Chicago Family Asthma & Allergy

Omalizumab (brand name Xolair) is an injectable medicine that binds allergy-type antibodies, called "immunoglobulin E" or "IgE" for short, that are circulating through the bloodstream. It was approved by the FDA in February 2024 for use in food allergy patients one year old and older who are at risk of life-threatening anaphylaxis. 

Here are some points about it:

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• It has been used for asthma since 2003, and it also has been used for chronic hives and nasal polyps. We have a lot of severe asthma and chronic hives patients who have received this medicine with significant relief.

• The concept is that this medicine soaks up most of the free-floating IgE allergy-type antibodies that provide the fuel for the fire of anaphylaxis (like the antibodies we see when we get food blood test values).

• In one to two months of using the injection, it is likely to reduce the risk of anaphylaxis with accidental food allergen ingestion, making it easier not to worry about trace amounts in prepared foods, including in restaurants, bakeries, parties, day cares, and school settings.

• This will not be a food allergy cure. It will be a shield against accidents, and we will not know when to discontinue it as long as someone has food allergy risks. You will still be expected to avoid eating your food allergen(s) and to carry self-injectable epinephrine. If you stop receiving the medicine, you are likely to return back to your baseline food allergy risk.

• It is likely to assist with successful and perhaps more speedy food desensitization with patients undergoing sublingual or oral immunotherapy.

• We need to obtain food IgE and total IgE lab values for all qualified and interested food allergy patients. There is a table defining the dose and frequency of injections based on total IgE and the patient's weight.

• The subcutaneous injections are given in the skin of the back of the arm, the thigh, or the abdomen and will be given every 2 to 4 weeks, depending on that dosing table.

• It is not clear how many injections will need to be given in the office with an observation period before you have the option to give it at home. The first one to three injections will be mandatory in the office and may require 30 to 90 minutes observation. You may choose to continue to receive each injection in office appointments rather than giving them at home.

• Our greatest challenge may be cost and insurance coverage. The shots are expensive without insurance, so we are navigating how to get the best coverage possible. We do not want to create an expense burden for the patient and the healthcare environment, so we hope costs and insurance coverage will improve.

• Give us time to learn more about the details as they unfold. The application process can be complicated and time-consuming. There are usually kinks that have to be ironed out with such new drug indications.

• Who might be good candidates for receiving Xolair?

  • High-risk patient with history of severe reactions

    • Severe reactions with very small food exposures

    • Someone allergic to many foods or foods commonly contaminating the environment (such as milk, egg, or wheat)

    • History of multiple reactions despite best efforts of avoidance

    • History of severe reactions leading to hospitalization

  • Anticipating a high-risk area/situation

    • Traveling to locations where food labeling is not clear

    • Traveling where access to emergency medical care is compromised, like camping

    • Traveling to a location where food allergen exposure may be high 

  • Very anxious patient who has a poor quality of life limiting social interactions due to fear of food allergy exposure (while also working with a counselor).

  • As a potential bridge to SLIT or OIT (see above).

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All interested food allergy patients and their families need to make an office visits or televisit to discuss this treatment option and how it applies to each patient's situation.

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See more info at the Xolair website: https://www.xolair.com/food-allergies.html