New treatment ‘huge, like a breath of fresh air’ for people with multiple food allergies

Doctors at MUSC Health are thrilled to have a new option to offer patients with multiple food allergies. “It's a huge, like, breath of fresh air for them,” said Kelli Williams, M.D. She’s with the Pediatric Allergy Care Team.

Just how huge was apparent at the annual conference of the American Academy of Allergy, Asthma and Immunology in Washington. Williams and fellow pediatric allergist Emily Campbell, M.D., were there when details of research on a drug called Xolair were announced. Campbell said the excitement was palpable. 

“There wasn't even room in the room. It was completely packed, standing room only. The balconies were full; there were people sitting on the floor and on the steps. I think this development is really revolutionary and just shows about the excitement that there is for this moving forward.”

 

Revolutionary, because Xolair just became the only FDA-approved medication for people allergic to more than one food, Williams said. “The only other FDA-approved food allergy medication is Palforzia, which is only for peanut allergy. Xolair is a very different type of medication.”

The study evaluated the use of Xolair in people from the age of 1 up to 55 years old who have peanut allergies and were allergic to at least two other foods included in the trial (cashews, milk, eggs, walnuts, wheat and hazelnuts). Researchers published their findings in the New England Journal of Medicine. 

They found that 67% of the people who got Xolair were able to eat small amounts of peanuts, equal to at least 2.5 peanuts, without significant symptoms. 

Campbell described how Xolair works. “Food allergies are mediated by something that we call an IgE antibody. Your immune system makes this antibody against the food you’re allergic to and sends a danger signal to the body.”

Williams chimed in. “It’s essentially an explosion of that allergy cell.”

Campbell continued: “And, so, what Xolair does is, it binds up a lot of the IgE in the body, preventing that danger signal from being sent. It's been used for about 20 years for asthma and for chronic hives. Now, it can be used for this. So it's really exciting.”

 

Allergy specialists will meet this week at MUSC Health to talk about using the brand-new treatment for patients who qualify. And that’s a lot of patients. “Tons,” Williams said. 

To put that in perspective, researchers on the Xolair study said up to 8% of kids and 10% of adults in the United States have food allergies. Between 30% and 86% of them are allergic to more than one kind of food.

But the study showed that they don’t all respond the same way to treatment, Williams said. “The data showed that about 14% of people didn't get any better. But the majority of people at least had increased dose tolerance – meaning they could eat more of the food than prior to receiving the medication,” Williams said.

There were also some side effects, but Williams called them minimal. “The most common side effect with most biologics, or any type of injection, is that you can have local site reactions to the injections. And they saw that both in the placebo and the medication arm but a little bit higher in the medication arm,” she said.

“There was also an increased risk for fevers in those receiving the medication, but they were short-lived. Those were the main side effects that they noticed.”

Questions remain, including whether/when insurance will cover the treatment. And when it comes to kids, their tolerance for regular shots of the medication may factor in as well, Campbell said. “I think the important thing is is it's not one size fits all, and it's not for everyone. And it's really patient-specific and family-specific and talking about their goals and their concerns.”

Some kids don’t even like peanuts or tree nuts and don’t want to take a medication. “That's fine,” Campbell said. “But for the people who are very allergic, who have multiple food allergies, who have had accidental exposures by no fault of their own and are in environments that their parents can't control, like daycare or school, this may be a really good option.”