IgE Immunoapheresis for Treatment of Pediatric Patients with Severe Asthma and Multiple Food Anaphylaxis: a Pilot Study

In multiple food allergy, the avoidance of offending foods reduces the patient’s and his family’s quality of life. Biologics (omalizumab) represent the most promising approach1, but serum IgE levels > 1,500 kUI/L may limit their use. IgE immunoapheresis may be used to decrease IgE levels and to improve the patients’ conditions2. We aim to assess the efficacy of IgE immunoapheresis on food tolerance and clinical status of children with asthma and multiple food allergy. In this prospective, open label efficacy study (IAO, ImmunoApheresis for Omalizumab; OPBG EC approval 599/18), we evaluated children with severe asthma, allergy to 2+ foods and total IgE levels >1500 kUI/L. To establish the food reactivity threshold before apheretic procedures, each patient underwent two oral food challenges (OPT). The patients were then admitted to daily selective IgE immunoapheresis (Therasorb Miltenyi®) aimed to reduce total IgE to < 500 kUI/L, up to a maximum of twelve sessions. Before and after each immunoapheresis cycle, CBC, chemistry, IgA, IgG, IgM and total and specific IgE were evaluated. The variation of food tolerance was assessed at OPT soon after the last immunoadsorption with the most allergenic food. Furthermore, before the procedure and at the end of the study, the children underwent assessment for the definition of rhinitis control test (CARATKids), Asthma Control Test (ACT), and Quality of Life (PedsQL). Four males, mean age 11.5 ± 5 years (range 6 – 18), underwent an average of five (2 – 12) sessions of IgE immunoadsorption. Each session reduced IgE levels by a mean 3436.3 kUI/L. After the cycles, total IgE dropped from 12,306±9,181 to 638.5±319.8 kUI/L (- 91.15%; p=0001). The food tolerance threshold for the four tested foods (two baked milk, one baked egg, and one hazelnut) increased from a mean 0.45±0.19 g food to 9.28±3.90 g eliciting dose (P=0.0004). This translates in a 44.5 times increase of the original food tolerance threshold. CARATKids decreased from 9.75±2.87 to 2.50±3.00), ACT increased from 14.5±3.31 to 20.5±4.79. The PedsQL increased from 69.0±11.35 to 89.5±1.77. Selective IgE immunoapheresis reduces symptoms and increases food tolerance over a short time. As it may reduce the risk of food reactions, it could be a promising therapeutic approach in patients with severe asthma, high IgE-levels, and multiple food allergy to make them eligible for the administration of Omalizumab.