New food allergy treatments are on the horizon, notably for biologic medications. Multiple studies are underway evaluating whether biologic medications can help increase the amount patients with food allergy can consume before having an allergic reaction. Other studies are evaluating biological therapy with oral immunotherapy (OIT).
Xolair and Ligelizumab
There have been several studies with Xolair evaluating its ability to allow patients to have a higher threshold for reactivity to an offending food. Studies with peanut have found an increase in the tolerated peanut dose, but severe reactions were seen along the way. However 1 study reported an increase from 80 mg to 10,000 mg (35 peanut kernels) after 6 months. Other studies showed an 8 fold increase in milk, egg, wheat and hazelnuts with Xolair. There is a current study called the omalizumab as monotherapy and as adjunct therapy to multi-allergen OIT in food allergic participants (OUtMATCH).
As described previously, ligelizumab seems to have a better ability to block mast cells and basophil mediated events than Omalizumab (Xolair).
There are no current published studies for Dupixent and food allergy, but studies are underway. Most are to evaluate if the dose threshold eliciting is increased. Dupixent and OIT studies are looking at peanut and another with milk.
Etokimab is an anti-IL 33 monoclonal that was evaluated in 20 patients with peanut allergy. After 1 dose, 73% passed a 275 mg challenge after 2 weeks. More studies for Etokimab will need to be done to evaluate whether this is a safe long term option for patients.
New food allergy treatments are currently being developed and it is very exciting for the millions of patients who have food allergies. Its too soon to say if any of these treatments will get FDA approval in the future. It will be difficult to predict the biologics role as either monotherapy or in conjunction with immunotherapy.
There are currently about 32 million Americans who have food allergies and the health care system could not support all of these patients on expensive biologic medications.