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Kenney HM, Battaglia J, Herman K, Beck LA. Atopic dermatitis and IgE-mediated food allergy: Common biologic targets for therapy and prevention. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00370-3. [PMID: 38908432 DOI: 10.1016/j.anai.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE To highlight common mechanistic targets for the treatment of atopic dermatitis (AD) and IgE-mediated food allergy (IgE-FA) with potential to be effective for both diseases and prevent atopic progression. DATA SOURCES Data sources were PubMed searches or National Clinical Trials (NCT)-registered clinical trials related to AD, IgE-FA, and other atopic conditions, especially focused on the pediatric population. STUDY SELECTIONS Human seminal studies and/or articles published in the past decade were emphasized with reference to preclinical models when relevant. NCT-registered clinical trials were filtered by inclusion of pediatric subjects younger than 18 years with special focus on children younger than 12 years as a critical period when AD and IgE-FA diseases may often be concurrent. RESULTS AD and IgE-FA share several pathophysiologic features, including epithelial barrier dysfunction, innate and adaptive immune abnormalities, and microbial dysbiosis, which may be critical for the clinical progression between these diseases. Revolutionary advances in targeted biologic therapies have shown the benefit of inhibiting type 2 immune responses, using dupilumab (anti-interleukin-4Rα) or omalizumab (anti-IgE), to potentially reduce symptom burden for both diseases in pediatric populations. Although the potential for biologics to promote disease remission (AD) or sustained unresponsiveness (IgE-FA) remains unclear, the refinement of biomarkers to predict infants at risk for atopic disorders provides promise for prevention through timely intervention. CONCLUSION AD and IgE-FA exhibit common features that may be leveraged to develop biologic therapeutic strategies to treat both conditions and even prevent atopic progression. Future studies should be designed with consistent age stratification in the pediatric population and standardized regimens of adjuvant oral immunotherapy or dose escalation (IgE-FA) to improve cross-study interpretation.
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Affiliation(s)
- H Mark Kenney
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Jennifer Battaglia
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Katherine Herman
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York; Division of Allergy and Immunology, University of Rochester Medical Center, Rochester, New York
| | - Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York.
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Bozek A, Rogala B, Miodonska M, Canonica GW. Progressive clinical effects of the combination omalizumab and HDM - allergen immunotherapy in asthma. J Asthma 2024; 61:532-538. [PMID: 38064236 DOI: 10.1080/02770903.2023.2293057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/03/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE The combination of allergen immunotherapy (AIT) and omalizumab is used to treat patients at risk of anaphylaxis. There is currently a very little evidence that this combination increases the effectiveness of AIT in patients with inhalant allergies. The study aimed to evaluate the effectiveness of HDM-SCIT therapy (injection immunotherapy for house dust mites) in combination with omalizumab in treating HDM-induced asthma. METHODS This study was a placebo-controlled, randomized, multicenter trial including 82 patients with HDM-driven mild to moderate asthma. Omalizumab alone (A), HDM SCIT + omalizumab (B), SCIT alone (C), or placebo (D) for 24 months were applied. All patients received asthma treatment in accordance with GINA recommendations. The treatment efficacy was defined by a reduction in the daily dose of inhaled steroids (ICS) and a reduction in the number of asthma exacerbations (AX). RESULTS After 24 months of therapy, a statistically significant reduction in the daily doses of ICS in groups A and B was observed (p = 0.021 and p = 0.008). Daily ICS reduction was considerably more significant in group B (p = 0.01). During 24 months of observation, the AX was significantly reduced in all study groups, with the greatest significant difference observed between groups A and B and groups C and D (placebo) as follows: 0.42 patient/per year vs. 0.39 vs. 0.84 vs. 0.91 (p = 0.023). CONCLUSION The combination of HDM SCIT and omalizumab is significantly and progressively reducing ICS use and AX in a 24-month study. The combination is significantly more effective than the single treatments or placebo.
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Affiliation(s)
- Andrzej Bozek
- Clinical Department of Internal Diseases, Dermatology and Allergology, Medical University of Silesia, Katowice, Poland
| | | | - Martyna Miodonska
- Clinical Department of Internal Diseases, Dermatology and Allergology, Medical University of Silesia, Katowice, Poland
| | - Giorgio Walter Canonica
- Head Personalized Medicine Asthma & Allergy Clinic-Humanitas, Research Hospital, Humanitas University, Milano, Italy
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Casale TB, Fiocchi A, Greenhawt M. A practical guide for implementing omalizumab therapy for food allergy. J Allergy Clin Immunol 2024; 153:1510-1517. [PMID: 38599291 DOI: 10.1016/j.jaci.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
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.
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Affiliation(s)
- Thomas B Casale
- Department of Internal Medicine, Division of Allergy and Immunolgy, University of South Florida Morsani College of Medicine, Tampa, Fla.
| | | | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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Dinardo G, Cafarotti A, Fierro V, Artesani MC, Indolfi C, Miraglia Del Giudice M, Fiocchi A. Role of biologics in severe food allergy. Curr Opin Allergy Clin Immunol 2024; 24:138-143. [PMID: 38538153 DOI: 10.1097/aci.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW This review examine the dynamic landscape of food allergy treatment within the context of emerging biologics. Our purpose is to comprehensively evaluate the potential benefits, challenges, and transformative impact associated with the utilization of biologics in comparison to conventional therapeutic modalities. RECENT FINDINGS This document synthesizes recent scientific investigations to various biologics, such as omalizumab, ligelizumab, dupilumab, and tezepelumab, providing a nuanced understanding of their roles in oral immunotherapy, rapid desensitization, and overall food allergy management. Recent studies and clinical trials highlight the impact of anti-IgE treatment on food allergies, revealing critical findings such as dose-related efficacy, facilitation of rapid desensitization in peanut allergies, and the sustained positive outcomes observed in individuals with multifood allergies. SUMMARY The use of biologics presents a groundbreaking approach in the treatment of food allergies. The multifaceted action of these agents, along with their potential to overcome the challenges associated with traditional therapies, marks a significant advancement. Despite the persisting challenges of economic constraints and the need for further safety studies, biologics offer a promising avenue for improving the quality of life for individuals with food allergies. Ongoing research and collaborative efforts are imperative to fully realize the transformative potential inherent in these emerging therapeutic frontiers.
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Affiliation(s)
- Giulio Dinardo
- Department of Women, Children, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples
| | - Arianna Cafarotti
- Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Vincenzo Fierro
- Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Cristiana Indolfi
- Department of Women, Children, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples
| | - Michele Miraglia Del Giudice
- Department of Women, Children, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples
| | - Alessandro Fiocchi
- Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Schuetz JP, Anderson B, Sindher SB. New biologics for food allergy. Curr Opin Allergy Clin Immunol 2024; 24:147-152. [PMID: 38547423 DOI: 10.1097/aci.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW This review aims to explore role of emerging biologics, including ligelizumab, UB-221, dupilumab, and antialarmins, in food allergy management. With a focus on recent developments, we evaluate their promise in mitigating adverse events during oral immunotherapy (OIT), reducing allergic reactions, and addressing the limitations of current therapeutic options. RECENT FINDINGS Antiimmunoglobulin E mAbs, exemplified by omalizumab, demonstrate efficacy in desensitization and safety improvement during multiallergen OIT. Next-generation antibodies like ligelizumab and UB-221 exhibit enhanced potency and unique mechanisms, holding promise for food allergy treatment. Dupilumab, targeting IL-4 receptor alpha, presents potential benefits in decreasing allergen-specific IgE and modifying the atopic march. Exploration of antialarmins, specifically anti-IL-33 (etokimab) and anti-TSLP (tezepelumab), reveals encouraging results, with etokimab showing early success in peanut allergy trials. SUMMARY Biologics hold promising potential for food allergy treatment. Tailoring therapeutic approaches based on shared decision-making becomes pivotal. While omalizumab remains a significant option, next-generation anti-IgE antibodies and agents targeting alarmins exhibit unique strengths. Dupilumab, despite limited success as monotherapy, shows promise as an adjunct for OIT. Careful consideration of treatment goals, patient preferences, and the evolving landscape of biologics will shape future clinical practice, offering allergists an expanded toolbox for personalized food allergy management.
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Affiliation(s)
- Jackson P Schuetz
- Department of Pathology, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California, USA
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Gupta RS, Epstein E, Wood RA. The role of pediatricians in the diagnosis and management of IgE-mediated food allergy: a review. Front Pediatr 2024; 12:1373373. [PMID: 38873581 PMCID: PMC11169649 DOI: 10.3389/fped.2024.1373373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
Importance Food allergy can often cause a significant burden on patients, families, and healthcare systems. The complexity of food allergy management requires a multidisciplinary approach involving different types of healthcare providers, including allergists, dieticians, psychologists, nurses, family practitioners and, of particular relevance for this article, pediatric primary caretakers. Pediatricians may be the first-line healthcare providers for food allergy: strategies for management and guideline adherence have been highlighted. Observations This review article summarizes the up-to-date recommendations on the role of pediatricians in the diagnosis, management, and prevention of IgE-mediated food allergy. Early introduction of allergenic foods like peanut is known to be of importance to reduce the development of peanut allergy in infants, and pediatricians are essential for educating and supporting parents in this decision. In scenarios of limited allergist availability, as is often the case among rural, Medicaid and minority populations, pediatricians can assist in the evaluation and management of food allergy, and provide action plans, education and counselling for patients and families. Conclusions and relevance Pediatric primary caretakers play a key role in the diagnosis, management, and prevention of IgE-mediated food allergy. As more diagnostic tools and therapies in food allergy become available, the need for a multidisciplinary team is paramount to optimize patient care.
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Affiliation(s)
- Ruchi S. Gupta
- Institute for Public Health and Medicine, Center for Food Allergy & Asthma, Northwestern University, Chicago, IL, United States
| | - Ellen Epstein
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Robert A. Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Hui Shi En E, Cheng-Chung Wei J. Omalizumab for the Treatment of Multiple Food Allergies. N Engl J Med 2024; 390:1936. [PMID: 38810197 DOI: 10.1056/nejmc2404288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
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Conway AE, Lieberman J, Codispoti CD, Mahdavinia M, Anagnostou A, Hsu Blatman KS, Lang DM, Oppenheimer J, Mosnaim GS, Bukstein D, Shaker M. Pharmacoequity and Biologics in the Allergy Clinic: Providing the Right Care, at the Right Time, Every Time, to Everyone. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1170-1180. [PMID: 38458435 DOI: 10.1016/j.jaip.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/10/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
Pharmacoequity refers to equity in access to pharmacotherapy for all patients and is an especially large barrier to biologic agents in patients with allergic diseases. Value-based care models can prompt clinicians to address social determinants of health, promoting pharmacoequity. Pharmacoequity is influenced by numerous factors including socioeconomic status, which may be mediated through insurance status, educational attainment, and access to specialist care. In addition to lower socioeconomic status, race and ethnicity, age, locations isolated from care systems, and off-label indications for biologic agents all constitute barriers to pharmacoequity. Whereas pharmaco-inequity is more apparent for expensive biologics, it also affects many other allergy treatments including epinephrine autoinjectors and SMART for asthma. Current programs aimed at alleviating cost barriers are imperfect. Patient assistance programs, manufacturer-sponsored free drug programs, and rebates often increase the complexity of care, with resultant inequity, particularly for patients with lower health literacy. Ultimately, single silver-bullet solutions are elusive. Long-term improvement instead requires a combination of research, advocacy, and creative problem-solving to design more intelligent and efficient systems that provide timely access to necessary care for every patient, every time.
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Affiliation(s)
| | - Jay Lieberman
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tenn
| | - Christopher D Codispoti
- Department of Internal Medicine, Division of Allergy, Rush University Medical Center, Chicago, Ill
| | - Mahboobeh Mahdavinia
- Department of Internal Medicine, Division of Allergy, Rush University Medical Center, Chicago, Ill
| | | | - Karen S Hsu Blatman
- Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Lebanon, NH; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
| | | | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Don Bukstein
- Allergy, Asthma, and Sinus Center, Milwaukee, Wis
| | - Marcus Shaker
- Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Lebanon, NH; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH.
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Zhang YY, Zhang M, Zhang JQ, Li QQ, Lu MP, Cheng L. Combination of omalizumab with allergen immunotherapy versus immunotherapy alone for allergic diseases: A meta-analysis of randomized controlled trials. Int Forum Allergy Rhinol 2024; 14:794-806. [PMID: 37715592 DOI: 10.1002/alr.23268] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Allergen immunotherapy (AIT)-associated adverse events (AEs) limit its usage in the management of allergic diseases. The monoclonal anti-IgE antibody (omalizumab) and AIT have complementary actions. However, no consensus has been reached on whether their combination could exert superior efficacy and safety. OBJECTIVE To evaluate whether the combination of AIT with omalizumab is superior to AIT alone in treating allergic diseases. METHODS The MEDLINE/PubMed, Embase, Scopus and Cochrane Library databases were searched to identify randomized control trials (RCTs) reporting the outcomes of omalizumab combined with AIT (omalizumab + AIT) versus AIT alone. A random-effect model was established to estimate outcomes with a 95% confidence interval (CI). RESULTS A total of 11 eligible RCTs (involving 901 patients) were screened out for the meta-analysis. According to a pooled analysis, omalizumab + AIT significantly increased the number of patients achieving the target maintenance dose (TMD) and sustained unresponsiveness (SU) to allergens (odds ratio [OR] = 2.43; 95% CI: 1.33-4.44; p = 0.004; I2 = 35%, and OR = 6.77; 95% CI: 2.10-21.80; p = 0.001; I2 = 36%, respectively). Similarly, individuals receiving the combination therapy reported significantly fewer episodes of severe systemic AEs than AIT alone (OR = 0.32; 95% CI: 0.18-0.59; p = 0.0003; I2 = 0%). Meanwhile, the improvements in symptom severity score (mean difference [MD] = -0.26), rescue medication daily means score (MD = -0.14), and number of patients consuming epinephrine in AIT (OR = 0.20) were all more evident than those in AIT alone. CONCLUSION Omalizumab + AIT can significantly enhance the efficacy and safety of AIT by increasing TMD and SU to allergens, while decreasing severe systemic AEs.
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Affiliation(s)
- Ying-Ying Zhang
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Min Zhang
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Jia-Qi Zhang
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Qiu-Qi Li
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Mei-Ping Lu
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
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Wood RA, Togias A, Sicherer SH, Shreffler WG, Kim EH, Jones SM, Leung DYM, Vickery BP, Bird JA, Spergel JM, Iqbal A, Olsson J, Ligueros-Saylan M, Uddin A, Calatroni A, Huckabee CM, Rogers NH, Yovetich N, Dantzer J, Mudd K, Wang J, Groetch M, Pyle D, Keet CA, Kulis M, Sindher SB, Long A, Scurlock AM, Lanser BJ, Lee T, Parrish C, Brown-Whitehorn T, Spergel AKR, Veri M, Hamrah SD, Brittain E, Poyser J, Wheatley LM, Chinthrajah RS. Omalizumab for the Treatment of Multiple Food Allergies. N Engl J Med 2024; 390:889-899. [PMID: 38407394 PMCID: PMC11193494 DOI: 10.1056/nejmoa2312382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Food allergies are common and are associated with substantial morbidity; the only approved treatment is oral immunotherapy for peanut allergy. METHODS In this trial, we assessed whether omalizumab, a monoclonal anti-IgE antibody, would be effective and safe as monotherapy in patients with multiple food allergies. Persons 1 to 55 years of age who were allergic to peanuts and at least two other trial-specified foods (cashew, milk, egg, walnut, wheat, and hazelnut) were screened. Inclusion required a reaction to a food challenge of 100 mg or less of peanut protein and 300 mg or less of the two other foods. Participants were randomly assigned, in a 2:1 ratio, to receive omalizumab or placebo administered subcutaneously (with the dose based on weight and IgE levels) every 2 to 4 weeks for 16 to 20 weeks, after which the challenges were repeated. The primary end point was ingestion of peanut protein in a single dose of 600 mg or more without dose-limiting symptoms. The three key secondary end points were the consumption of cashew, of milk, and of egg in single doses of at least 1000 mg each without dose-limiting symptoms. The first 60 participants (59 of whom were children or adolescents) who completed this first stage were enrolled in a 24-week open-label extension. RESULTS Of the 462 persons who were screened, 180 underwent randomization. The analysis population consisted of the 177 children and adolescents (1 to 17 years of age). A total of 79 of the 118 participants (67%) receiving omalizumab met the primary end-point criteria, as compared with 4 of the 59 participants (7%) receiving placebo (P<0.001). Results for the key secondary end points were consistent with those of the primary end point (cashew, 41% vs. 3%; milk, 66% vs. 10%; egg, 67% vs. 0%; P<0.001 for all comparisons). Safety end points did not differ between the groups, aside from more injection-site reactions in the omalizumab group. CONCLUSIONS In persons as young as 1 year of age with multiple food allergies, omalizumab treatment for 16 weeks was superior to placebo in increasing the reaction threshold for peanut and other common food allergens. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT03881696.).
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Affiliation(s)
- Robert A Wood
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Alkis Togias
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Scott H Sicherer
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Wayne G Shreffler
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Edwin H Kim
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Stacie M Jones
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Donald Y M Leung
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Brian P Vickery
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - J Andrew Bird
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Jonathan M Spergel
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Ahmar Iqbal
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Julie Olsson
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Monica Ligueros-Saylan
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Alkaz Uddin
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Agustin Calatroni
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Charmaine Marquis Huckabee
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Nicole H Rogers
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Nancy Yovetich
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Jennifer Dantzer
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Kim Mudd
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Julie Wang
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Marion Groetch
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - David Pyle
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Corinne A Keet
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Michael Kulis
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Sayantani B Sindher
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Andrew Long
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Amy M Scurlock
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Bruce J Lanser
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Tricia Lee
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Christopher Parrish
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Terri Brown-Whitehorn
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Amanda K Rudman Spergel
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Maria Veri
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Sanaz Daneshfar Hamrah
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Erica Brittain
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Julian Poyser
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Lisa M Wheatley
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - R Sharon Chinthrajah
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
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11
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Dantzer JA, Kim EH. New Approaches to Food Allergy Immunotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:546-552. [PMID: 37852441 DOI: 10.1016/j.jaip.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
Food allergy is an increasing public health problem in children and adults. In addition to the risk of potentially severe reactions, food allergy can have a significant burden on quality of life, nutrition, cost of living, and social activities. Traditionally, treatment has primarily included strict food allergen avoidance and use of emergency medications to treat an allergic reaction. However, in recent years, there have been significant strides in the advancement of food allergy treatment, including the approval of the first and only approved therapy (peanut oral immunotherapy) for food allergy in 2020. Clinical trials have primarily focused on food allergen immunotherapy (oral, epicutaneous, sublingual). Building off of a foundation of promising data supporting the efficacy of food oral immunotherapy and our greater understanding of the underlying mechanism of immunotherapy, newer approaches, including alternative routes of delivery, adjuncts to therapy, modified allergens, and utilization in younger patients, aim to provide safer and more effective treatment approaches to the millions of patients burdened by food allergy.
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Affiliation(s)
- Jennifer A Dantzer
- Johns Hopkins University School of Medicine, Division of Pediatric Allergy, Immunology, and Rheumatology, Baltimore, Md.
| | - Edwin H Kim
- University of North Carolina School of Medicine, Division of Pediatric Allergy and Immunology, Chapel Hill, NC
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12
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Sindher SB, Fiocchi A, Zuberbier T, Arasi S, Wood RA, Chinthrajah RS. The Role of Biologics in the Treatment of Food Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:562-568. [PMID: 38013157 PMCID: PMC11104487 DOI: 10.1016/j.jaip.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
The landscape of food allergy (FA) treatment is poised for a paradigm shift with the emergence of biologic therapies. The Food and Drug Administration approval of a standardized peanut powder for oral immunotherapy in 2020 marked a milestone, signaling a departure from allergen avoidance toward proactive treatment strategies. Although oral immunotherapy has been proven effective in desensitizing patients to specific allergens, there are several limitations such as lacking standardization, a long-time commitment to achieve maintenance, and adverse events. Biologics, including omalizumab, dupilumab, and antialarmins, have shown promise in treating various allergic diseases, including FA. These biologics target the underlying immunologic pathways driving allergic reactions, offering an antigen-agnostic approach. Omalizumab (anti-IgE) has been the most studied biologic in this space and can be used both as an adjunct therapy with oral immunotherapy and as monotherapy. Dupilumab targeting IL-4 and IL-13 also shows promise as an adjunct therapy. The emergence of antialarmins further broadens the spectrum of FA treatment possibilities. Biologics represent a transformative approach to FA treatment, directly addressing the underlying mechanisms. Future research should focus on patient selection criteria, personalized biomarker panels, optimal timing of intervention, and treatment durations.
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Affiliation(s)
- Sayantani B Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif
| | | | - Torsten Zuberbier
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefania Arasi
- Allergy Unit - Bambino Gesù Children's Hospital, Rome, Italy
| | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif.
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13
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Kim S, Ahn K, Kim J. Practical issues of oral immunotherapy for egg or milk allergy. Clin Exp Pediatr 2024; 67:140-148. [PMID: 37350169 PMCID: PMC10915454 DOI: 10.3345/cep.2023.00234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 06/24/2023] Open
Abstract
Oral immunotherapy (OIT) has been recommended to reduce parental burden related to strict allergen avoidance and induce desensitization and immune tolerance for patients with long-lasting allergies to hen's eggs (HE) or cow's milk (CM). OIT should be monitored by pediatric allergists specializing in OIT and oral food challenge tests to manage allergic reactions. Although a previous history of anaphylaxis or multiple food allergies is not a contraindication to OIT, it is contraindicated if the patient has uncontrolled asthma, a malignancy, active systemic autoimmune disorders, or diseases requiring treatment with beta-blockers. A variety of OIT protocols have been de veloped to ensure better outcomes and safe up-dosing, including adjunctive therapies with biologics. This review provides insight into the practical issues of various immunotherapy options for children with HE or CM allergies.
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Affiliation(s)
- Sukyung Kim
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwaseong, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea
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14
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Shibata R, Itoh N, Nakanishi Y, Kato T, Suda W, Nagao M, Iwata T, Yoshida H, Hattori M, Fujisawa T, Shimojo N, Ohno H. Gut microbiota and fecal metabolites in sustained unresponsiveness by oral immunotherapy in school-age children with cow's milk allergy. Allergol Int 2024; 73:126-136. [PMID: 38182280 DOI: 10.1016/j.alit.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/28/2023] [Accepted: 09/21/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Oral immunotherapy (OIT) can ameliorate cow's milk allergy (CMA); however, the achievement of sustained unresponsiveness (SU) is challenging. Regarding the pathogenesis of CMA, recent studies have shown the importance of gut microbiota (Mb) and fecal water-soluble metabolites (WSMs), which prompted us to determine the change in clinical and gut environmental factors important for acquiring SU after OIT for CMA. METHODS We conducted an ancillary cohort study of a multicenter randomized, parallel-group, delayed-start design study on 32 school-age children with IgE-mediated CMA who underwent OIT for 13 months. We defined SU as the ability to consume cow's milk exceeding the target dose in a double-blind placebo-controlled food challenge after OIT followed by a 2-week-avoidance. We longitudinally collected 175 fecal specimens and clustered the microbiome and metabolome data into 29 Mb- and 12 WSM-modules. RESULTS During OIT, immunological factors improved in all participants. However, of the 32 participants, 4 withdrew because of adverse events, and only 7 were judged SU. Gut environmental factors shifted during OIT, but only in the beginning, and returned to the baseline at the end. Of these factors, milk- and casein-specific IgE and the Bifidobacterium-dominant module were associated with SU (milk- and casein-specific IgE; OR for 10 kUA/L increments, 0.67 and 0.66; 95%CI, 0.41-0.93 and 0.42-0.90; Bifidobacterium-dominant module; OR for 0.01 increments, 1.40; 95%CI, 1.10-2.03), and these associations were observed until the end of OIT. CONCLUSIONS In this study, we identified the clinical and gut environmental factors associated with SU acquisition in CM-OIT.
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Affiliation(s)
- Ryohei Shibata
- Laboratory for Intestinal Ecosystem, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan; Immunobiology Laboratory, Graduate School of Medical Life Science, Yokohama City University, Kanagawa, Japan; Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoka Itoh
- Department of Pediatrics, National Hospital Organization Kanagawa National Hospital, Kanagawa, Japan
| | - Yumiko Nakanishi
- Laboratory for Intestinal Ecosystem, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan; Immunobiology Laboratory, Graduate School of Medical Life Science, Yokohama City University, Kanagawa, Japan
| | - Tamotsu Kato
- Laboratory for Intestinal Ecosystem, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan; Immunobiology Laboratory, Graduate School of Medical Life Science, Yokohama City University, Kanagawa, Japan
| | - Wataru Suda
- Laboratory for Microbiome Sciences, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Mizuho Nagao
- Allergy Center, National Hospital Organization Mie National Hospital, Mie, Japan
| | - Tsutomu Iwata
- The Graduate School of Tokyo Kasei University, Saitama, Japan
| | - Hideo Yoshida
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahira Hattori
- Laboratory for Microbiome Sciences, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan; Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan
| | - Takao Fujisawa
- Allergy Center, National Hospital Organization Mie National Hospital, Mie, Japan
| | - Naoki Shimojo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Hiroshi Ohno
- Laboratory for Intestinal Ecosystem, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan; Immunobiology Laboratory, Graduate School of Medical Life Science, Yokohama City University, Kanagawa, Japan; Laboratory for Microbiome Sciences, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan.
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15
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Goldberg MR, Epstein-Rigbi N, Elizur A. Eosinophil-Associated Gastrointestinal Manifestations During OIT. Clin Rev Allergy Immunol 2023; 65:365-376. [PMID: 37957456 DOI: 10.1007/s12016-023-08974-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/15/2023]
Abstract
Gastrointestinal adverse events are common during oral immunotherapy (OIT) for food allergy and range from immediate IgE-mediated reactions to non-anaphylactic clinical presentations. This review aims to summarize recent findings on non-anaphylactic eosinophil-associated gastrointestinal adverse events during OIT. Two clinical presentations of non-anaphylactic eosinophil-associated gastrointestinal adverse events during OIT are identified, each with a different paradigm for treatment, and distinguished by their time of onset. In the first clinical entity, characterized by its onset early in the course of treatment, patients present with abdominal pain, nausea, and/or vomiting. The symptoms become evident typically within weeks to months of starting OIT. These symptoms, however, are not temporally related to the time of dose administration, as in the case of immediate IgE-mediated anaphylactic reactions. While esophageal biopsies, when performed, can demonstrate eosinophilic esophagitis (EoE), baseline esophageal eosinophilia has also been observed in food allergic patients prior to OIT. A potential non-invasive biomarker, the peripheral absolute eosinophil count (AEC), often rises during these reactions and subsides after dose reduction and subsequent resolution of symptoms. OIT can usually then be resumed, albeit at a slower pace, without a recurrence of symptoms. Risk factors for development of symptoms early during OIT include a high starting dose and a baseline AEC of greater than 600. The second, and much less frequently encountered, non-anaphylactic gastrointestinal adverse event related to OIT, presents months to years after initiating OIT. In this latter group, patients present with the classical clinical symptoms and endoscopic findings of EoE. In contrast to the acute onset group, peripheral eosinophilia is usually not observed in these cases. This OIT-associated EoE has shown good response to standard EoE treatment approaches of proton pump inhibitors or swallowed steroids. Most patients with eosinophil-associated adverse reactions are able to continue OIT and remain desensitized. Treatment approaches depend on the specific subtype of these reactions and relate to the stages of OIT treatment.
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Affiliation(s)
- Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center (Assaf Harofeh), Zerifin, 70300, Israel.
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Naama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center (Assaf Harofeh), Zerifin, 70300, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center (Assaf Harofeh), Zerifin, 70300, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Akarcan SE, Şenol HD, Gülen F, Demir E. Food oral immunotherapy: Any distinguishing factors predicting the need of anti-IgE? Allergol Immunopathol (Madr) 2023; 51:104-111. [PMID: 37968804 DOI: 10.15586/aei.v51i6.907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/10/2023] [Indexed: 11/17/2023]
Abstract
Oral immunotherapy (OIT) has gained popularity recently for IgE-mediated food allergy. Omalizumab (OMZ) has been used in patients (10-20%) who have too severe/frequent allergic reactions (AR) to continue OIT, to reduce these reactions. In this study, it was aimed to compare two groups of patients who completed OIT with and without OMZ and to seek determinants predicting the need of this treatment. It was also aimed to share the clinical findings regarding the long-term use of OMZ and the withdrawal process. Forty-one patients were started OIT and 93% could be desensitized. Two groups were similar in means of demographic characteristics, and clinical and laboratory findings. The patients who needed OMZ during OIT had also lower reaction doses during oral challenge (p = 0.037). Higher AR rate in this group declined after starting OMZ (p < 0.001). The injection intervals of OMZ were gradually extended. Most patients were able to discontinue OMZ (81%). There were no severe reactions during drug withdrawal attempts. The low reaction thresholds during oral food challenge may give a clue about OMZ requirement during OIT. It may be an option to start the treatment before OIT if reaction was seen in the first few steps of the oral food challenge. For the sake of safety, extension of injection intervals should be preferred instead of abruptly stopping OMZ.
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Affiliation(s)
- Sanem Eren Akarcan
- Tepecik Training and Research Hospital, Pediatric Allergy and Immunology Clinic, İzmir, Turkiye;
| | - Handan Duman Şenol
- Ege University Faculty of Medicine, Department of Pediatric Allergy and Immunology, İzmir, Turkiye
| | - Figen Gülen
- Ege University Faculty of Medicine, Department of Pediatric Allergy and Immunology, İzmir, Turkiye
| | - Esen Demir
- Ege University Faculty of Medicine, Department of Pediatric Allergy and Immunology, İzmir, Turkiye
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17
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Fowler J, Lieberman J. Update on clinical research for food allergy treatment. FRONTIERS IN ALLERGY 2023; 4:1154541. [PMID: 37520143 PMCID: PMC10379782 DOI: 10.3389/falgy.2023.1154541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/20/2023] [Indexed: 08/01/2023] Open
Abstract
The incidence of IgE-mediated food allergy (FA) has continued to increase over the years which places substantial burden on patient health and quality of life. With no cure for this disease, the mainstay of management has been allergen avoidance. However, there have been advancements in FA treatment in recent years with multiple clinical trials utilizing novel and innovative therapeutic strategies. A landmark event came in 2020 with the first drug approval for food allergy with the approval of a product for peanut oral immunotherapy. In addition to oral immunotherapy, different delivery systems of immunotherapy (SLIT, EPIT) are being studied in addition to probiotics, biologic agents - used as monotherapy and as an adjunct, and modified allergens has taken place with the hope to further enhance existing therapeutic options. The hope through these continued developments is for therapies to emerge that will provide a more comprehensive benefit to this patient population.
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Anagnostou A, Lieberman J, Greenhawt M, Mack DP, Santos AF, Venter C, Stukus D, Turner PJ, Brough HA. The future of food allergy: Challenging existing paradigms of clinical practice. Allergy 2023; 78:1847-1865. [PMID: 37129472 DOI: 10.1111/all.15757] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/05/2023] [Accepted: 04/25/2023] [Indexed: 05/03/2023]
Abstract
The field of food allergy has seen tremendous change over the past 5-10 years with seminal studies redefining our approach to prevention and management and novel testing modalities in the horizon. Early introduction of allergenic foods is now recommended, challenging the previous paradigm of restrictive avoidance. The management of food allergy has shifted from a passive avoidance approach to active interventions that aim to provide protection from accidental exposures, decrease allergic reaction severity and improve the quality of life of food-allergic patients and their families. Additionally, novel diagnostic tools are making their way into clinical practice with the goal to reduce the need for food challenges and assist physicians in the-often complex-diagnostic process. With all the new developments and available choices for diagnosis, prevention and therapy, shared decision-making has become a key part of medical consultation, enabling patients to make the right choice for them, based on their values and preferences. Communication with patients has also become more complex over time, as patients are seeking advice online and through social media, but the information found online may be outdated, incorrect, or lacking in context. The role of the allergist has evolved to embrace all the above exciting developments and provide patients with the optimal care that fits their needs. In this review, we discuss recent developments as well as the evolution of the field of food allergy in the next decade.
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Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Texas, USA
- Section of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas, USA
| | - Jay Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, LeBonheur Children's Hospital, Memphis, Tennessee, USA
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Food Challenge and Research Unit, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Douglas Paul Mack
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Courses Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service and Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, UK
| | - Carina Venter
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado, Denver, Colorado, USA
| | - David Stukus
- Section of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas, USA
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Ohio, USA
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Helen A Brough
- Department of Women and Children's Health (Pediatric Allergy), School of Life Courses Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service and Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, UK
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19
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Berin C. Jak out of the box: Targeting Bruton's tyrosine kinase, sialic acid-binding immunoglobulin-like lectin-8, and Janus kinase 1 in food allergy. Ann Allergy Asthma Immunol 2023; 131:23-28. [PMID: 36738782 PMCID: PMC10330066 DOI: 10.1016/j.anai.2023.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Abstract
There has been rapid growth in the field of immunoglobulin E-mediated food allergy therapeutics, with 1 US Food and Drug Administration-approved therapy in 2020 and several others in various stages of investigation. Oral immunotherapy is the approach with the longest track record of study and provides desensitization for most individuals undertaking the therapy. However, the therapy must be maintained for continued clinical protection, and adverse effects of the therapy are frequent. There is a need to improve allergen immunotherapy safety and durability and to provide a treatment that can target multiple food allergies. In this review, we discuss novel adjunct therapies that may improve safety, such as omalizumab, Bruton's tyrosine kinase inhibitors, and agonists of sialic acid-binding immunoglobulin-like lectin-8, which suppress hypersensitivity responses. We also discuss approaches that may improve magnitude or durability of the treatment response, such as dupilumab and Janus kinase 1 inhibitors.
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Affiliation(s)
- Cecilia Berin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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20
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Wang J, Wood RA, Raymond S, Suárez-Fariñas M, Yang N, Sicherer SH, Sampson HA, Li XM. Double-Blind, Placebo-Controlled Study of E-B-FAHF-2 in Combination With Omalizumab-Facilitated Multiallergen Oral Immunotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2208-2216.e1. [PMID: 37087097 PMCID: PMC10330343 DOI: 10.1016/j.jaip.2023.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Oral immunotherapy (OIT) is limited by adverse events, and most patients require continued treatment to maintain their increased threshold. Adjunctive treatments have been explored to increase the safety and efficacy of OIT. OBJECTIVE This study aimed to determine the safety and efficacy of enhanced, butanol purified Food Allergy Herbal Formula-2 (E-B-FAHF-2) for inducing remission in subjects undergoing omalizumab-facilitated multiallergen OIT (multi-OIT). METHODS In this double-blind, placebo-controlled clinical trial, subjects were randomized 1:1 to receive either E-B-FAHF-2 or placebo, starting 2 months before OIT and continuing throughout OIT. All subjects received a 4-month course of omalizumab, starting 2 months before OIT through the 2-month OIT build-up phase. After 24 months of multi-OIT (maintenance dose of 1000 mg of each allergen), desensitization and remission were assessed. The primary objective was to determine if subjects in the E-B-FAHF-2 group (EOIT) were more likely than the placebo group (OIT) to develop remission to all 3 allergens treated with multi-OIT, as defined by the absence of dose-limiting symptoms to a cumulative dose of 4444 mg of protein after discontinuing treatment for 3 months. RESULTS Thirty-three subjects were randomized. A total of 63.6% were desensitized to 4444 mg of protein for each allergen at 26 months, and 24.2% met the primary outcome of remission at 29 months, with no difference between the treatment groups. There was good adherence (>85%) with study medications, with no difference between the treatment groups. There was no difference in reported overall adverse events between the treatment groups. CONCLUSION Omalizumab-facilitated multifood OIT was safe and effective, and remission was achieved in about a quarter of subjects. However, outcomes were not improved by the addition of E-B-FAHF-2.
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Affiliation(s)
- Julie Wang
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Samantha Raymond
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mayte Suárez-Fariñas
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Genetics and Genomics Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nan Yang
- General Nutraceutical Technology, Elmsford, NY; Department of Pathology, Microbiology and Immunology, New York Medical College, Valhalla, NY
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hugh A Sampson
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Xiu-Min Li
- Department of Pathology, Microbiology and Immunology, New York Medical College, Valhalla, NY; Department of Otolaryngology, New York Medical College, Valhalla, NY
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21
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Sindher SB, Hillier C, Anderson B, Long A, Chinthrajah RS. Treatment of food allergy: Oral immunotherapy, biologics, and beyond. Ann Allergy Asthma Immunol 2023; 131:29-36. [PMID: 37100276 PMCID: PMC10330596 DOI: 10.1016/j.anai.2023.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 04/28/2023]
Abstract
The prevalence of food allergy (FA) has been increasing globally and comes with a heavy burden not just economically, but also on quality of life. Although oral immunotherapy (OIT) is effective at inducing desensitization to food allergens, it has several limitations that weaken its success. Limitations include a long duration of build-up, especially when used for multiple allergens, and a high rate of reported adverse events. Furthermore, OIT may not be effective in all patients. Efforts are underway to identify additional treatment options, either as monotherapy or in combination, to treat FA or enhance the safety and efficacy of OIT. Biologics such as omalizumab and dupilumab, which already have US Food and Drug Administration approval for other atopic conditions have been the most studied, but additional biologics and novel strategies are emerging. In this review, we discuss therapeutic strategies including immunoglobulin E inhibitors, immunoglobulin E disruptors, interleukin-4 and interleukin-13 inhibitors, antialarmins, JAK1 and BTK inhibitors, and nanoparticles, and the data surrounding their application in FA and highlighting their potential.
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Affiliation(s)
- Sayantani B Sindher
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California.
| | - Claire Hillier
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California
| | - Brent Anderson
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California
| | - Andrew Long
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California
| | - R Sharon Chinthrajah
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California
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22
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Dispenza MC, Metcalfe DD, Olivera A. Research Advances in Mast Cell Biology and Their Translation Into Novel Therapies for Anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2032-2042. [PMID: 36958519 PMCID: PMC10330051 DOI: 10.1016/j.jaip.2023.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
Anaphylaxis is an acute, potentially life-threatening systemic allergic reaction for which there are no known reliable preventative therapies. Its primary cell mediator, the mast cell, has several pathophysiologic roles and functions in IgE-mediated reactions that continue to be poorly understood. Recent advances in the understanding of allergic mechanisms have identified novel targets for inhibiting mast cell function and activation. The prevention of anaphylaxis is within reach with new drugs that could modulate immune tolerance, mast cell proliferation and differentiation, and IgE regulation and production. Several US Food and Drug Administration-approved drugs for chronic urticaria, mastocytosis, and cancer are also being repurposed to prevent anaphylaxis. New therapeutics have not only shown promise in potential efficacy for preventing IgE-mediated reactions, but in some cases, they are able to inform us about mast cell mechanisms in vivo. This review summarizes the most recent advances in the treatment of anaphylaxis that have arisen from new pharmacologic tools and our current understanding of mast cell biology.
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Affiliation(s)
- Melanie C Dispenza
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Dean D Metcalfe
- Mast Cell Biology Section, Laboratory of Allergy Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Ana Olivera
- Mast Cell Biology Section, Laboratory of Allergy Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
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23
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Mutarelli A, Giavina-Bianchi B, Arasi S, Cafarotti A, Fiocchi A. Biologicals in IgE-mediated food allergy. Curr Opin Allergy Clin Immunol 2023; 23:205-209. [PMID: 37185824 DOI: 10.1097/aci.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW A better understanding of the most recent scientific literature in the use of biological therapy in the treatment of patients with IgE-mediated food allergy. RECENT FINDINGS A systematic review and meta-analysis demonstrated safety and effectiveness of omalizumab in the treatment of food allergy. The findings support the potential use of omalizumab as a monotherapy or as an adjunct to oral immunotherapy in IgE-mediated cow's milk allergy. The potential use of other biologics in the management of food allergy is subject of speculation. SUMMARY Different biological therapies are under evaluation for food allergic patients. The advance in literature will guide for a personalized treatment in the near future. However, additional research is needed to better understand the best candidate for each treatment, the optimal dose and timing.
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Affiliation(s)
| | | | - Stefania Arasi
- Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Arianna Cafarotti
- Federal University of Minas Gerais, Belo Horizonte, MG
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandro Fiocchi
- Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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24
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Šošić L, Paolucci M, Flory S, Jebbawi F, Kündig TM, Johansen P. Allergen immunotherapy: progress and future outlook. Expert Rev Clin Immunol 2023:1-25. [PMID: 37122076 DOI: 10.1080/1744666x.2023.2209319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Allergy, the immunological hypersensitivity to innocuous environmental compounds, is a global health problem. The disease triggers, allergens, are mostly proteins contained in various natural sources such as plant pollen, animal dander, dust mites, foods, fungi and insect venoms. Allergies can manifest with a wide range of symptoms in various organs, and be anything from just tedious to life-threatening. A majority of all allergy patients are self-treated with symptom-relieving medicines, while allergen immunotherapy (AIT) is the only causative treatment option. AREAS COVERED This review will aim to give an overview of the state-of-the-art allergy management, including the use of new biologics and the application of biomarkers, and a special emphasis and discussion on current research trends in the field of AIT. EXPERT OPINION Conventional AIT has proven effective, but the years-long treatment compromises patient compliance. Moreover, AIT is typically not offered in food allergy. Hence, there is a need for new, effective and safe AIT methods. Novel routes of administration (e.g. oral and intralymphatic), hypoallergenic AIT products and more effective adjuvants holds great promise. Most recently, the development of allergen-specific monoclonal antibodies for passive immunotherapy may also allow treatment of patients currently not treated or treatable.
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Affiliation(s)
- Lara Šošić
- Department of Dermatology, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Marta Paolucci
- Department of Dermatology, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Stephan Flory
- Department of Dermatology, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Fadi Jebbawi
- Department of Dermatology, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Thomas M Kündig
- Department of Dermatology, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Pål Johansen
- Department of Dermatology, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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25
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Berin MC. Targeting type 2 immunity and the future of food allergy treatment. J Exp Med 2023; 220:213917. [PMID: 36880703 PMCID: PMC9997511 DOI: 10.1084/jem.20221104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/27/2022] [Accepted: 01/13/2023] [Indexed: 03/08/2023] Open
Abstract
IgE-mediated food allergy affects 6-8% of the population in the United States. Type 2 immune responses are central to the pathogenesis of food allergy, but type 2 CD4+ T cell responses have been found to be heterogeneous in food allergy suggesting a division of labor between Tfh13 and peTH2 cells in promotion of IgE class switching, modulation of intestinal barrier function, and regulation of mast cell expansion. Oral immunotherapy for the treatment of food allergy incompletely targets subsets of type 2 immunity in a transient manner, but new therapeutics targeting different levels of type 2 immunity are in current or planned trials for food allergy. These new treatments and the basis for their use are the focus of this review.
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Affiliation(s)
- M Cecilia Berin
- Northwestern University Feinberg School of Medicine , Chicago, IL, USA
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26
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Emmert V, Lendvai-Emmert D, Eklics K, Prémusz V, Tóth GP. Current Practice in Pediatric Cow's Milk Protein Allergy-Immunological Features and Beyond. Int J Mol Sci 2023; 24:ijms24055025. [PMID: 36902457 PMCID: PMC10003246 DOI: 10.3390/ijms24055025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023] Open
Abstract
Cow's milk protein allergy is one of the most common pediatric food allergies. It poses a significant socioeconomic burden in industrialized countries and has a profound effect on the quality of life of affected individuals and their families. Diverse immunologic pathways can lead to the clinical symptoms of cow's milk protein allergy; some of the pathomechanisms are known in detail, but others need further elucidation. A comprehensive understanding of the development of food allergies and the features of oral tolerance could have the potential to unlock more precise diagnostic tools and novel therapeutic approaches for patients with cow's milk protein allergy.
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Affiliation(s)
- Vanessza Emmert
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
- Erzsébet Teaching Hospital and Rehabilitation Institute, 9400 Sopron, Hungary
- Correspondence:
| | - Dominika Lendvai-Emmert
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
- Department of Neurosurgery, Medical School, University of Pécs, 7623 Pécs, Hungary
- Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
| | - Kata Eklics
- Department of Languages for Biomedical Purposes, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Viktória Prémusz
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
- Institute of Physiotherapy and Sport Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | - Gergely Péter Tóth
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
- Erzsébet Teaching Hospital and Rehabilitation Institute, 9400 Sopron, Hungary
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27
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Sindher SB, Barshow S, Tirumalasetty J, Arasi S, Atkins D, Bauer M, Bégin P, Collins MH, Deschildre A, Doyle AD, Fiocchi A, Furuta GT, Garcia-Lloret M, Mennini M, Rothenberg ME, Spergel JM, Wang J, Wood RA, Wright BL, Zuberbier T, Chin AR, Long A, Nadeau KC, Chinthrajah RS. The role of biologics in pediatric food allergy and eosinophilic gastrointestinal disorders. J Allergy Clin Immunol 2023; 151:595-606. [PMID: 36872039 PMCID: PMC9993424 DOI: 10.1016/j.jaci.2023.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 03/06/2023]
Abstract
Continuing insight into the molecular mechanisms of atopic disorders has enabled the development of biologics to precisely target these diseases. Food allergy (FA) and eosinophilic gastrointestinal disorders (EGIDs) are driven by similar inflammatory molecular mechanisms and exist along the same atopic disease spectrum. Therefore, many of the same biologics are being investigated to target key drivers of mechanisms shared across the disease states. The enormous potential of biologics for the treatment of FA and EGIDs is highlighted by the significant increases in the number of ongoing clinical trials (more than 30) evaluating their use in these disease states, as well as by the recent US Food and Drug Administration approval of dupilumab for the treatment of eosinophilic esophagitis. Here we discuss past and current research into the use of biologics in FA and EGIDs and their potential role in improving treatment options in the future, with the need to have biologics widely clinically available.
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Affiliation(s)
- Sayantani B Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif
| | - Suzanne Barshow
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif
| | - Jyothi Tirumalasetty
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif
| | - Stefania Arasi
- Translational Research in Paediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Dan Atkins
- Department of Pediatrics, Section of Allergy and Immunology, Digestive Health Institute, Gastrointestinal Eosinophilic Diseases Program, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Maureen Bauer
- Department of Pediatrics, Section of Allergy and Immunology, Digestive Health Institute, Gastrointestinal Eosinophilic Diseases Program, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Philippe Bégin
- Department of Pediatrics, Service of Allergy and Clinical Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montréal; Department of Medicine, Service of Allergy and Clinical Immunology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Margaret H Collins
- Division of Pathology and Laboratory Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Antoine Deschildre
- CHU Lille, Université Lille, Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, Lille, France
| | - Alfred D Doyle
- Division of Allergy, Asthma and Clinical Immunology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Ariz
| | - Alessandro Fiocchi
- Translational Research in Paediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Glenn T Furuta
- Department of Pediatrics, Section of Allergy and Immunology, Digestive Health Institute, Gastrointestinal Eosinophilic Diseases Program, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Maria Garcia-Lloret
- Department of Pediatrics, Division of Immunology, Allergy, and Rheumatology, David Geffen School of Medicine at UCLA, Los Angeles, Calif
| | - Maurizio Mennini
- Translational Research in Paediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan M Spergel
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai and the Jaffe Food Allergy Institute, New York, NY
| | - Robert A Wood
- Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Benjamin L Wright
- Division of Allergy, Asthma and Clinical Immunology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Ariz
| | - Torsten Zuberbier
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Andrew R Chin
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif
| | - Andrew Long
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif.
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28
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Dramburg S, Hilger C, Santos AF, de Las Vecillas L, Aalberse RC, Acevedo N, Aglas L, Altmann F, Arruda KL, Asero R, Ballmer-Weber B, Barber D, Beyer K, Biedermann T, Bilo MB, Blank S, Bosshard PP, Breiteneder H, Brough HA, Bublin M, Campbell D, Caraballo L, Caubet JC, Celi G, Chapman MD, Chruszcz M, Custovic A, Czolk R, Davies J, Douladiris N, Eberlein B, Ebisawa M, Ehlers A, Eigenmann P, Gadermaier G, Giovannini M, Gomez F, Grohman R, Guillet C, Hafner C, Hamilton RG, Hauser M, Hawranek T, Hoffmann HJ, Holzhauser T, Iizuka T, Jacquet A, Jakob T, Janssen-Weets B, Jappe U, Jutel M, Kalic T, Kamath S, Kespohl S, Kleine-Tebbe J, Knol E, Knulst A, Konradsen JR, Korošec P, Kuehn A, Lack G, Le TM, Lopata A, Luengo O, Mäkelä M, Marra AM, Mills C, Morisset M, Muraro A, Nowak-Wegrzyn A, Nugraha R, Ollert M, Palosuo K, Pastorello EA, Patil SU, Platts-Mills T, Pomés A, Poncet P, Potapova E, Poulsen LK, Radauer C, Radulovic S, Raulf M, Rougé P, Sastre J, Sato S, Scala E, Schmid JM, Schmid-Grendelmeier P, Schrama D, Sénéchal H, Traidl-Hoffmann C, Valverde-Monge M, van Hage M, van Ree R, Verhoeckx K, Vieths S, Wickman M, Zakzuk J, Matricardi PM, Hoffmann-Sommergruber K. EAACI Molecular Allergology User's Guide 2.0. Pediatr Allergy Immunol 2023; 34 Suppl 28:e13854. [PMID: 37186333 DOI: 10.1111/pai.13854] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/05/2022] [Indexed: 05/17/2023]
Abstract
Since the discovery of immunoglobulin E (IgE) as a mediator of allergic diseases in 1967, our knowledge about the immunological mechanisms of IgE-mediated allergies has remarkably increased. In addition to understanding the immune response and clinical symptoms, allergy diagnosis and management depend strongly on the precise identification of the elicitors of the IgE-mediated allergic reaction. In the past four decades, innovations in bioscience and technology have facilitated the identification and production of well-defined, highly pure molecules for component-resolved diagnosis (CRD), allowing a personalized diagnosis and management of the allergic disease for individual patients. The first edition of the "EAACI Molecular Allergology User's Guide" (MAUG) in 2016 rapidly became a key reference for clinicians, scientists, and interested readers with a background in allergology, immunology, biology, and medicine. Nevertheless, the field of molecular allergology is moving fast, and after 6 years, a new EAACI Taskforce was established to provide an updated document. The Molecular Allergology User's Guide 2.0 summarizes state-of-the-art information on allergen molecules, their clinical relevance, and their application in diagnostic algorithms for clinical practice. It is designed for both, clinicians and scientists, guiding health care professionals through the overwhelming list of different allergen molecules available for testing. Further, it provides diagnostic algorithms on the clinical relevance of allergenic molecules and gives an overview of their biology, the basic mechanisms of test formats, and the application of tests to measure allergen exposure.
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Affiliation(s)
- Stephanie Dramburg
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christiane Hilger
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | | | - Rob C Aalberse
- Sanquin Research, Dept Immunopathology, University of Amsterdam, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Nathalie Acevedo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia, Colombia
| | - Lorenz Aglas
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Friedrich Altmann
- Department of Chemistry, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Karla L Arruda
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brasil, Brazil
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - Barbara Ballmer-Weber
- Klinik für Dermatologie und Allergologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Domingo Barber
- Institute of Applied Molecular Medicine Nemesio Diez (IMMAND), Department of Basic Medical Sciences, Facultad de Medicina, Universidad San Pablo CEU, CEU Universities, Madrid, Spain
- RETIC ARADyAL and RICORS Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University Munich, Munich, Germany
| | - Maria Beatrice Bilo
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
- Allergy Unit Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Torrette, Italy
| | - Simon Blank
- Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, Munich, Germany
| | - Philipp P Bosshard
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Heimo Breiteneder
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Helen A Brough
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Merima Bublin
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Dianne Campbell
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia, Colombia
| | - Jean Christoph Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Giorgio Celi
- Centro DH Allergologia e Immunologia Clinica ASST- MANTOVA (MN), Mantova, Italy
| | | | - Maksymilian Chruszcz
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina, USA
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Rebecca Czolk
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Janet Davies
- Queensland University of Technology, Centre for Immunology and Infection Control, School of Biomedical Sciences, Herston, Queensland, Australia
- Metro North Hospital and Health Service, Emergency Operations Centre, Herston, Queensland, Australia
| | - Nikolaos Douladiris
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Bernadette Eberlein
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University Munich, Munich, Germany
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Anna Ehlers
- Chemical Biology and Drug Discovery, Utrecht University, Utrecht, The Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Philippe Eigenmann
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Gabriele Gadermaier
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Francisca Gomez
- Allergy Unit IBIMA-Hospital Regional Universitario de Malaga, Malaga, Spain
- Spanish Network for Allergy research RETIC ARADyAL, Malaga, Spain
| | - Rebecca Grohman
- NYU Langone Health, Department of Internal Medicine, New York, New York, USA
| | - Carole Guillet
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christine Hafner
- Department of Dermatology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Robert G Hamilton
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Hauser
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Thomas Hawranek
- Department of Dermatology and Allergology, Paracelsus Private Medical University, Salzburg, Austria
| | - Hans Jürgen Hoffmann
- Institute for Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Tomona Iizuka
- Laboratory of Protein Science, Graduate School of Life Science, Hokkaido University, Sapporo, Japan
| | - Alain Jacquet
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thilo Jakob
- Department of Dermatology and Allergology, University Medical Center, Justus Liebig University Gießen, Gießen, Germany
| | - Bente Janssen-Weets
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
| | - Uta Jappe
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Borstel, Germany
- Leibniz Lung Center, Airway Research Center North (ARCN), Member of the German Center for Lung Research, Germany
- Interdisciplinary Allergy Outpatient Clinic, Dept. of Pneumology, University of Lübeck, Lübeck, Germany
| | - Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
| | - Tanja Kalic
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
- Department of Dermatology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Sandip Kamath
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Sabine Kespohl
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr- Universität Bochum, Bochum, Germany
| | - Jörg Kleine-Tebbe
- Allergy & Asthma Center Westend, Outpatient Clinic and Clinical Research Center, Berlin, Germany
| | - Edward Knol
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - André Knulst
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jon R Konradsen
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Korošec
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Annette Kuehn
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Gideon Lack
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Thuy-My Le
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Andreas Lopata
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Olga Luengo
- RETIC ARADyAL and RICORS Enfermedades Inflamatorias (REI), Madrid, Spain
- Allergy Section, Internal Medicine Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mika Mäkelä
- Division of Allergy, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Pediatric Department, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Clare Mills
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Manchester Institute of Biotechnology, The University of Manchester, Manchester, UK
| | | | - Antonella Muraro
- Food Allergy Referral Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | - Anna Nowak-Wegrzyn
- Division of Pediatric Allergy and Immunology, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, New York, USA
- Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Roni Nugraha
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Department of Aquatic Product Technology, Faculty of Fisheries and Marine Science, IPB University, Bogor, Indonesia
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
| | - Kati Palosuo
- Department of Allergology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Sarita Ulhas Patil
- Division of Rheumatology, Allergy and Immunology, Departments of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Allergy and Immunology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas Platts-Mills
- Division of Allergy and Clinical Immunology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Pascal Poncet
- Institut Pasteur, Immunology Department, Paris, France
- Allergy & Environment Research Team Armand Trousseau Children Hospital, APHP, Paris, France
| | - Ekaterina Potapova
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lars K Poulsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Christian Radauer
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Suzana Radulovic
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr- Universität Bochum, Bochum, Germany
| | - Pierre Rougé
- UMR 152 PharmaDev, IRD, Université Paul Sabatier, Faculté de Pharmacie, Toulouse, France
| | - Joaquin Sastre
- Allergy Service, Fundación Jiménez Díaz; CIBER de Enfermedades Respiratorias (CIBERES); Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Sakura Sato
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Enrico Scala
- Clinical and Laboratory Molecular Allergy Unit - IDI- IRCCS, Fondazione L M Monti Rome, Rome, Italy
| | - Johannes M Schmid
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Schmid-Grendelmeier
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - Denise Schrama
- Centre of Marine Sciences (CCMAR), Universidade do Algarve, Faro, Portugal
| | - Hélène Sénéchal
- Allergy & Environment Research Team Armand Trousseau Children Hospital, APHP, Paris, France
| | - Claudia Traidl-Hoffmann
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Marcela Valverde-Monge
- Allergy Service, Fundación Jiménez Díaz; CIBER de Enfermedades Respiratorias (CIBERES); Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Marianne van Hage
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kitty Verhoeckx
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Stefan Vieths
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - Magnus Wickman
- Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Josefina Zakzuk
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia, Colombia
| | - Paolo M Matricardi
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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Treatment of severe cow's milk allergy with omalizumab in an adult. Allergol Select 2023; 7:20-24. [PMID: 36756389 PMCID: PMC9904097 DOI: 10.5414/alx02372e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The therapy of severe food allergy so far consists mainly of allergen abstinence and emergency treatment. The use of anti-IgE antibodies represents a promising therapy. CASE REPORT We report on a 22-year-old male with severe cow's milk allergy with multiple anaphylactic reactions, known since infancy and persisting into adulthood with sometimes severe immediate-type reactions on accidental ingestion. The prick test for native whole milk was positive, the CAP-FEIA was also positive for milk protein, mare's milk, whey, sheep's milk whey as well as Bos d4, Bos d5, and Bos d8 and blue cheese; total IgE was 1,265 kU/L. The patient's history included well-controlled bronchial asthma. An off-label therapy with omalizumab (3 × 150 mg/month SC) and cetirizine 10 mg once daily was initiated. Under this therapy, we performed a double-blind oral exposure test to cow's milk in the patient after long term. Thereby 14 mL could be tolerated. After consumption of 30 mL of cow's milk, urticaria, dyspnea, and angioedema occurred. CONCLUSION Under therapy with omalizumab, an increase of the tolerance to cow's milk was shown in our patient. As a consequence, reactions during accidental consumption could be prevented.
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Wong L, Kost L, Anderson B, Long A, Sindher SB, Chinthrajah RS, Collins WJ. Transitioning from epicutaneous to oral peanut immunotherapy. FRONTIERS IN ALLERGY 2023; 4:1089308. [PMID: 36814725 PMCID: PMC9939758 DOI: 10.3389/falgy.2023.1089308] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
Introduction Epicutaneous immunotherapy (EPIT) has been tested in clinical trials for children with peanut allergy (PA) for its safety and efficacy in inducing desensitization. Aside from peanut avoidance and symptom management, oral immunotherapy (OIT) is another option for PA patients. However, OIT can be associated with adverse events and pose safety concerns to children and their caregivers. Methods This study assessed 27 children who successfully completed a peanut EPIT trial. 18 of them transitioned to peanut OIT with starting doses ranging from 10-600 mg of peanut protein. Our aim was to learn more about the EPIT to OIT experience through descriptive survey responses and to gather information that may support the sequential use of the two immunotherapies for safe and positive outcomes that may not be achieved by either alone. Results Overall, children and their caregivers had less anxiety about starting OIT after having had peanut exposure through EPIT. Most children who transitioned from EPIT to OIT had no or minor symptoms initially, with symptoms lessening later in OIT. Most were also able to maintain or increase their peanut dose over time, achieving maintenance doses of 60-2,000 mg. Discussion In comparison with current literature on OIT for PA in children, the reported symptoms appeared less severe and less prevalent in the EPIT to OIT group. However, there were 3 participants who withdrew from OIT due to the development of intolerable symptoms. This study provides initial data in support of EPIT to OIT, and larger randomized controlled trials assessing effectiveness of the two therapies together are warranted.
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Affiliation(s)
- Lauren Wong
- Sean N Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - Laurie Kost
- Sean N Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - Brent Anderson
- Sean N Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - Andrew Long
- Sean N Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - Sayantani B. Sindher
- Sean N Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - R. Sharon Chinthrajah
- Sean N Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - William J. Collins
- Sean N Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States,Division of Hospital Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States,Correspondence: William J. Collins
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Pouessel G, Lezmi G. Oral immunotherapy for food allergy: Translation from studies to clinical practice? World Allergy Organ J 2023; 16:100747. [PMID: 36816599 PMCID: PMC9932561 DOI: 10.1016/j.waojou.2023.100747] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/14/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023] Open
Abstract
Oral immunotherapy (OIT) is now recognized as an alternative active treatment to strict food avoidance in certain patients with IgE-mediated food allergy. Studies have confirmed the efficacy of OIT to desensitize children with allergy to cow's milk, eggs, and peanuts. The benefits, risks, and constraints of OIT are becoming increasingly well understood. However, there is no consensual criteria to select patients to whom OIT could be proposed, and many issues remain to address including the definitions of desensitization and long-term efficacy, the assessment of patient's experience in real life, the optimization of buildup and maintenance protocols, and the utility of multiple food OIT. The recent authorization by medical agency concerning the first medicine for peanut OIT is a step forward towards higher standardization in the practice of OIT. This article summarizes in comprehensive narrative format data on efficacy, tolerance, impact on quality of life and adverse effects of OIT and discuss elements to consider in clinical practice before starting OIT.
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Affiliation(s)
- Guillaume Pouessel
- Department of Paediatrics, CH Roubaix 59056, France,Paediatric Pneumology and Allergology Unit, CHRU Lille, 59037, France,Corresponding author. Service de Pédiatrie, Pavillon Médicochirurgical de Pédiatrie, Boulevard Lacordaire, F-59056 Roubaix, France. Fax: 0033 3 20 99 30 97
| | - Guillaume Lezmi
- Paediatric Pneumology and Allergology Unit, Children's Hospital Necker, Paris, 75013, France
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New Indications of Biological Drugs in Allergic and Immunological Disorders: Beyond Asthma, Urticaria, and Atopic Dermatitis. Biomedicines 2023; 11:biomedicines11020236. [PMID: 36830772 PMCID: PMC9953090 DOI: 10.3390/biomedicines11020236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 01/18/2023] Open
Abstract
Asthma, chronic urticaria, and atopic dermatitis are some of the most numerous allergic diseases affecting children. Recent advances in the understanding of their specific intracellular molecular pathways have led to the approval of monoclonal antibodies targeting definite inflammatory molecules in order to control symptoms and improve quality of life. Less is known about other allergic and immunologic disorders such as rhinosinusitis with nasal polyps, eosinophilic esophagitis, anaphylaxis, and food allergy undergoing allergen immunotherapy. The increasing evidence of the molecular mechanisms underlying their pathogeneses made it possible to find in children new indications for known biological drugs, such as omalizumab and dupilumab, and to develop other ones even more specific. Promising results were recently obtained, although few are currently approved in the pediatric population. In this review, we aim to provide the latest evidence about the role, safety, and efficacy of biologic agents to treat allergic and immunologic diseases in children.
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Efficacy and safety of omalizumab in adult patients with wheat-dependent exercise-induced anaphylaxis: Reduction of in vitro basophil activation and allergic reaction to wheat. Allergol Int 2023:S1323-8930(22)00142-3. [PMID: 36641300 DOI: 10.1016/j.alit.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/17/2022] [Accepted: 11/30/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In patients with wheat-dependent exercise-induced anaphylaxis (WDEIA), anaphylactic shock occurs frequently, therefore avoidance of wheat products is recommended. We aimed to evaluate efficacy and safety of long-term omalizumab treatment for adult patients with WDEIA. METHODS In this phase 2, multicentre single-arm trial, 20 adult patients with WDEIA were enrolled (UMIN 000019250). All patients were administered 150-600 mg of omalizumab subcutaneously and evaluations (basophil activation and blood examination) were performed at regular intervals during administration period (0-48 weeks) and observation period (48-68 weeks). Primary endpoint was proportion of the patients who achieved a basophil activation rate below 10% with fractionated wheat preparations, and secondary endpoint was proportion of the patients with no allergic reactions after wheat products ingestion. RESULTS During the omalizumab treatment, more than 80% of the patients achieved the basophil activation rate less than 10% against all fractionated wheat preparations, and 68.8% of the patients who achieved the primary endpoint experienced no allergic reaction. During the observation period, the proportion of the patients who achieved a basophil activation rate below 10% decreased gradually, and the proportion of patients with positive allergic reactions increased gradually thereafter and reached maximum of 46.7%. Severe adverse events were not observed during the study. CONCLUSIONS Long-term omalizumab treatment is safe and effective for adult patients with WDEIA when assessed by basophil activation rate with wheat allergens as well as allergic reactions after lifting of restrictions on wheat intake. However, this is not enough to achieve desensitization.
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Dantzer JA, Kim EH, Chinthrajah RS, Wood RA. Treatment for food allergy: Current status and unmet needs. J Allergy Clin Immunol 2023; 151:1-14. [PMID: 35998790 DOI: 10.1016/j.jaci.2022.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 02/04/2023]
Abstract
The treatment of food allergy has traditionally relied on avoidance of the offending food(s) and use of emergency medications in the event of accidental exposures. However, this long-standing paradigm is beginning to shift, as a variety of treatment approaches have been and are being developed. This report provides an overview of the past, present, and future landscape of interventional clinical trials for the treatment of food allergy. It focuses on specific issues related to participant characteristics, protocol design, and study end points in the key clinical trials in the literature and examine how differences between studies may impact the clinical significance of the study results. Recommendations are provided for the optimization of future trial designs and focus on specific unmet needs in this rapidly evolving field.
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Affiliation(s)
- Jennifer A Dantzer
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Edwin H Kim
- Division of Pediatric Allergy and Immunology and University of North Carolina Food Allergy Initiative, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - R Sharon Chinthrajah
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research, and Department of Pediatrics, Stanford University, Stanford, Calif
| | - Robert A Wood
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md.
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35
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Cafarotti A, Giovannini M, Begìn P, Brough HA, Arasi S. Management of IgE-mediated food allergy in the 21st century. Clin Exp Allergy 2023; 53:25-38. [PMID: 36200952 PMCID: PMC10092460 DOI: 10.1111/cea.14241] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/15/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023]
Abstract
The 21st century has seen the propulsion of research in the field of food allergy, which has driven real changes in the clinical approach. Allergen immunotherapy has been recommended for the active management of food allergy. Data have shown promising additional methods of treatment, including biologics. Efforts have been devoted to the risk stratification of food allergy and the standardization of the assessment of food-allergic severity. Alternative routes of administration of epinephrine are under investigation to minimize any mechanical issue and the fear of injections. Evidence-based guidelines have been published by the main international societies in the field of anaphylaxis and food allergy management and new updates are in preparation. In the coming years, treatment options that are currently in pre-clinical or early clinical evaluation will hopefully lead to safe and effective disease-modifying therapies for food allergy in clinical practice. The identification of reliable biomarkers and the standardization of definitions and measurement approaches, alongside a shared decision-making with patients and families, will be key for the development of personalized care and to help minimize the substantial burden of food allergy.
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Affiliation(s)
- Arianna Cafarotti
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Philippe Begìn
- Allergy, Immunology and Rheumatology Division, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.,Allergy and Clinical Immunology Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' NHS Foundation Hospital, London, UK.,Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Stefania Arasi
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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36
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Weiler CR, Schrijvers R, Golden DBK. Anaphylaxis: Advances in the Past 10 Years. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:51-62. [PMID: 36162799 DOI: 10.1016/j.jaip.2022.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 01/11/2023]
Abstract
In the past 10 years, anaphylaxis has grown into its own special area of study within Allergy-Immunology, both at the bench and at the bedside. This review focuses on some of the most clinically relevant advances over the past decade. These include simplified and more inclusive diagnostic criteria for adults and children, uniform definition of biphasic anaphylaxis, and improved systems for objective severity grading. Studies reported in the past decade have led to improved understanding of normal and abnormal regulation of mast cell function, translating into better diagnostic and therapeutic approaches to patients with anaphylaxis. Research has provided improved recognition and treatment of mast cell disorders and has identified a new condition, hereditary α-tryptasemia, that may impact anaphylactic syndromes. We have learned to recognize new causes (α-gal), new pathways (Mas-related G protein-coupled receptor-X2), and many risk factors for severe anaphylaxis. The stability of epinephrine in autoinjectors was reported to be very good for several years after the labeled expiry date, and it can tolerate freezing and thawing. Repeated and prolonged exposure to excessive heat leads to degradation of epinephrine activity. New treatments to prevent severe anaphylaxis have been described, using new ways to block the IgE receptor or modulate intracellular signaling pathways.
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Affiliation(s)
| | - Rik Schrijvers
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium
| | - David B K Golden
- Division of Allergy/Clinical Immunology, Johns Hopkins School of Medicine, Baltimore, Md.
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Turner PJ, Tang MLK, Wood RA. Food Allergy and Eosinophilic Gastrointestinal Diseases-The Next 10 Years. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:72-78. [PMID: 36371062 DOI: 10.1016/j.jaip.2022.10.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022]
Abstract
The first report of food allergy desensitization was in 1908, at least a few years before the first published description of a diagnostic test for food allergy. It has taken almost 100 years for food allergy to move from passive management of avoidance to a more proactive approach including prevention and treatment. In parallel, this has been matched by recognition of eosinophil gastrointestinal diseases, which were first described in the 1980s (although eosinophilic esophagitis was itself described in 1978). As we celebrate 10 years of The Journal of Allergy and Clinical Immunology: In Practice, we take the opportunity to look into the future and speculate how our practice may develop over the next decade.
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Affiliation(s)
- Paul J Turner
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia
| | - Robert A Wood
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
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Sakamoto D, Hamada S, Kobayashi Y, Shimono M, Shimamura A, Kanda A, Asako M, Iwai H. Omalizumab is effective for a patient with pollen-food allergy syndrome who experienced intractable lip edema. Auris Nasus Larynx 2022:S0385-8146(22)00229-2. [PMID: 36581536 DOI: 10.1016/j.anl.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/18/2022] [Accepted: 12/02/2022] [Indexed: 12/28/2022]
Abstract
Pollen-food allergy syndrome (PFAS) is an immunoglobulin E (IgE)-mediated allergic reaction caused when patients with pollen allergy ingest food having cross-reactivity with pollen. To date, no effective treatment method for this has been established. Here we report the case of a patient with PFAS who experienced lip edema, causing difficulties in treatment. This report describes the case of a 12-year-old boy with perennial allergic rhinitis since the age of 8 years. After ingesting fresh fruits and raw vegetables at the age of 11 years, he started to experience lip edema repeatedly. Thus, the patient was referred to our department. Based on the results of serum antigen-specific IgE, prick-to-prick, and allergen component tests, he was diagnosed with PFAS. He has been instructed to avoid causative food. Furthermore, the treatment using an antihistamine and antileukotriene receptor antagonist was initiated for pollen allergy. Sublingual immunotherapy (SLIT) for Japanese cedar pollen was initiated because the patient experienced severe nasal allergy symptoms during the dispersal season of this pollen. These treatments alleviated the nasal symptoms; however, the lip edema persisted. Omalizumab administration improved the lip edema. The combination of SLIT and omalizumab may be an effective treatment option for patients with PFAS.
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Affiliation(s)
- Daiki Sakamoto
- Department of Otorhinolaryngology, Head and neck surgery, Kansai Medical University, Osaka, Japan
| | - Satoko Hamada
- Department of Otorhinolaryngology, Head and neck surgery, Kansai Medical University, Osaka, Japan; Allergy center, Kansai Medical University, Osaka, Japan.
| | - Yoshiki Kobayashi
- Department of Otorhinolaryngology, Head and neck surgery, Kansai Medical University, Osaka, Japan; Allergy center, Kansai Medical University, Osaka, Japan
| | - Masami Shimono
- Department of Otorhinolaryngology, Head and neck surgery, Kansai Medical University, Osaka, Japan
| | - Akihiro Shimamura
- Department of Otorhinolaryngology, Head and neck surgery, Kansai Medical University, Osaka, Japan
| | - Akira Kanda
- Department of Otorhinolaryngology, Head and neck surgery, Kansai Medical University, Osaka, Japan; Allergy center, Kansai Medical University, Osaka, Japan
| | - Mikiya Asako
- Department of Otorhinolaryngology, Head and neck surgery, Kansai Medical University, Osaka, Japan; Allergy center, Kansai Medical University, Osaka, Japan
| | - Hiroshi Iwai
- Department of Otorhinolaryngology, Head and neck surgery, Kansai Medical University, Osaka, Japan
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Zuberbier T, Wood RA, Bindslev-Jensen C, Fiocchi A, Chinthrajah RS, Worm M, Deschildre A, Fernandez-Rivas M, Santos AF, Jaumont X, Tassinari P. Omalizumab in IgE-Mediated Food Allergy: A Systematic Review and Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 11:1134-1146. [PMID: 36529441 DOI: 10.1016/j.jaip.2022.11.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/14/2022] [Accepted: 11/26/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND A growing number of studies have shown encouraging results with omalizumab (OMA) as monotherapy and as an adjunct to oral immunotherapy (OMA+OIT) in patients with single/multiple food allergies. OBJECTIVES To evaluate the efficacy and safety of OMA or OMA+OIT in patients with immunoglobulin E (IgE)-mediated food allergy. METHODS An extensive literature search (inception to December 31, 2020) was performed to identify randomized, controlled, and observational studies that assessed OMA as monotherapy or OMA+OIT in patients with IgE-mediated food allergy. The outcomes were an increase in tolerated dose of foods, successful desensitization, sustained unresponsiveness, immunological biomarkers, severity of allergic reactions to food, quality of life (QoL), and safety. A P less than .05 was considered significant. RESULTS In total, 36 studies were included. The OMA monotherapy (vs pre-OMA) significantly increased the tolerated dose of multiple foods; increased the threshold of tolerated dose for milk, egg, wheat, and baked milk; improved QoL; and reduced food-induced allergic reactions (all P < .01). The OMA+OIT significantly increased the tolerated dose of multiple foods (vs placebo and pre-OMA), desensitization (vs placebo+OIT and pre-OMA) (all P ≤ .01), and improved QoL (vs pre-OMA) and immunoglobulin G4 levels (both P < .01). No major safety concerns were identified. CONCLUSIONS In IgE-mediated food allergy, OMA can help patients consume multiple foods and allow for food dose escalation. As an adjunct to OIT, OMA can also support high-dose desensitization and higher maintenance doses. Further studies are warranted to empirically evaluate the effect of OMA and confirm these findings.
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Affiliation(s)
- Torsten Zuberbier
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; Institute for Allergology, Charité - University Medicine Berlin, Corporate Member of Freie University of Berlin and Humboldt University of Berlin, Berlin, Germany.
| | - Robert A Wood
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Carsten Bindslev-Jensen
- Odense Research Centre for Anaphylaxis, Odense University Hospital, Odense, Denmark; Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Alessandro Fiocchi
- Translational Research in Paediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - R Sharon Chinthrajah
- Sean N. Parker Centre for Allergy and Asthma Research, Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Division of Allergy, Immunology and Rheumatology, Stanford University, Stanford, Calif
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité - University Medicine, Berlin, Germany
| | - Antoine Deschildre
- CHU Lille, Pediatric Pulmonology and Allergy Unit, Jeanne de Flandre Hospital, University of Nord de France, Lille, France
| | - Montserrat Fernandez-Rivas
- Allergy Department, Hospital Clinico San Carlos, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK; Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, UK; Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
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Abstract
PURPOSE OF REVIEW To highlight the current evidence on food desensitization in children with food allergy. RECENT FINDINGS Food Allergen Specific Immunotherapy (FA-AIT) is currently recognised as a treatment option for treating children with allergy at least to the main common foods (i.e. milk, egg and peanut). The oral route of administration has been proven to be the most effective in achieving desensitisation. Efforts are devoted to overcome the current unmet needs mainly related to safety issues and long-term efficacy, as well as adherence to the treatment and improvement of health-related quality of life. In this perspective, alternative routes of administration and adjunctive treatments are under investigation. SUMMARY The future of food allergy management is a personalised approach based on a shared decision-making that takes into account the needs of patients and families. Health professionals will be able to offer multiple treatment options, including FA-AIT with adjunctive or alternative therapies. Thus, patients should be correctly identified, using validated predictive factors, in order to select appropriate candidates for these therapies.
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Vers une prise en charge globale et personnalisée de l’allergie alimentaire. REVUE FRANÇAISE D'ALLERGOLOGIE 2022. [DOI: 10.1016/s1877-0320(22)00489-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Actualités dans l’immunothérapie orale pour les allergies alimentaires. REVUE FRANÇAISE D'ALLERGOLOGIE 2022. [DOI: 10.1016/s1877-0320(22)00488-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Wood RA, Chinthrajah RS, Rudman Spergel AK, Babineau DC, Sicherer SH, Kim EH, Shreffler WG, Jones SM, Leung DY, Vickery BP, Bird JA, Spergel JM, Kulis M, Iqbal A, Kaufman D, Umetsu DT, Ligueros-Saylan M, Uddin A, Fogel RB, Lussier S, Mudd K, Poyser J, MacPhee M, Veri M, Davidson W, Hamrah S, Long A, Togias A. Protocol design and synopsis: Omalizumab as Monotherapy and as Adjunct Therapy to Multiallergen OIT in Children and Adults with Food Allergy (OUtMATCH). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2022; 1:225-232. [PMID: 37779534 PMCID: PMC10509974 DOI: 10.1016/j.jacig.2022.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/21/2022] [Accepted: 05/24/2022] [Indexed: 10/03/2023]
Abstract
Background Food allergy is common and causes substantial morbidity and even mortality. Safe and effective treatments for food allergy would therefore be highly desirable, especially for individuals with multiple food allergies. Objectives Our aim was to describe a phase 3 study on treatment of patients with multiple food allergies with omalizumab. Methods The study was developed as a collaboration between the Consortium for Food Allergy Research, the National Institute of Allergy and Infectious Diseases, and 2 industry sponsors (Genentech and Novartis). Results The study is currently under way, enrolling participants from age 1 year to age 55 years who are allergic to peanut and at least 2 other foods (including milk, egg, wheat, cashew, hazelnut, and walnut). The study is designed to address 3 major questions. First, stage 1 will study the potential value of omalizumab for the treatment of patients with peanut allergy and at least 2 other common food allergens. Second, stage 2 will directly compare treatment of patients with multifood allergies using omalizumab as monotherapy versus treatment with omalizumab-facilitated multiallergen oral immunotherapy in which omalizumab is used as an adjunctive treatment. Third, stage 3 will address the longer-term outcomes following these treatment approaches, including the introduction of dietary forms of the study foods to induce or maintain desensitization. Conclusions This phase 3 study will provide important information on the potential of omalizumab to treat patients with multiple food allergies.
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Affiliation(s)
- Robert A. Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - R. Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif
| | - Amanda K. Rudman Spergel
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | | | - Scott H. Sicherer
- Division of Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Edwin H. Kim
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Wayne G. Shreffler
- Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Stacie M. Jones
- University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Ark
| | | | - Brian P. Vickery
- Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Ga
| | - J. Andrew Bird
- Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Jonathan M. Spergel
- Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Michael Kulis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | | | | | - Alkaz Uddin
- Novartis Pharmaceuticals, Basel, Switzerland
| | | | | | - Kim Mudd
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Julian Poyser
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Martin MacPhee
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Maria Veri
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Wendy Davidson
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Sanaz Hamrah
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Andrew Long
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif
| | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - OUtMATCH study team
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
- Rho Federal Systems Division, Chapel Hill, NC
- Division of Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
- Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
- University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Ark
- Department of Pediatrics, National Jewish Health, Denverr, Colo
- Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Ga
- Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex
- Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
- Genentech/Roche, South San Francisco, Calif
- Novartis Pharmaceuticals, Basel, Switzerland
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Baloh CH, Huffaker MF, Laidlaw T. Biomarkers and mechanisms of tolerance induction in food allergic patients drive new therapeutic approaches. Front Immunol 2022; 13:972103. [PMID: 36263023 PMCID: PMC9574092 DOI: 10.3389/fimmu.2022.972103] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/12/2022] [Indexed: 12/01/2022] Open
Abstract
Immunotherapy for food-allergic patients has been effective in inducing desensitization in some populations, but long-term tolerance has remained an elusive target. A challenge facing our field is how to differentiate immune markers that are impacted by immunotherapy from those that are critical biomarkers of tolerance. Data from recent clinical trials have identified several biomarkers and mechanisms for achieving tolerance. These biomarkers include younger age, lower food-specific IgE, lower food component-specific IgE, specific linear epitope profiles, and subsets of food-specific CD4+ T cells. Additional biomarkers under investigation for their relevance in tolerance induction include TCR repertoires, gastrointestinal and skin microbiome, and local tissue immunity. This mini-review highlights recent advances in understanding biomarkers and mechanisms of tolerance induction in food immunotherapy and how these are influencing clinical trial development.
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Affiliation(s)
- Carolyn H. Baloh
- Immune Tolerance Network, Benaroya Research Institute at Virginia Mason, Seattle, WA, United States
- Department of Medicine, Harvard Medical School, the Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA, United States
- *Correspondence: Carolyn H. Baloh,
| | - Michelle F. Huffaker
- Immune Tolerance Network, University of California San Francisco, San Francisco, CA, United States
| | - Tanya Laidlaw
- Immune Tolerance Network, Benaroya Research Institute at Virginia Mason, Seattle, WA, United States
- Department of Medicine, Harvard Medical School, the Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA, United States
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Tang L, Yu Y, Pu X, Chen J. Oral immunotherapy for Immunoglobulin E‐mediated cow's milk allergy in children: A systematic review and meta analysis. Immun Inflamm Dis 2022; 10:e704. [PMID: 36169249 PMCID: PMC9476891 DOI: 10.1002/iid3.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/11/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022] Open
Abstract
Backgound Cow's milk allergy (CMA) is the most common allergy in infants that decreases the quality of life of patients and their families. Standard treatment for CMA is the strict avoidance of milk; new treatment strategies such as oral immunotherapy (OIT) have been sought for patients with CMA. We aimed to assess the clinical efficacy and safety of OIT in the treatment of children with immunoglobulin E‐mediated CMA (IMCMA). Methods We searched all randomized controlled trials in which OIT is used to treat children with IMCMA from five international electronic databases. We estimated a pooled risk ratio (RR) for each outcome using a Mantel–Haenzel fixed‐effects model if statistical heterogeneity was low. Results Eleven studies were chosen for meta‐analysis, including a total of 469 children (242 OITs, 227 controls). One hundred and seventy‐six patients (72.7%) in the OIT were desensitized compared with 49 patients (21.6%) in the control group (RR: 7.35, 95% confidence interval (CI): 2.82–19.13, p < .0001). The desensitization effect of OIT was particularly significant in children over 3 years old (RR: 18.05, 95% CI: 6.48–50.26, p < .00001). Although adverse effects were common, they usually involved mild reactions, but epinephrine use was more common in the OIT group (RR: 7.69, 95% CI: 2.16–27.33, p < .002). Conclusion OIT can lead to desensitization in the majority of individuals with IMCMA, especially in patients over 3 years old. A major problem of OIT is the frequency of adverse events, although most are mild. OIT may be an alternative treatment in the future.
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Affiliation(s)
- Lujing Tang
- Department of Gastroenterology, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Yu Yu
- Department of Gastroenterology, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
| | - Xiangyuan Pu
- Department of Cardiology First Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China
| | - Jie Chen
- Department of Gastroenterology, The Children's Hospital, Zhejiang University School of Medicine National Clinical Research Center for Child Health Hangzhou China
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Wood RA, Chinthrajah RS, Eggel A, Bottoli I, Gautier A, Woisetschlaeger M, Tassinari P, Altman P. The rationale for development of ligelizumab in food allergy. World Allergy Organ J 2022; 15:100690. [PMID: 36185545 PMCID: PMC9483652 DOI: 10.1016/j.waojou.2022.100690] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Food allergy (FA) is a growing healthcare problem worldwide and the rising prevalence in many countries can be attributed to lifestyle, environmental, and nutritional changes. Immunoglobulin E (IgE)-mediated FA is the most common form of FA affecting approximately 3%-10% of adults and 8% of children across the globe. Food allergen-induced immediate hypersensitivity reactions mediated by IgE and high-affinity IgE receptor (FcεRI) complexes on mast cells and basophils are a major hallmark of the disease. FA can affect several aspects of health-related quality of life and impose a substantial financial burden on patients and healthcare systems. Although currently there is one United States Food and Drug Administration (FDA) and European Medicines Agency (EMA)-approved treatment for peanut allergy (Palforzia), the main treatment approaches are based on allergen avoidance and symptom management. Thus, there is an urgent need for more effective and ideally disease-modifying strategies. Given the crucial role of IgE in FA, anti-IgE monoclonal antibodies are considered promising therapeutic agents. Talizumab was the first humanized anti-IgE antibody to demonstrate substantial protection against allergic reactions from accidental peanut exposure by substantially increasing the peanut reactivity threshold on oral food challenge. However, development of talizumab was discontinued and further trials were performed using omalizumab. In double-blind, Phase 2, placebo-controlled trials in patients with multi-FAs, sustained dosing with omalizumab, or omalizumab in combination with oral immunotherapy, enabled rapid desensitization to multiple trigger foods. In this review, we describe the development of ligelizumab (a derivative of talizumab), a next generation, humanized monoclonal anti-IgE antibody, its existing clinical evidence, and its potential in the management of FA. When compared with omalizumab, ligelizumab binds with ∼88-fold higher affinity for human IgE and recognizes a different epitope that substantially overlaps with the binding site of FcεRI. These properties translate into a high potency to block IgE/FcεRI signaling in both in vitro and in vivo studies. Given its efficient suppression of IgE levels, good safety and pharmacokinetic/pharmacodynamic profile, ligelizumab clearly warrants further studies for the potential management of FA.
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Affiliation(s)
- Robert A Wood
- Division of Allergy & Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA
| | - Alexander Eggel
- Department of BioMedical Research, University of Bern, Bern, Switzerland.,Department of Rheumatology and Immunology, University Hospital Bern, Bern, Switzerland
| | | | | | | | | | - Pablo Altman
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guideline update - XIII - Oral immunotherapy for CMA - Systematic review. World Allergy Organ J 2022; 15:100682. [PMID: 36185550 PMCID: PMC9474924 DOI: 10.1016/j.waojou.2022.100682] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/07/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Allergy to cow's milk is the most common food allergy in infants and it is usually outgrown by 5 years of age. In some individuals it persists beyond early childhood. Oral immunotherapy (OIT, oral desensitization, specific oral tolerance induction) has been proposed as a promising therapeutic strategy for persistent IgE-mediated cow's milk allergy. We previously published the systematic review of OIT for cow's milk allergy (CMA) in 2010 as part of the World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines. Objective To systematically synthesize the currently available evidence about OIT for IgE-mediated CMA and to inform the updated 2022 WAO guidelines. Methods We searched the electronic databases including PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and the websites of selected allergy organizations. We included all studies irrespective of the language of the original publication. The last search was conducted in February 2021. We registered the protocol on Open Science Framework (10.17605/OSF.IO/AH2DT). Results We identified 2147 unique records published between 2010 and 2021, including 13 randomized trials and 109 observational studies addressing cow's milk OIT. We found low-certainty evidence that OIT with unheated cow's milk, compared to elimination diet alone, increased the likelihood of being able to consume ≥150 ml of cow's milk in controlled settings (risk ratio (RR): 12.3, 95% CI: 5.9 to 26.0; risk difference (RD): 25 more per 100, 95% CI 11 to 56) as well as accidently ingest a small amount (≥5 ml) of cow's milk (RR: 8.7, 95% CI: 4.7 to 16.1; RD: 25 more per 100, 95% CI 12 to 50). However, 2–8 weeks after discontinuation of a successful OIT, tolerance of cow's milk persisted in only 36% (range: 20%–91%) of patients. OIT increased the frequency of anaphylaxis (rate ratio: 60.0, 95% CI 15 to 244; rate difference 5 more anaphylactic reactions per 1 person per year, 95% CI: 4 to 6; moderate evidence) and the frequency of epinephrine use (rate ratio: 35.2, 95% CI: 9 to 136.5; rate difference 268 more events per 100 person-years, 95% CI: 203 to 333; high certainty). OIT also increased the risk of gastrointestinal symptoms (RR 6.9, 95% CI 1.6–30.9; RD 28 more per 100, CI 3 to 100) and respiratory symptoms (RR 49.0, 95% CI 3.12–770.6; RD 77 more per 100, CI 62 to 92), compared with avoidance diet alone. Single-arm observational studies showed that on average 6.9% of OIT patients (95% CI: 3.8%–10%) developed eosinophilic esophagitis (very low certainty evidence). We found 1 trial and 2 small case series of OIT with baked milk. Conclusions Moderate certainty evidence shows that OIT with unheated cow's milk in patients with IgE-mediated CMA is associated with an increased probability of being able to drink milk and, at the same time, an increased risk of serious adverse effects.
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Weimer DS, Demory Beckler M. Underlying Immune Mechanisms Involved in Cow’s Milk-Induced Hypersensitivity Reactions Manifesting as Atopic Dermatitis. Cureus 2022; 14:e27604. [PMID: 36059314 PMCID: PMC9433788 DOI: 10.7759/cureus.27604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022] Open
Abstract
Of the many symptoms associated with cow’s milk allergy (CMA), many populations face the burden of the appearance or worsening of atopic dermatitis (AD) when consuming milk products. Due to the prevalence and possible severity of symptoms, it is important to understand the underlying immune mechanisms involved in such reactions. Hypersensitivity reactions are exaggerated immune responses to often benign antigens, many times resulting in a cascade of pro-inflammatory processes. Of the four major types, type I and IV are of most relevance when considering atopic dermatitis worsened by cow’s milk. Considered a “true allergy,” type I (immediate) hypersensitivity reactions occur within hours after secondary exposure to an allergen and are primarily driven by antibodies and humoral immune responses. On the contrary, type IV (delayed) hypersensitivity reactions are driven by cell-mediated responses involving T-cell activation. Due to the array of symptoms induced by these complex reactions, it is imperative to diagnose early and treat appropriately. In this literature review, we aim to highlight the primary underlying immune contributors to hypersensitivity reactions, discuss AD as a manifestation of hypersensitivity reactions to cow’s milk, and consider current and future treatment options for combatting hypersensitivities manifesting as AD.
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Arasi S, Cafarotti A, Fiocchi A. Cow's milk allergy. Curr Opin Allergy Clin Immunol 2022; 22:181-187. [PMID: 35266897 DOI: 10.1097/aci.0000000000000823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To highlight the most recent insights on cow's milk allergy (CMA), its treatment, and management. RECENT FINDINGS CMA is one of the most common food allergies among children. Burdened by the risk for fatal reaction, CMA may imply also a severe impairment of health-related quality of life at individual and family level as well as well as individual and societal costs. The updated Diagnosis and Rationale for Action against Cow's Milk Allergy series is going to provide a series of manuscripts that will offer a comprehensive state-of-the-art specifically on CMA, including international evidence-based recommendations. The current results from randomized clinical trials highlight that oral immunotherapy may be effective by itself in providing desensitization. Preliminary data suggest that biologicals such as omalizumab may be able to increase the threshold of reactivity to milk or several foods (if multiple food allergies) without requiring allergen exposure. Breastfeeding is the first choice for infants with CMA. Extensively hydrolyzed formula and amino-acid formula are valid alternatives and may be particularly helpful when eliminating multiple foods, with severe complex gastrointestinal food allergies, eosinophilic esophagitis, severe eczema, or symptoms while exclusively breastfeeding. Heed is needed to ensure the formula is nutritionally sufficient. Due to a high degree of cross-reactivity with cow's milk proteins and risk for allergic reactions, goats' milk or other mammals' milk should not be used. SUMMARY The adoption and implementation of evidence-based recommendations may guide a proper diagnostics and management and awaited advances in knowledge will allow the development of a personalized treatment tailored on the specific CMA patient's profile.
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Affiliation(s)
- Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Sindher SB, Kumar D, Cao S, Purington N, Long A, Sampath V, Zedeck SS, Woch MA, Garcia‐Lloret M, Chinthrajah RS. Phase 2, randomized multi oral immunotherapy with omalizumab 'real life' study. Allergy 2022; 77:1873-1884. [PMID: 35014049 DOI: 10.1111/all.15217] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Oral immunotherapy (OIT) is frequently discontinued due to adverse events (AEs) and current data suggests that lowering OIT doses can minimize severity and frequency of AEs. However, the minimum daily dose that can enable desensitization and induce immune responses in multi-food OIT (mOIT) is unknown. METHODS Participants aged 2-25 years with multi-food allergies were pretreated with fixed-dose omalizumab (150 mg, 3 doses, every 4 weeks), and randomized 1:1 to receive mOIT to a total maintenance dose of either 300 or 1200 mg total protein, (total dose includes at least two and up to a max of five allergens) and then transitioned to real-food protein equivalents after 18 weeks of treatment. The primary endpoint was the proportion of subjects with increases in IgG4/IgE ratio of at least 2 allergens by ≥25% from baseline after 18 weeks of therapy. The primary efficacy and safety analyses were done in the intention-to-treat population. RESULTS Sixty participants were enrolled across two sites. Seventy percent of participants in both arms showed changes in sIgG4/sIgE ratio in at least 2 allergens with no difference between the treatment groups (OR [95% CI] = 1.00 [0.29, 3.49]). Overall, there were no differences in AEs between the 300 and 1200 mg groups (19% vs. 17%, p = .69), respectively. CONCLUSIONS Our data suggest that plasma marker changes are induced early, even at a total protein dose of 300 mg inclusive of multiple allergens when mOIT is combined with fixed-dose omalizumab. Identification of optimal mOIT dosing with adjunct omalizumab is needed for the long-term success of OIT. TRIAL REGISTRATION ClinicalTrials.gov (NCT03181009).
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Affiliation(s)
- Sayantani B. Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
- Division of Pulmonary and Critical Care Medicine Stanford University Stanford California USA
| | - Divya Kumar
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
- Division of Pulmonary and Critical Care Medicine Stanford University Stanford California USA
| | - Shu Cao
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
- Division of Pulmonary and Critical Care Medicine Stanford University Stanford California USA
| | - Natasha Purington
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
- Quantitative Sciences Unit Stanford University Stanford California USA
| | - Andrew Long
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
- Division of Pulmonary and Critical Care Medicine Stanford University Stanford California USA
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
- Division of Pulmonary and Critical Care Medicine Stanford University Stanford California USA
| | - Stacey S. Zedeck
- University of California Los Angeles California USA
- Department of Pediatrics Division of Immunology Allergy, and Rheumatology Los Angeles California USA
| | - Margaret A. Woch
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
| | - Maria Garcia‐Lloret
- University of California Los Angeles California USA
- Department of Pediatrics Division of Immunology Allergy, and Rheumatology Los Angeles California USA
| | - Rebecca Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
- Division of Pulmonary and Critical Care Medicine Stanford University Stanford California USA
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