Extensive use of omalizumab for asthma, FDA approved since 2003. Anaphylaxis rate is 0.1-0.2% so initial injections must be supervised (and adrenaline provided for home). Use in under 5s only approved since 2024, however.

Various small studies showed benefit in food allergy. 2024 OUtMATCH study of 180 patients (mostly children) with peanut allergy and at least 2 other food allergies found that after 16 weeks treatment, 67% of those treated with omalizumab could tolerate a 600mg single dose (1044mg cumulative) of peanut plus 1000mg challenge of the 2 other foods (cashew, egg, milk, walnut, hazelnut, wheat all included).

Dosing is as done for asthma, based on weight and total IgE.

1 study found efficacy with only 3-8 weeks of treatment. Duration of regimens varies from 16-34 weeks.

Sustained unresponsiveness (“cure”) has not yet been documented. In fact, protection seems to drop off within 8-12 weeks, so important to continue OIT.

Skin testing and sIgE levels are unreliable once omalizumab is started, so the only way to monitor response to treatment is with food challenges.