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Asthma Drug Helps Desensitize Multiple Food Allergies

Kari Nadeau

Kari Nadeau (Stanford University)

28 February 2014. Medical researchers at Stanford University in California and Johns Hopkins University in Baltimore found in an early-stage clinical trial that an asthma drug dramatically reduces the time needed for patients to lower their sensitivity to several food allergies at one time. The team led by Stanford’s Kari Nadeau and Johns Hopkins’s Robert Hamilton published its findings online yesterday in the journal Allergy, Asthma & Clinical Immunology.

Nadeau, Hamilton, and colleagues cite studies from the past three years showing 8 percent of children in the U.S. have a food allergy, with 30 percent of that group reporting allergies to more than one food. Food allergies in the U.S. are estimated to cost $25 billion, mainly from lost work time, changing careers, and emergency room visits, with that cost borne largely by families. People with food allergies are advised to avoid allergy triggers and always carry injectable epinephrine because of the risk of anaphylactic shock from accidental consumption.

This study is the second in a series of clinical trials on multiple food allergies. Many of the same Stanford/Johns Hopkins researchers published its earlier findings in the same journal on 15 January 2014. In that study, the researchers showed patients with several food allergies could be desensitized at once to several multiple foods causing an allergic reaction, rather than going through the process sequentially for each food.

In that process, called oral immunotherapy, patients with food allergies eat small amounts of the offending foods, gradually increasing the amounts they eat in a controlled setting and under a doctor’s supervision. In the earlier study, 25 patients allergic to peanuts and to at least one of other types of foods — sesame, other nuts, dairy, or egg — underwent oral immunotherapy. The researchers found the rates of allergic reactions to the multiple offending foods in this group of patients, was similar to a group of 15 patients with only a peanut allergy, also receiving oral immunotherapy.

In the later study, 25 children and adults with food allergies were first given the drug omalizumab, developed to reduce the number of allergic asthma attacks, those caused by environmental allergens, such as dander, pollen, and dust mites. Omalizumab, marketed as Xolair by Genentech and Novartis, reduces activity of imunoglobulin E (IgE), a type of antibody that binds to allergens and triggers the release of substances from mast cells — tiny cells with chemicals causing inflammation.

Eight weeks after omalizumab injections, the 25 patients underwent an oral immunotherapy regimen for multiple offending foods similar to the earlier trial group. The results show 19 of 25 patients receiving omalizumab injections were able to complete the six stage oral immunotherapy process, with little or no need for rescue therapy.

Patients receiving omalizumab were able to tolerate up to four grams each of the offending foods, in powdered protein form, in a median period of 18 weeks. Patients in the earlier trial of oral immunotherapy, without the omalizumab, needed a median of 85 weeks to become desensitized to the  offending foods.

The trials’ main objective was to test for the safety of oral immunotherapy, both with and without omalizumab. In the earlier study, most reactions to the allergens were mild, although two severe reactions were reported each in the peanut-only and multiple-foods groups requiring epinephrine injections. In the later study, with omalizumab, 94 percent of reactions were considered mild, with one severe reaction reported.

Nadeau and colleagues are now planning for an intermediate-stage clinical trial at Stanford and four other sites.

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