After more than 20 years since its initial approval for asthma, Xolair has been approved by the FDA to help reduce allergic reactions to multiple foods after accidental exposure. This approval marks a significant milestone for millions of Americans who suffer from severe and potentially fatal food allergies, offering them a chance at a more normal life. The journey to this point has been long, with researchers and clinicians recognizing the potential of Xolair to treat food allergies for many years.
Xolair's Mechanism and Early Observations
Xolair functions by intercepting IgE, an immune molecule known to trigger allergic reactions. The drug's potential to mitigate food allergies was evident early on, with clinicians observing that asthma patients treated with Xolair experienced diminished allergic reactions to food. As Dr. Scott Commins, an allergist at the University of North Carolina, noted, Xolair was sometimes prescribed off-label to food allergy patients who also had asthma or chronic hives, conditions often associated with elevated IgE levels.
Clinical Evidence and the OUtMATCH Trial
To secure FDA approval for food allergies, robust clinical trial data was necessary. The OUtMATCH trial, a collaboration between the National Institute of Allergy and Infectious Diseases and Xolair’s manufacturers, provided the needed evidence. The trial's results, published in February, demonstrated that after 16 weeks of Xolair treatment, two-thirds of participants with peanut allergies and allergies to at least two other foods could tolerate the equivalent of two and a half peanuts. Similar results were observed for other allergy-inducing foods.
Impact on Patients' Lives
The approval of Xolair is particularly impactful for individuals with allergies that are difficult to avoid. Christine Robinson, who has a severe corn allergy, shared that Xolair has reduced her reactivity significantly. While she still avoids corn, her reactions are now more of an annoyance than an emergency. For Tami McGraw, who was severely allergic to red meat, Xolair has allowed her to cook and eat red meat again without fear of anaphylactic shock.
Comparison with Other Treatments
Currently, oral immunotherapy is another available treatment, but it is food-specific and can be arduous, especially for those with multiple allergies. Xolair offers the advantage of treating multiple food allergies simultaneously. Stacie Jones, a pediatric allergist at Arkansas Children’s Hospital, highlighted this benefit, noting that Xolair and oral immunotherapy could potentially be used together to enhance safety and effectiveness.
Future Directions
Ongoing research is exploring whether adding Xolair can make oral immunotherapy safer and more effective. Additionally, researchers are studying participants after they discontinue Xolair to understand how they can reincorporate allergy-inducing foods back into their diets. According to Dr. Robert Wood, a pediatric allergist at Johns Hopkins, data suggests that many individuals can start eating foods they were previously allergic to, which could dramatically change how Xolair is used in the future.
Challenges and Considerations
While Xolair has shown great promise, it is not effective for everyone. Approximately one-third of participants in the clinical trial did not respond to the treatment. Researchers are working to identify factors that predict who will respond to Xolair and understand the underlying mechanisms. Additionally, the cost of Xolair, which can range from $30,000 to $60,000 per year, may be a barrier for some patients, although insurance coverage is expected to improve with the FDA approval for food allergies.
