Oral immunotherapy in severe cow's milk allergic patients treated with omalizumab: Real life survey from a Spanish registry.

BACKGROUND: Oral immunotherapy is a frequent treatment for the management of food allergies, but adverse events (AE) are common. This study assessed the outcome of cow's milk oral immunotherapy (MOIT) in severe cow`s milk-allergic patients treated with omalizumab in a real-life setting. METHODS: OmaBASE was a national, multicenter, open, and observational registry that collected clinical, immunologic, and treatment from patients with food allergy receiving omalizumab. RESULTS: Data derived from 58 patients aged 10.3 years (IQR 6.3-13.2) and median milk-specific IgE 100 kUA /L at the start of omalizumab treatment. Most had experienced anaphylaxis by accidental exposures (70.7%) and had asthma (81.0%). Omalizumab in monotherapy induced tolerance to ≥6000 mg of cow's milk protein (CMP) to 34.8% of patients tested by oral food challenge. Omalizumab combined with MOIT conferred desensitization to ≥6000 mg of CMP to 83.0% of patients. Omalizumab withdrawal triggered more AE (P = .013) and anaphylaxis (P = .001) than no discontinuation. Anaphylaxis was observed in 36.4% of patients who discontinued omalizumab, and more in those with sudden (50.0%) rather than progressive (12.5%) discontinuation. At database closure, 40.5% of patients who had completed follow-up tolerated CMP without omalizumab (7.2% 1500-4500 mg; 33.3% ≥6000 mg). CONCLUSION: Milk oral immunotherapy initiated under omalizumab allows the desensitization of subjects with severe cow's milk allergy even after omalizumab discontinuation. However, discontinuation of omalizumab can lead to severe AE and should be carefully monitored.

Aerobiological importance and allergic sensitization to Amaranthaceae under arid climate conditions.

Species of the Amaranthaceae family are abundant in the Southeast of Spain, one of the driest areas in Europe. The Amaranthaceae include species of interest from the point of view of allergic diseases. With the expansion of aridity, many species belonging to this family will be favoured. The objectives of this study were: first, to define the prevalence of sensitization to Amaranthaceae pollen in allergic patients in the Southeast of Spain; second, to present the aerobiological features of this taxon; and, finally, to demarcate those periods of increased risk of suffering allergic symptoms with the aim of improving the diagnosis and prevention of hay fever. Skin prick tests with extracts of pollen were performed on patients with symptoms of respiratory allergy referred for consultation for the first time in Almería and Murcia. Samples of the atmospheric bioaerosol were taken using a Lanzoni VPPS 2000 volumetric sampler, samples treatment and subsequent counts being carried out according to the methodology approved by the Spanish Aerobiological Network. The statistical significance of the correlation between aerobiological and meteorological data from this arid region in 2010-2014 was determined. The aerobiological study revealed the presence of two distinct peaks responsible for pollen symptoms. The flowering of this taxon is especially noteworthy in the city of Cartagena, where it supposes 94% of the total pollen collected in these periods. This situation converts Amaranthaceae pollen in the second leading cause of hay fever in the Southeast of Spain. With the expansion of aridity, an increase in the presence of these species is expected. Bearing in mind their prevalence in the spring and summer/autumn periods and their extensive presence in the bioaerosol, this makes data from Southeastern Spanish a benchmark with respect to the aerobiology of this type of pollen.