D3.181 - Oral Immunotherapy for food allergy through a personalised approach

The prevalence of allergic diseases has increased significantly, positioning food allergies among today's primary health challenges. In this context, biological therapies have emerged as precision treatments capable of modulating the immunological pathways involved in allergic responses. Notably, Omalizumab—an anti-IgE monoclonal antibody—has been shown to act as an effective adjuvant therapy for patients with severe food allergies undergoing oral immunotherapy (OIT). It enhances the safety profile of the treatment and facilitates desensitization in high-risk settings.

Descriptive and analytical observational study based on a retrospective review of medical records of patients with severe food allergies undergoing OIT associated with biological therapy in the Allergy Department of a secondary hospital from 2011 to 2025. A total of 39 variables were analysed.

Twelve patients were included, with a median age of 10 years at the start of OIT; 60% were female. All patients had asthma, 40% had allergic rhinitis or conjunctivitis, and 50% had atopic dermatitis; additionally, 30% had other associated food allergies. The primary indication for initiating biological therapy was severe food allergy refractory to previous OIT attempts. Omalizumab was used in all cases except for one patient treated with Dupilumab due to concomitant eosinophilic oesophagitis. The mean duration of biological treatment prior to OIT was from 3 to 6 months.

The culprit foods were mainly cow’s milk (75%), followed by peanut (16%) and hen egg (8%). Before starting biological therapy, most patients had experienced severe allergic reactions, including anaphylaxis requiring adrenaline, as well as previous OIT failure. During OIT associated with biological treatment, 40% of patients experienced adverse reactions, these were mostly mild, with exceptional adrenaline use and a significant reduction in severe reactions compared to the previous stage (p < 0.05).

At the end of follow-up, all patients except one were able to maintain regular intake of the food, achieving clinical tolerance, with no serious late complications reported.

Biological therapies enable a personalised approach to the management of severe food allergies, reducing complications and improving prognosis and quality of life through successful desensitization.