IgE-immunoadsorption for severe allergy to multiple foods: A case series of five children

Stefania Arasi, MD, PhD, MSC; Anna Lucia Piscitelli, MD; Arianna Cafarotti, MD; Beatrice Marziani, MD; Valentina Pecora, MD; Lamia Dahdah, MD; Giovanna Leone, MD; Giorgia Bracaglia, PhD; Ottavia Porzio, MD; Andrea Onetti Muda, MD; Alessandro Fiocchi, MD

World Allergy Organization Journal (Feb 2023)

IgE-immunoadsorption for severe allergy to multiple foods: A case series of five children

Stefania Arasi, MD, PhD, MSC,
Anna Lucia Piscitelli, MD,
Arianna Cafarotti, MD,
Beatrice Marziani, MD,
Valentina Pecora, MD,
Lamia Dahdah, MD,
Giovanna Leone, MD,
Giorgia Bracaglia, PhD,
Ottavia Porzio, MD,
Andrea Onetti Muda, MD,
Alessandro Fiocchi, MD

Affiliations

Stefania Arasi, MD, PhD, MSC: Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, Italy; Corresponding author. Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy. Tel.: +39 0668592309; Fax: +39 0668592914.
Anna Lucia Piscitelli, MD: Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, Italy
Arianna Cafarotti, MD: Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, Italy
Beatrice Marziani, MD: Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, Italy
Valentina Pecora, MD: Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, Italy
Lamia Dahdah, MD: Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, Italy
Giovanna Leone, MD: Unit of Transfusion Medicine, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
Giorgia Bracaglia, PhD: Department of Diagnostics and Laboratory Medicine, Unit of Allergy and Autoimmunity, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
Ottavia Porzio, MD: Unit of Transfusion Medicine, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
Andrea Onetti Muda, MD: Unit of Transfusion Medicine, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
Alessandro Fiocchi, MD: Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, Italy

Journal volume & issue: Vol. 16, no. 2
p. 100750

Abstract

Read online

Background: Children with severe food allergy may present high risk of fatal anaphylaxis and a highly impaired quality of life. Anti IgE-treatment has been shown to be a promising approach as monotherapy for severe allergy to multiple foods. However, very high serum total IgE levels may limit its use.This study aims to assess the efficacy of IgE-selective immunoadsorption (IgE-IA) on total IgE levels and threshold of reactivity to the culprit foods in children with history of severe anaphylaxis due to multiple foods and allergic comorbidities. Methods: In this single-center, prospective, open-label efficacy study we evaluated children with severe asthma, allergy to 2+foods and total IgE levels >2300 kUI/L. To establish the food reactivity threshold, each patient underwent oral food challenges (OFCs) before and after IgE-IA. Results: Five patients (4 males; age, 12.2 ± 5 years, mean ± SD) underwent an average of 3 (range 2–4) sessions of IgE-IA. Each session reduced IgE levels by a mean of 1958.87 kUI/L. After the IgE-IA cycle, serum total IgE dropped from 3948 ± 1652.7 (mean ± SD) to 360.8 ± 71.9 kUI/L (−10.9 folds; p = 0.01). The threshold of reactivity (No Observed Adverse Effect Level, NOAEL) tested at OFCs for the culprit foods (4 baked-milk + 2 baked-egg + 1 lentil + 2 hazelnut + 1 wheat) increased overall from 21.5 (median, IQR 1.5–82.6) protein milligrams to 1115 (837.2–4222.8) milligrams (p < 0.001), ie, up to 51.8 times higher than baseline. 8/10 OFCs were negative after IgE-IA. Conclusions: IgE-IA increased food threshold quickly. It can be considered in well-selected patients with severe food allergies and high IgE-levels especially if otherwise eligible to anti IgE treatment.

Published in World Allergy Organization Journal

ISSN: 1939-4551 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: https://www.sciencedirect.com/journal/world-allergy-organization-journal

About the journal

Abstract

Keywords