esophagitis after 2 years of discontinuation of OMZ. Currently, after a median time of 9 years (IQR: 7-10) since the initiation of OMZ, 75.6% (31/41) are desensitized (27/31 without OMZ).

CONCLUSIONS

Omalizumab allows desensitisation of children with severe allergies to cow's milk and/or egg without developing severe reactions while receiving this treatment. However, discontinuation of OMZ leads to severe allergic reactions, and hence must be monitored carefully.

摘要

背景

口服免疫疗法（OIT）是治疗牛奶和鸡蛋过敏的一种很有前途的方法，但会经常出现反应，而且有些患者无法脱敏。

目的

评估奥马珠单抗（OMZ）在儿科重度鸡蛋和/或牛奶过敏患者中的长期 OIT 结果。

方法

这项回顾性真实世界研究分析了 2010 年 1 月 1 日至 2015 年 12 月 31 日期间在我科接受 OMZ 治疗的对牛奶和/或鸡蛋不耐受的 IgE 介导过敏的儿童的 OIT 结果。

结果

共纳入 41 例患者（中位年龄：7 岁；四分位距 [IQR]：5.5-9.5）；26/41（63.4%）患者接受 OIT 治疗牛奶过敏，8/41（19.5%）患者接受 OIT 治疗鸡蛋过敏，7/41（17.1%）患者接受 OIT 治疗牛奶和鸡蛋过敏。从开始使用 OMZ 到开始 OIT 的中位时间为 27 周（IQR：22-33）。40 例（97.56%）患者在中位时间 27 周（IQR：18-37）内达到维持阶段（200 毫升牛奶和 30 毫升生鸡蛋或 1 个熟鸡蛋）。使用 OMZ 的中位总时间为 117 周（IQR：88-144）。在 OMZ 期间，2.44%（1/41）的患者出现过敏反应。停用 OMZ 后，12/41（29.3%）的患者出现过敏反应，其中 50%的患者对每日摄入的药物依从性差。停用 OMZ 2 年后，1 例（2.44%）患者被诊断为嗜酸性食管炎。目前，在开始使用 OMZ 后中位时间 9 年（IQR：7-10）后，75.6%（31/41）的患者脱敏（31 例无 OMZ）。