Asia Pac Allergy.  2014 Oct;4(4):257-260. 10.5415/apallergy.2014.4.4.257.

Successful management of severe cow's milk allergy with omalizumab treatment and CD-sens monitoring

Affiliations
  • 1Department of Clinical Science and Education, Södersjukhuset, Centre for Allergy Research, Karolinska Institutet and Sach's Children's Hospital, Södersjukhuset, 118 83 Stockholm, Sweden.
  • 2Department of Women's and Children's Health, Uppsala University Hospital, 751 85 Uppsala, Sweden.
  • 3Department of Medicine, Clinical Immunology and Allergy Unit, Karolinska Institutet and University Hospital, 171 76 Stockholm, Sweden. anna.nopp@ki.se

Abstract

Food allergy is common in children and young adults and may be difficult to diagnose and is at present treated with avoidance of the food in question. The aim of this report is to share our clinical experiences monitoring omalizumab treatment by basophil allergen threshold sensitivity, CD-sens. Five children, 6-16 years of age, with a severe milk allergy including episodes of anaphylaxis and IgE-antibodies, between 30 and 160 kU(A)/L to casein and alpha-lactalbumin (milk proteins), were treated with omalizumab. CD-sens, was tested prior to and after 4 months of omalizumab and if turned negative, it was followed by an oral milk challenge. All children became negative in CD-sens and had a negative milk challenge, but one child required doubling of the omalizumab dose to achieve a negative CD-sens before a challenge was done. Omalizumab appears useful in treatment of severe food allergy, e.g., anaphylaxis to milk, and CD-sens monitoring may decide when and how to perform a food challenge.

Keyword

Basophil; Food hypersensitivity; Anaphylaxis; Child; Omalizumab

MeSH Terms

Anaphylaxis
Basophils
Caseins
Child
Food Hypersensitivity
Humans
Lactalbumin
Milk Hypersensitivity*
Milk*
Omalizumab*
Young Adult
Caseins
Lactalbumin
Omalizumab

Cited by  1 articles

In the memory of Professor Felicidad Cua-Lim
Yoon-Seok Chang
Asia Pac Allergy. 2014;4(4):185-186.    doi: 10.5415/apallergy.2014.4.4.185.


Reference

1. Burks AW, Tang M, Sicherer S, Muraro A, Eigenmann PA, Ebisawa M, Fiocchi A, Chiang W, Beyer K, Wood R, Hourihane J, Jones SM, Lack G, Sampson HA. ICON: food allergy. J Allergy Clin Immunol. 2012; 129:906–920.
Article
2. Glaumann S, Nopp A, Johansson SG, Borres MP, Nilsson C. Oral peanut challenge identifies an allergy but the peanut allergen threshold sensitivity is not reproducible. PLoS One. 2013; 8:e53465.
Article
3. Nopp A, Johansson SG, Ankerst J, Bylin G, Cardell LO, Gronneberg R, Irander K, Palmqvist M, Oman H. Basophil allergen threshold sensitivity: a useful approach to anti-IgE treatment efficacy evaluation. Allergy. 2006; 61:298–302.
Article
4. Dahlen B, Nopp A, Johansson SG, Eduards M, Skedinger M, Adedoyin J. Basophil allergen threshold sensitivity, CD-sens, is a measure of allergen sensitivity in asthma. Clin Exp Allergy. 2011; 41:1091–1097.
5. Glaumann S, Nopp A, Johansson SG, Rudengren M, Borres MP, Nilsson C. Basophil allergen threshold sensitivity, CD-sens, IgE-sensitization and DBPCFC in peanut-sensitized children. Allergy. 2012; 67:242–247.
Article
6. Rafi A, Do LT, Katz R, Sheinkopf LE, Simons CW, Klaustermeyer W. Effects of omalizumab in patients with food allergy. Allergy Asthma Proc. 2010; 31:76–83.
Article
7. Lieberman JA, Chehade M. Use of omalizumab in the treatment of food allergy and anaphylaxis. Curr Allergy Asthma Rep. 2013; 13:78–84.
Article
8. Muraro A, Roberts G, Clark A, Eigenmann PA, Halken S, Lack G, Moneret-Vautrin A, Niggemann B, Rance F. EAACI Task Force on Anaphylaxis in Children. The management of anaphylaxis in childhood: position paper of the European academy of allergology and clinical immunology. Allergy. 2007; 62:857–871.
Article
9. Komjölksprovokation [Internet]. Swedish Pediatric Society, Section of Allergy;2011. cited 2014 Jun 1. Available from: http://www.barnallergisektionen.se/stenciler_nya06/c6%20fodoamnesprov.pdf.
10. Johansson SG, Nopp A, Oman H, Ankerst J, Cardell LO, Gronneberg R, Matsols H, Rudblad S, Strand V, Stalenheim G. The size of the disease relevant IgE antibody fraction in relation to 'total-IgE' predicts the efficacy of anti-IgE (Xolair) treatment. Allergy. 2009; 64:1472–1477.
11. Lafeuille MH, Gravel J, Zhang J, Gorsh B, Figliomeni M, Lefebvre P. Association between consistent omalizumab treatment and asthma control. J Allergy Clin Immunol Pract. 2013; 1:51–57.
Article
12. Nopp A, Cardell LO, Johansson SG, Oman H. CD-sens: a biological measure of immunological changes stimulated by ASIT. Allergy. 2009; 64:811–814.
Article
13. Nadeau KC, Schneider LC, Hoyte L, Borras I, Umetsu DT. Rapid oral desensitization in combination with omalizumab therapy in patients with cow's milk allergy. J Allergy Clin Immunol. 2011; 127:1622–1624.
Article
14. Anagnostou K, Islam S, King Y, Foley L, Pasea L, Bond S, Palmer C, Deighton J, Ewan P, Clark A. Assessing the efficacy of oral immunotherapy for the desensitisation of peanut allergy in children (STOP II): a phase 2 randomised controlled trial. Lancet. 2014; 383:1297–1304.
Article
15. Schneider LC, Rachid R, LeBovidge J, Blood E, Mittal M, Umetsu DT. A pilot study of omalizumab to facilitate rapid oral desensitization in high-risk peanut-allergic patients. J Allergy Clin Immunol. 2013; 132:1368–1374.
Article
Full Text Links
  • APA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr