Department of Internal Medicine, Division of Allergy and Immunolgy, University of South Florida Morsani College of Medicine, Tampa, Fla.
Allergy Department, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
J Allergy Clin Immunol. 2024 Jun;153(6):1510-1517. doi: 10.1016/j.jaci.2024.03.019. Epub 2024 Apr 9.
The recent approval of omalizumab for the treatment of IgE-mediated food allergy is an important step forward for the millions of food allergy patients in the United States. Through the depletion of circulating IgE and the subsequent reduction of FcεR1 on key effector cells, patients increase their tolerance to food allergens. However, omalizumab does not permit patients to eat foods that they are allergic to with impunity. Rather, it protects them from most accidental exposures. In addition, omalizumab does not cure food allergy and has not demonstrated true immunomodulation. Thus, omalizumab might be a lifelong therapy for some patients. Furthermore, there are many important questions and issues surrounding the appropriate administration of omalizumab to treat food allergy, which we discuss. Managing treatment of patients with disease that falls outside the dosing range, assessing treatment response or nonresponse, addressing its appropriateness for patients older than 55, and determining whether immunotherapy plus omalizumab provides any advantage over omalizumab alone all need to be examined. Identifying appropriate patients for this therapy is critical given the cost of biologics. Indeed, not all food allergy patients are good candidates for this therapy. Also, when and how to stop omalizumab therapy in patients who may have outgrown their food allergy needs to be elucidated. Thus, although this therapy provides a good option for patients with food allergies, much information is needed to determine how best to use this therapy. Despite many unanswered questions and issues, we provide clinicians with some practical guidance on implementing this therapy in their patients.
奥马珠单抗获批用于 IgE 介导的食物过敏治疗，这是美国数以百万计食物过敏患者向前迈出的重要一步。通过耗尽循环 IgE 并随后减少关键效应细胞上的 FcεR1，患者增加了对食物过敏原的耐受性。然而，奥马珠单抗并不能让患者在食用过敏食物时免受影响。相反，它保护他们免受大多数意外暴露。此外，奥马珠单抗不能治愈食物过敏，也没有显示出真正的免疫调节作用。因此，奥马珠单抗可能是一些患者的终身治疗。此外，围绕奥马珠单抗治疗食物过敏的适当管理，还有许多重要的问题和争议，我们将对此进行讨论。管理超出剂量范围的患者的治疗、评估治疗反应或无反应、确定其对 55 岁以上患者的适宜性，以及确定免疫疗法联合奥马珠单抗是否优于单独使用奥马珠单抗，所有这些都需要进行检查。鉴于生物制剂的成本，为这种治疗确定合适的患者至关重要。事实上，并非所有食物过敏患者都是这种治疗的合适人选。此外，对于那些可能已经过了食物过敏需求阶段的患者，何时以及如何停止奥马珠单抗治疗也需要阐明。因此，尽管这种治疗为食物过敏患者提供了一个很好的选择，但仍需要更多信息来确定如何最好地使用这种治疗。尽管存在许多未解决的问题和争议，我们仍为临床医生提供了一些实用的指导，以帮助他们在患者中实施这种治疗。
