Anti-IgE antibody and food IgE-mediated diseases in severe asthmatic patients

BACKGROUND: It is now recognized that immunoglobulin E (IgE) plays a central role in mediating the allergic response. Omalizumab, a recombinant humanized monoclonal antibody (Xolair®), has been currently used in the treatment of patients with allergic asthma with moderate to severe persistent allergic asthma with a serum IgE.

OBJECTIVE: To investigate the efficacy of anti-IgE to treat IgE-mediated hypersensitivity to foods.

METHODS: In a court of 12 patients (9 females, 3 males; range 6-46 years old; mean 32 years) with severe attacks asthma and food allergy to IgE-mediated, they were treated with omalizumab and monitored during the treatment. The appropriate dose and frequency of administration of Xolair®  was determined by levels of IgE basal (IU / mL), measured before starting treatment, and body weight (kg).

RESULTS: Seven female patients and one male patient with severe attacks of IgE-mediated asthma and food allergy to milk, while three female patients and two male patients with severe asthma and food allergy to egg proteins. All patients experienced allergic food reactions based on history of Anaphylaxis and Dermatitis. Before treatment with Omalizumab, they had asthma with a mean of symptom scores of 7.2 ± 2.1  [scale from 0 (least) to 9 (severe)]. The total IgE concentrations were a mean 1046 ± 84.3 IU/mL. After 16 weeks of treatment with Xolair®, total IgE were decreased with a mean of 440 ± 92.7 lU/ml. No access to intensive care unit was needed during the treatment and the asthma symptom score decreased with a mean of  3.7 ± 2.4  and peak expiratory flow (PEF) of the morning increased each four weeks in all patients. Whereas the introduction (after challange test), in their diet, after 16 weeks of treatment with Xolair®, of cow's milk, egg and its derivatives: in nine patients no reactions (anaphylaxis and dermatitis); in one patient a mild reaction with angioedema;in two patients a episode of hives it was registered.

CONCLUSION: These new features suggest further prospective regarding the use of this biological drug for patients suffering of severe allergies such as the food allergy.