Milk allergy successfully treated with Xolair

By Dr. Ananya Mandal, MDMar 22 2011

A latest study suggests that children with severe milk allergies may be able to rapidly overcome their sensitivities with the help of a biologic drug that helps to quiet an overly aggressive immune response. This is a small study still waiting to be proved in larger populations say researchers.

The new drug Xolair, if proven might become the first treatment to help the increasing numbers of kids who react to common foods like milk, egg, or peanuts. Scott H. Sicherer, professor of pediatrics at Mount Sinai School of Medicine’s Jaffe Food Allergy Institute in New York, an independent observer called the results “interesting but very preliminary”. He said, “This drug may make it easier to give oral immunotherapy with fewer side effects, but more studies are clearly needed.” Sicherer said he is embarking on a larger trial to test Xolair, an asthma drug, for food allergies.

For the study the team at Children’s Hospital Boston and Stanford University enrolled 11 children between the ages of 7 and 17 with milk allergies so severe that even tiny amounts would cause hives, vomiting, facial swelling, and possibly anaphylaxis, a potentially life-threatening reaction. For the nine weeks of the study they gave the children injections of the biologic drug Xolair or omalizumab, which blocks the immune protein IgE, an important chemical signal that causes specialized cells called mast cells to release a host of chemicals that cause swelling, itching, and other signs of an allergic reaction.

“IgE is the match that lights the fire behind reactions to foods or dog- or cat-allergies,” said a co-author of the study, Dr. Kari Nadeau, director of food allergy research at Stanford and an assistant professor of pediatrics. “Anti-IgE is a way to protect the person from having reactions while they are increasing their exposure to the food.”

Over the next two to three months, the kids continued the medication. In addition they were given ever greater amounts of milk to drink each day, working up to about 2 ounces of milk daily. For the next two months, the kids continued drinking their 2 ounces of milk each day. Nine of the 11 children successfully completed the study. At the study’s end, after six months, the researchers challenged the remaining nine children with a full 8-ounce glass of milk or a placebo drink. All nine were successfully able to drink the milk.

“It’s life changing,” says study researcher Dale Umetsu, the Prince Turki al Saud Professor of Pediatrics in the division of immunology at Children’s Hospital Boston. “Now they can eat pizza and ice cream with their friends. It’s a very important change to their lifestyle.”

Genentech, the company that makes Xolair, donated the medication for the study, which can cost $500 to $2,000 a month. The preliminary study was presented at the annual meeting of the American Academy of Allergy and Asthma and Immunology in San Francisco.