18 March2024
Commentary by Dr. Donald Greig
7 min read
According to a recent report in The Times, ground-breaking research from the Johns Hopkins Children's Centre in Baltimore, recently published in the New England Journal of Medicine (NEJM), has revealed that a two-decade-old asthma medication, Xolair, can significantly mitigate severe allergic reactions to a range of foods, such as peanuts, cashews, wheat, milk, and eggs. This pioneering treatment is the first of its kind to offer protection against multiple life-threatening food allergies, heralding a transformative breakthrough that could dramatically improve the lives of thousands of children and adults.
Xolair, also known by its generic name omalizumab, is a revolutionary monoclonal antibody that has been a game-changer in the field of allergy treatment, particularly for individuals who suffer from severe allergies. This commentary provides an educational overview of the life-saving benefits of Xolair.
What is Xolair?
Xolair is an injectable prescription medicine that falls under the category of monoclonal antibodies. It is designed to lower sensitivity to allergens by targeting and blocking immunoglobulin E (IgE), a naturally occurring antibody in the body that plays a central role in allergic reactions. Xolair is specifically approved for use in patients with moderate to severe persistent asthma caused by year-round allergens in the air and for chronic idiopathic urticaria (chronic hives) without a known cause.
How Does Xolair Work?
Xolair works by binding to IgE antibodies, which are responsible for triggering allergy symptoms. Normally, when an individual with allergies comes into contact with an allergen, IgE antibodies recognize the substance and signal the immune system to release chemicals such as histamine, leading to allergic symptoms. By binding to IgE, Xolair prevents it from interacting with mast cells and basophils, hence stopping the release of the allergy-inducing chemicals. This process significantly reduces allergic reactions and asthma related to allergen exposures.
Benefits in Food Allergy Treatment
Although not originally designed as a treatment for food allergies, researchers have explored the use of Xolair in this capacity and have uncovered several potential benefits, including:
1. Decreased Sensitivity to Allergens: For those with food allergies, small amounts of allergens can provoke serious reactions. Xolair reduces this sensitivity, potentially decreasing the severity of reactions.
2. Oral Immunotherapy Aid: In conjunction with oral immunotherapy (OIT), where patients are gradually given increasing amounts of a food allergen, Xolair can enhance outcomes, allowing for a safer and more effective tolerance-building process.
3. Emergency Response: Xolair can provide an additional safety net for accidental exposures, which could be life-saving for individuals at risk of anaphylaxis, a severe allergic reaction.
Clinical Evidence and FDA Approval
Clinical trials have demonstrated that omalizumab can significantly improve symptoms for individuals with severe allergies. However, as of the last update (April 2023) and not including the recently NEJM article, it is important to note that the FDA has not specifically approved Xolair for the treatment of food allergies. However, the latest research from the Johns Hopkins Children's Centre may change these guidelines.
Safety and Considerations
Xolair is generally well-tolerated, but it can have side effects ranging from mild to severe. Common side effects may include joint pain, dizziness, fatigue, and skin reactions at the injection site. More serious risks involve a slight increased chance of heart and cerebrovascular adverse events and anaphylaxis. Xolair is usually administered in a healthcare setting where patients can be monitored for severe reactions, especially after the first few doses.
In Summary
Xolair has provided a promise for individuals with severe allergies, including food-related allergies, although it's not specifically FDA-approved for such use. As research progresses, the potential of Xolair to change the lives of individuals with severe food allergies becomes more poignant. However, it is crucial to consult with a healthcare provider to discuss the suitability of Xolair as a treatment option and to consider its administration under professional supervision to manage side effects and risks effectively.
Asthma drug significantly reduces risk of fatal food allergies
Tanya Ednan-Laperouse (left) and Emma Turay both lost daughters to severe allergic reactions to food
The first drug found to protect against several potentially life-threatening food allergies promises to be “life-changing” for thousands of children and adults, researchers have said.
Xolair, a 20-year-old asthma drug, significantly reduced potentially dangerous reactions in people with severe allergies to foods including peanuts, cashews, wheat, milk and eggs.
Those who take it will still need to avoid foods they are allergic to, but they will be able to worry less about accidentally consuming tiny amounts, said Dr Robert Wood of Johns Hopkins Children’s Center in Baltimore, who led the study. That may mean that they can eat in restaurants or at friends’ houses, a step that many consider too risky at present.
“Over the past 35 years, I have seen how debilitating food allergies can be for patients and their loved ones, as they are consumed by the fear of accidental exposure,” Wood said. “There are a lot of patients and families for whom this will make a big difference.”
Natasha Ednan-Laperouse died in 2016 after eating a baguette containing sesame
Experts believe that the treatment could help patients like Natasha Ednan-Laperouse, 15, who was allergic to several foods and died after eating a Pret a Manger baguette containing sesame on a flight to France in 2016, and Shanté Turay-Thomas, 18, who suffered fatal anaphylaxis in 2018 after eating a hazelnut. Last year their mothers called for a national allergy tsar to drive reform, including speeding up ambulance response times.
Food allergies in children are becoming increasingly common with up to one in every 12 children estimated to have one. Severe peanut allergies affect about one in 50 children in the UK, and are one of the most common causes of food-related deaths.
The trial included 177 children aged from one to 18 as well as three adults, all of whom had severe food allergies. At the outset of the study, they reacted to less than 100 milligrams of peanut protein, the equivalent of about one third of a peanut, and to less than 300 mg of at least two other allergens, including milk, egg, cashew, walnut, hazelnut and wheat.
Two thirds of them were given Xolair, a monoclonal antibody also known as omalizumab, while the rest received a placebo. The drug is administered as an injection every two or four weeks, depending on the patient’s weight and the amount of allergy-related antibodies in their blood. In the trial, it was given for 16 to 20 weeks.
Afterwards, 67 per cent of those given Xolair could consume the equivalent of about four peanuts without experiencing moderate to severe allergic reactions, compared to only 7 per cent of patients who received a placebo.
Shanté Turay-Thomas died in 2018 after eating a hazelnut
About 44 per cent of those treated with the drug could consume the equivalent of about 25 peanuts, and similar results were recorded for other foods.
In the Xolair group, 41 per cent of those with a cashew allergy could consume 1,000 mg without a moderate or severe reaction, compared with 3 per cent in the placebo group. For milk, it was 66 per cent compared with 10 per cent. In those with egg allergies, 68 per cent could tolerate exposure after treatment while nobody in the placebo group could.
The treatment works by binding to immunoglobulin E, which is produced by the immune system and drives allergic reactions. Another drug, called Palforzia, is already used by the NHS for reducing the chance of a severe reaction, known as anaphylaxis, but is only for peanut allergies. Xolair is not a cure and does not entirely eliminate the risk of a severe reaction. Even so, experts said it was a breakthrough.
Chris Elliott, professor of food safety at Queen’s University Belfast, who was not involved in the latest trial, said: “This is a very exciting development in terms of treatment of food allergies. For many years the only way to protect those with food allergies was by excluding all sources of the allergens from the diet.
“This is very difficult to achieve due to the complex nature of the food supply system and lack of information on all food ingredients used in some products. More recently the use of low-dose administration of allergens such as peanuts has shown a lot of promise.
“This publication shows strong evidence that an already available antibody which is effective in treating ailments such as asthma has very pronounced effects in reducing or totally removing allergic reactions to a wide range of common allergens. This important finding should bring a lot of hope to the many millions of people who suffer from a wide range of food allergies.”
Adam Fox, professor of paediatric allergy at St Thomas’ Hospital and King’s College London, said that drug was likely to be of “huge value” to several of his patients. However, he warned that Xolair is relatively expensive and that a decision was yet to be made on whether the NHS will use it for food allergies. Assessing which patients have the most severe allergies and would benefit most is not straightforward, he added.
The results were published in the New England Journal of Medicine and were presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology.
Source: (The original article cannot be viewed unless you are a subscriber to the Times.)
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