IgE-immunoadsorption for severe allergy to multiple foods: A case series of five children
Background: Children with severe food allergy may present high risk of fatal anaphylaxis and a highly impaired quality of life. Anti IgE-treatment has been shown to be a promising approach as monotherapy for severe allergy to multiple foods. However, very high serum total IgE levels may limit its us...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-02-01
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| Series: | World Allergy Organization Journal |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1939455123000108 |
| _version_ | 1827999819061264384 |
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| author | Stefania Arasi, MD, PhD, MSC Anna Lucia Piscitelli, MD Arianna Cafarotti, MD Beatrice Marziani, MD Valentina Pecora, MD Lamia Dahdah, MD Giovanna Leone, MD Giorgia Bracaglia, PhD Ottavia Porzio, MD Andrea Onetti Muda, MD Alessandro Fiocchi, MD |
| author_facet | Stefania Arasi, MD, PhD, MSC Anna Lucia Piscitelli, MD Arianna Cafarotti, MD Beatrice Marziani, MD Valentina Pecora, MD Lamia Dahdah, MD Giovanna Leone, MD Giorgia Bracaglia, PhD Ottavia Porzio, MD Andrea Onetti Muda, MD Alessandro Fiocchi, MD |
| author_sort | Stefania Arasi, MD, PhD, MSC |
| collection | DOAJ |
| description | Background: Children with severe food allergy may present high risk of fatal anaphylaxis and a highly impaired quality of life. Anti IgE-treatment has been shown to be a promising approach as monotherapy for severe allergy to multiple foods. However, very high serum total IgE levels may limit its use.This study aims to assess the efficacy of IgE-selective immunoadsorption (IgE-IA) on total IgE levels and threshold of reactivity to the culprit foods in children with history of severe anaphylaxis due to multiple foods and allergic comorbidities. Methods: In this single-center, prospective, open-label efficacy study we evaluated children with severe asthma, allergy to 2+foods and total IgE levels >2300 kUI/L. To establish the food reactivity threshold, each patient underwent oral food challenges (OFCs) before and after IgE-IA. Results: Five patients (4 males; age, 12.2 ± 5 years, mean ± SD) underwent an average of 3 (range 2–4) sessions of IgE-IA. Each session reduced IgE levels by a mean of 1958.87 kUI/L. After the IgE-IA cycle, serum total IgE dropped from 3948 ± 1652.7 (mean ± SD) to 360.8 ± 71.9 kUI/L (−10.9 folds; p = 0.01). The threshold of reactivity (No Observed Adverse Effect Level, NOAEL) tested at OFCs for the culprit foods (4 baked-milk + 2 baked-egg + 1 lentil + 2 hazelnut + 1 wheat) increased overall from 21.5 (median, IQR 1.5–82.6) protein milligrams to 1115 (837.2–4222.8) milligrams (p < 0.001), ie, up to 51.8 times higher than baseline. 8/10 OFCs were negative after IgE-IA. Conclusions: IgE-IA increased food threshold quickly. It can be considered in well-selected patients with severe food allergies and high IgE-levels especially if otherwise eligible to anti IgE treatment. |
| first_indexed | 2024-04-10T06:05:09Z |
| format | Article |
| id | doaj.art-ebef6eda74fb4dd79c453f88bb0c8b47 |
| institution | Directory Open Access Journal |
| issn | 1939-4551 |
| language | English |
| last_indexed | 2024-04-10T06:05:09Z |
| publishDate | 2023-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | World Allergy Organization Journal |
| spelling | doaj.art-ebef6eda74fb4dd79c453f88bb0c8b472023-03-03T04:24:24ZengElsevierWorld Allergy Organization Journal1939-45512023-02-01162100750IgE-immunoadsorption for severe allergy to multiple foods: A case series of five childrenStefania Arasi, MD, PhD, MSC0Anna Lucia Piscitelli, MD1Arianna Cafarotti, MD2Beatrice Marziani, MD3Valentina Pecora, MD4Lamia Dahdah, MD5Giovanna Leone, MD6Giorgia Bracaglia, PhD7Ottavia Porzio, MD8Andrea Onetti Muda, MD9Alessandro Fiocchi, MD10Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, Italy; Corresponding author. Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy. Tel.: +39 0668592309; Fax: +39 0668592914.Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, ItalyAllergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, ItalyAllergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, ItalyAllergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, ItalyAllergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, ItalyUnit of Transfusion Medicine, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, ItalyDepartment of Diagnostics and Laboratory Medicine, Unit of Allergy and Autoimmunity, Bambino Gesù Children's Hospital, IRCCS, Rome, ItalyUnit of Transfusion Medicine, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, ItalyUnit of Transfusion Medicine, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, ItalyAllergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, ItalyBackground: Children with severe food allergy may present high risk of fatal anaphylaxis and a highly impaired quality of life. Anti IgE-treatment has been shown to be a promising approach as monotherapy for severe allergy to multiple foods. However, very high serum total IgE levels may limit its use.This study aims to assess the efficacy of IgE-selective immunoadsorption (IgE-IA) on total IgE levels and threshold of reactivity to the culprit foods in children with history of severe anaphylaxis due to multiple foods and allergic comorbidities. Methods: In this single-center, prospective, open-label efficacy study we evaluated children with severe asthma, allergy to 2+foods and total IgE levels >2300 kUI/L. To establish the food reactivity threshold, each patient underwent oral food challenges (OFCs) before and after IgE-IA. Results: Five patients (4 males; age, 12.2 ± 5 years, mean ± SD) underwent an average of 3 (range 2–4) sessions of IgE-IA. Each session reduced IgE levels by a mean of 1958.87 kUI/L. After the IgE-IA cycle, serum total IgE dropped from 3948 ± 1652.7 (mean ± SD) to 360.8 ± 71.9 kUI/L (−10.9 folds; p = 0.01). The threshold of reactivity (No Observed Adverse Effect Level, NOAEL) tested at OFCs for the culprit foods (4 baked-milk + 2 baked-egg + 1 lentil + 2 hazelnut + 1 wheat) increased overall from 21.5 (median, IQR 1.5–82.6) protein milligrams to 1115 (837.2–4222.8) milligrams (p < 0.001), ie, up to 51.8 times higher than baseline. 8/10 OFCs were negative after IgE-IA. Conclusions: IgE-IA increased food threshold quickly. It can be considered in well-selected patients with severe food allergies and high IgE-levels especially if otherwise eligible to anti IgE treatment.http://www.sciencedirect.com/science/article/pii/S1939455123000108Anti-IgE treatmentChildrenIgE-immunoadsorptionOmalizumabSevere food allergy |
| spellingShingle | Stefania Arasi, MD, PhD, MSC Anna Lucia Piscitelli, MD Arianna Cafarotti, MD Beatrice Marziani, MD Valentina Pecora, MD Lamia Dahdah, MD Giovanna Leone, MD Giorgia Bracaglia, PhD Ottavia Porzio, MD Andrea Onetti Muda, MD Alessandro Fiocchi, MD IgE-immunoadsorption for severe allergy to multiple foods: A case series of five children World Allergy Organization Journal Anti-IgE treatment Children IgE-immunoadsorption Omalizumab Severe food allergy |
| title | IgE-immunoadsorption for severe allergy to multiple foods: A case series of five children |
| title_full | IgE-immunoadsorption for severe allergy to multiple foods: A case series of five children |
| title_fullStr | IgE-immunoadsorption for severe allergy to multiple foods: A case series of five children |
| title_full_unstemmed | IgE-immunoadsorption for severe allergy to multiple foods: A case series of five children |
| title_short | IgE-immunoadsorption for severe allergy to multiple foods: A case series of five children |
| title_sort | ige immunoadsorption for severe allergy to multiple foods a case series of five children |
| topic | Anti-IgE treatment Children IgE-immunoadsorption Omalizumab Severe food allergy |
| url | http://www.sciencedirect.com/science/article/pii/S1939455123000108 |
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