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Writer's pictureMarc Braunstein, MD

How Xolair is Redefining Food Allergy Management and Anaphylaxis Prevention

Food allergies pose a significant risk to individuals, with the potential for severe and life-threatening reactions, particularly anaphylaxis, upon accidental exposure to allergens. For many, the fear of such reactions significantly impacts daily life. However, advancements in medical science have introduced new options for managing these risks, one of the most promising being Xolair (omalizumab).



Understanding Food Allergy Anaphylaxis


Food allergy anaphylaxis is an acute, potentially life-threatening reaction that occurs when someone with a food allergy ingests even a small amount of their allergen. This reaction can cause a range of symptoms, from mild hives to severe respiratory distress and cardiovascular collapse. The only definitive way to manage the risk of anaphylaxis has traditionally been strict avoidance of the allergen and the immediate use of epinephrine if exposure occurs.


What is Xolair?


Xolair, or omalizumab, is a monoclonal antibody that targets immunoglobulin E (IgE), a key player in the allergic response. By binding to IgE, Xolair prevents it from attaching to receptors on immune cells, thereby reducing the likelihood of these cells triggering a severe allergic reaction.

Originally approved by the FDA in 2003 for the treatment of moderate to severe allergic asthma, Xolair has also been used to treat chronic urticaria (hives) and nasal polyps. Its recent approval for preventing anaphylaxis in patients with food allergies marks a significant milestone in allergy management​.


How Xolair Works for Food Allergy Prevention


Xolair's mechanism of action is specifically beneficial for those with IgE-mediated food allergies. In clinical trials, patients receiving Xolair showed a significant reduction in their sensitivity to allergens. For instance, participants allergic to peanuts who were treated with Xolair could tolerate higher doses of peanut protein without experiencing severe allergic reactions compared to those who received a placebo​ (FDA.gov).

Moreover, Xolair is effective across multiple food allergens, not just a single allergen like peanuts. This makes it a versatile option for individuals with multiple food allergies, helping to reduce the risk of accidental exposure to various allergens such as milk, eggs, and nuts ​(Verywell Health).


Clinical Trial Success and FDA Approval


The FDA's approval of Xolair for food allergy prevention was based on robust clinical trial data. In these trials, 68% of participants treated with Xolair were able to tolerate a single dose of 600 mg of peanut protein (about 2.5 peanuts) without experiencing moderate to severe allergic symptoms. Similar results were observed with other allergens, such as milk, eggs, and cashews​.

This efficacy demonstrates Xolair's potential to significantly raise the threshold of reactivity, offering a safety net for those at risk of severe allergic reactions due to accidental exposure. However, it is essential to note that while Xolair reduces the risk, it does not eliminate food allergies or allow patients to consume allergens freely. Continuous allergen avoidance remains crucial​(Allergic Living).


Who is a Candidate for Xolair?


Xolair is recommended for individuals with severe, persistent food allergies who have not found adequate protection through traditional avoidance strategies and emergency epinephrine use. It is suitable for patients aged 1 year and older and can be particularly beneficial for those with multiple food allergies​ (FDA.gov).

Patients who might consider Xolair include those with:

  • High levels of IgE

  • A history of severe reactions or anaphylaxis

  • Multiple food allergies that complicate avoidance strategies


Administration and Dosage


Xolair is administered as a subcutaneous injection every two to four weeks, with the dosage determined by the patient's weight and IgE levels. Initially, the injections are given under the supervision of a healthcare provider, but they may eventually be administered at home by the patient or a caregiver​.


Potential Side Effects and Considerations


Overall, the medication is very well tolerated with little to no side effects.  Rarely, anaphylaxis may occur.  Patients should discuss these risks with their allergist before starting treatment​(Allergic Living).


Cost and Insurance Coverage


The cost of Xolair can be significant, with prices ranging from approximately $2,900 to $5,000 per month, depending on the dosage. However, most insurance plans cover Xolair for food allergy treatment, and financial assistance programs are available for eligible patients ​(Allergic Living).


A New Era in Food Allergy Management


Xolair offers hope and a new level of protection for those living with severe food allergies. By reducing the risk of anaphylaxis, this medication can alleviate some of the anxiety associated with accidental allergen exposure, allowing patients to navigate their lives with greater confidence.

For individuals and families affected by food allergies, considering Xolair as part of a comprehensive allergy management plan could be a transformative decision. If you or a loved one suffers from severe food allergies, it may be time to discuss whether Xolair is the right option with a qualified allergist.


Meet Dr. Braunstein: Your Expert in Allergy Care


Dr. Braunstein, a Long Island native, is Board Certified in Pediatric & Adult Allergy and Immunology. With a solid educational background from Brandeis University and SUNY Downstate College of Medicine, and specialized training at the University at Buffalo, he expertly manages a range of allergic conditions, including food allergies, asthma, and eczema.

Committed to patient-centered care, Dr. Braunstein works closely with families to achieve the best outcomes. He is affiliated with Northwell Health System and Mercy Hospital and has conducted research on childhood food allergies and environmental factors affecting hay fever.

Considering Xolair or have other allergy concerns? Schedule an appointment with Dr. Braunstein today to find the right treatment plan.


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