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  • Brandström, JosefKarolinska Institutet (author)

Individually dosed omalizumab facilitates peanut oral immunotherapy in peanut allergic adolescents

  • Article/chapterEnglish2019

Publisher, publication year, extent ...

  • 2019-08-15
  • Wiley,2019
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:su-173144
  • https://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-173144URI
  • https://doi.org/10.1111/cea.13469DOI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:141631390URI

Supplementary language notes

  • Language:English
  • Summary in:English

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Classification

  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • Background: Peanut oral immunotherapy (pOIT) has showed good short-term outcomes, but allergic reactions may prevent effective up-dosing and is a major cause of stopping OIT. In placebo-controlled trials, omalizumab has been shown to facilitate allergen immunotherapy and increase tolerance to peanut.Objective: We hypothesized that by combining omalizumab with pOIT, and monitor treatment effects with basophil allergen threshold sensitivity tests (CD-sens), peanut allergic patients could safely initiate pOIT and thereafter slowly withdraw omalizumab.Methods: This is the 2nd part of a one-armed open phase-2 study where peanut allergic adolescents (n = 23) started pOIT after an individualized omalizumab treatment. The pOIT dose was increased from 280 to 2800 mg peanut protein in 8 weeks followed by an individualized step-wise withdrawal of omalizumab, based on clinical symptoms and CD-sens levels. pOIT continued for 12 weeks followed by an open peanut challenge. Peanut CD-sens and allergen-binding activity (ABA) and IgE-ab, IgG-ab and IgG4-ab to peanut and its components were measured during the study.Results: All 23 patients successfully reached the 2800 mg maintenance dose. Moderate/systemic allergic reactions were rare while receiving full-dose omalizumab. Eleven of 23 (48%) successfully continued with pOIT after omalizumab was stopped. Compared to treatment failures, median baseline IgE-ab to peanut components Ara h 1-3 and CD-sens to peanut were significantly lower among successfully treated patients and IgG4-ab to peanut, Ara h 2 and 6 increased significantly more during treatment.Conclusions and clinical relevance: This study indicates that omalizumab is an effective adjunctive therapy for initiation and rapid up-dosing of pOIT; however, adverse events from pOIT become more frequent as omalizumab doses are decreased.

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Added entries (persons, corporate bodies, meetings, titles ...)

  • Vetander, MirjaKarolinska Institutet (author)
  • Sundqvist, Ann-Charlotte (author)
  • Lilja, GunnarKarolinska Institutet (author)
  • Johansson, S. G. O. (author)
  • Melén, ErikKarolinska Institutet (author)
  • Sverremark-Ekström, EvaStockholms universitet,Institutionen för molekylär biovetenskap, Wenner-Grens institut(Swepub:su)esver (author)
  • Nopp, AnnaKarolinska Institutet (author)
  • Nilsson, CarolineKarolinska Institutet (author)
  • Karolinska InstitutetInstitutionen för molekylär biovetenskap, Wenner-Grens institut (creator_code:org_t)

Related titles

  • In:Clinical and Experimental Allergy: Wiley49:10, s. 1328-13410954-78941365-2222

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