TOPLINE:

In children with immunoglobulin E (IgE)-mediated food allergy, most oral food challenges (OFCs) performed during ongoing treatment with omalizumab reached clinically meaningful tolerable doses, and dietary introduction was permitted following more than 90% of challenges.

METHODOLOGY:

• Researchers performed a chart review of 51 children with IgE-mediated food allergy (median age, 9 years; 55% boys) who started omalizumab between February 2024 and February 2025; OFCs through August 2025 were also reviewed.
• Omalizumab dosing was based on patient weight and baseline total IgE level and ranged from 75 mg to 600 mg every 2 or 4 weeks.
• OFCs were performed at a median of 7 months after the initiation of omalizumab; goal doses were typically set at a cumulative total of 6000 mg of food protein, with open OFCs typically divided into six stepwise doses of 5%, 10%, 15%, 20%, 25%, and 25% of the goal dose.
• The primary outcome was the cumulative tolerated dose during OFCs, defined as the total amount of food protein successfully ingested without dose-limiting symptoms.

TAKEAWAY:

• Of 73 OFCs, 56 had a target dose of ≥ 6000 mg. Among these 56, 89% tolerated ≥ 1000 mg, 86% tolerated ≥ 2000 mg, 75% tolerated ≥ 4000 mg, and 66% tolerated ≥ 6000 mg.
• Overall, dietary introduction was permitted following 92% of OFCs, including 89%, 91%, and 100% of OFCs for milk, egg, and wheat, respectively.
• Allergic reactions occurred in 45% of OFCs and were mostly mild; treatment with intramuscular epinephrine was required in two OFCs.

IN PRACTICE:

“Depending on individual goals and preferences, OFCs may help assess treatment response and allow safe introduction of allergenic foods into the diet for many patients,” the authors of the study wrote.

SOURCE:

Jennifer Dantzer, MD, MHS, Johns Hopkins University School of Medicine, Baltimore, was the corresponding author of the study, which was published online on March 06, 2026, in The Journal of Allergy and Clinical Immunology: In Practice.

LIMITATIONS:

The study was limited by its relatively small sample size, especially for foods other than milk, eggs, and wheat. Generalizability was limited because the study was conducted at a single tertiary referral center. OFCs were open, non-placebo-controlled tests with variable goal doses, and because OFCs were not routinely performed before treatment with omalizumab, conclusions regarding within‑patient changes in reaction thresholds could not be drawn, and results require cautious interpretation.

DISCLOSURES:

The study was supported by the National Institute of Allergy and Infectious Diseases and the Doris Duke Charitable Foundation. Two authors reported receiving grant support from various institutions and pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.