In study of children and young people, 67% of those treated with omalizumab could tolerate a 600mg single dose (1044mg cumulative) of peanut. Similarly for cashew, egg, milk, walnut, hazelnut, wheat. But 14% did not respond at all…

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

See OUtMATCH study.

1 study found efficacy with only 3-8 weeks of treatment.

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

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.

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

[Hao Tseng review, Current op all clinic imm 2025 DOI: 10.1097/ACI.0000000000001114]