D1.45 - Omalizumab Reduces Anaphylactic Reactions and Facilitates Food Introduction in Food-Allergic Children with Severe Asthma: A Case Report

Introduction:

This case report highlights how omalizumab treatment can reduce anaphylactic reactions and allow gradual food reintroduction.

Backgroud:

Omalizumab mitigates severe asthma and food allergy-related anaphylaxis.

Objective:

Evaluate omalizumab's role in preventing anaphylaxis and enabling reintroduction.

Case Report:

At our "Respiratory Diseases of Pediatric Interest Unit" at the University of Campania "Luigi Vanvitelli" in Naples, we have been following a patient with severe asthma for six years (since the age of 16) who is undergoing treatment with omalizumab. The patient has multiple food allergies (fish, shellfish, and tree nuts) that previously caused severe anaphylactic reactions. As a result, he was forced to adopt an elimination diet and constantly carry an adrenaline autoinjector, significantly impacting his quality of life. The patient has consistently had a weight above 40 kg (currently 55 kg) and total IgE levels constantly exceeding 1100 kIU/L. Therefore, due to his severe asthma component, he receives a dose of 375 mg of omalizumab every two weeks, calculated based on his body weight and IgE levels. Over the years, we have monitored asthma control and performed annual ISAC tests (available for the past four years). Specific IgE levels showed fluctuations depending on the type of food allergen, with a general upward trend. Although the patient has developed new food allergies, particularly to storage proteins such as Ara h2, Ara h6, and Cor a14, he has not experienced any further anaphylactic reactions. Between 2016 and 2020, the patient underwent a series of Oral Food Challenges (OFCs) for various foods, including baked milk and eggs, fresh milk, eggs, cabbage, zucchini, celery, basil, parsley, garlic, onion, broccoli, lettuce, peanuts, legumes, chicken meat, and tomatoes. These foods were well tolerated and gradually reintroduced after 48 hours following the test. However, tree nuts (walnuts, hazelnuts, almonds) were not tolerated due to the onset of nausea. As a result, the patient currently consumes only foods that may contain "traces" of tree nuts.

Results and Conclusions:

Omalizumab prevents anaphylaxis, stabilizes allergic conditions, improves asthma control, enables dietary reintroduction, and enhances the patient’s quality of life.