Xolair may help patients from accidental exposure
By Deborah Jeanne Sergeant
Food allergies can cause serious, life-threatening reactions such as anaphylaxis upon exposure. The FDA recently approved Xolair (omalizumab) for people age older than 1for reducing food allergy reactions.
Anaphylaxis is when the patient’s immune system releases chemicals to cause the body to go into shock. The blood pressure plummets. The person struggles to breathe and presents with a fast but weak pulse, flushed skin and possibly nausea and vomiting. Administering epinephrine is lifesaving and the patient should go to an emergency room as a follow-up.
Although people who have life-threatening food allergies should avoid exposure to allergenic food, Xolair can help reduce the reaction in case of accidental exposure.
Xolair is not a new medication.
“It’s been around since 2003,” said Shahzad Mustafa, allergist and immunologist with Rochester Regional Health. “The FDA approved it for asthma in children and adults but this is a new application for food allergy.”
Patients receive an injection every two to four weeks. They can receive the injection at a doctor’s office or administer it themselves at home. Mustafa explained that it works by blocking the immunoglobulin E (IgE). The immune system produces this antibody, a protein, as a response to a possible attacker but mistakes harmless foods as invaders.
Mustafa explained that Xolair works by increasing the amount of allergen required to trigger a reaction such as anaphylaxis.
“You still avoid your food allergen but the likelihood of a reaction is less,” he said.
The side effects are minimal and “largely match placebos,” Mustafa said. “It’s incredibly well-tolerated.”
Xolair has no contraindications and has shown 0.1% risk of side effects in children, including mild injection site pain and fever. None of the reactions were severe enough to warrant discontinuation of the medication. Reaction data among adults is limited.
“Any individual who has a food allergy that meaningfully impacts their quality of life should discuss Xolair with their care provider,” Mustafa said. “I’d encourage anyone to discuss this option.
“In food allergies, there have been a lot of recent advances. Oral immunotherapy for young children, for example.”
This involves gradually increasing exposure to reduce reaction extremes and potentially introducing the food to their diet. Oral immunotherapy could possibly mean that eventually, the allergy could be minimized in its effect or even eliminated. But this type of therapy should only be undertaken with a healthcare provider’s approval and guidance.
“These are important discussions to have with a healthcare provider,” Mustafa said. “They should discuss therapeutic options.”