A new qualitative study reveals that allergists across the United States are largely optimistic about incorporating biological therapies into food allergy treatment protocols, despite concerns about cost and accessibility. The research, published in the Annals of Allergy, Asthma & Immunology, captured insights from 60 community and academic allergists across 34 states.
Shifting Treatment Paradigms
The enthusiasm for biologics comes in the wake of omalizumab's (Xolair) FDA approval in February for patients aged one year and older with food allergies. Unlike traditional oral immunotherapy, which gradually builds tolerance through controlled exposure, biologics target the underlying immune response, potentially offering protection against multiple food allergens simultaneously.
"It's going to get you at least the same benefit [as oral immunotherapy], hopefully, conceptually, increasing your threshold dose. But the ask, the lift, the commitment is much less, and the safety profile is probably better," noted one participating physician.
Key Advantages and Clinical Applications
The study identified several perceived benefits of biological therapies:
- Ability to address multiple food allergies concurrently
- Less frequent administration compared to oral immunotherapy
- Improved safety profile
- Greater convenience for younger patients
- Potential use as both monotherapy and adjunct treatment
Data from the OUtMATCH trial has demonstrated omalizumab's efficacy in increasing tolerance thresholds for multiple food allergens in children with various food allergies.
Barriers to Implementation
Despite the optimism, several significant concerns emerged:
The cost of treatment presents the most substantial barrier, with annual omalizumab therapy ranging from $30,000 to $60,000. "The risk is that they're unaffordable for almost everyone," one participant emphasized, expressing concern about worsening existing disparities in food allergy care.
Additional challenges include:
- Patient and parent hesitancy about long-term medication use
- Potential for overutilization
- Limited long-term safety data
- Insurance coverage uncertainties
Future Outlook
Many participants viewed biologics as a "turning point" in food allergy treatment. The convenience of periodic injections compared to daily oral immunotherapy protocols particularly appeals to both clinicians and patients, especially for situations involving travel or complex lifestyle demands.
Dr. Scott H. Sicherer of the Icahn School of Medicine at Mount Sinai noted that the study's timing - conducted before omalizumab's FDA approval - may not reflect current clinical perspectives. He expressed particular interest in how general allergists, beyond food allergy specialists, will incorporate these new treatment options into their practices.
The research team, led by Dr. Jill A. Fisher from the University of North Carolina at Chapel Hill, acknowledged that their sample might have overrepresented providers offering oral immunotherapy compared to the national average. However, the findings provide valuable insights into the potential integration of biologics into mainstream food allergy care.
