Beyond oral immunotherapy: How Xolair could change allergy treatment

Hives, rashes, shortness of breath, vomiting, and swelling are some of the quintessential symptoms of allergic reactions. To prevent these uncomfortable and sometimes life-threatening symptoms,  those with food allergies have to be extra cautious in many aspects of their life, whether it is triple-checking if their gifted oatmeal cookies contain tree nuts (one of the largest food allergens) or making sure that an an EpiPen is always on hand, ready to use in a moment’s notice. An article by The Atlantic highlights Tami McGraw, a mom who was severely allergic to red meat, where even trace amounts of steak or BBQ in the air at a family cookout could send her to the ER. Luckily, the frequency of her near-death experiences with food drastically reduced after she started Xolair (omalizumab), a medicine traditionally used for asthma, which she happened to be diagnosed with. 

For a small but growing population of people, leaving the comfort of their homes is dangerous. When someone is allergic to a food, proteins associated with the food are seen as intruders and cause the body to release antibodies, like immunoglobulin E (IgE). Although origins of food allergies are unclear, experts know there are two types of allergen-induced reactions: IgE-mediated and non-IgE mediated. Xolair only works for IgE mediated allergies (more common than non-IgE mediated allergies), which is when IgE antibodies bind to cell receptors to signal the release of histamines, causing typical allergy symptoms, or in extreme cases, anaphylaxis. 

Before the FDA approved Xolair for people with multiple food allergies earlier this year, patients’ main option was to undergo oral immunotherapy, which has to be repeated for each food allergen. Oral immunotherapy works by gradually increasing the body’s tolerance for an allergen by having a person consume increasing amounts of said allergen. It is a tedious process, especially for those who have many allergies that are hard to avoid. 

Xolair is unique and more effective than oral immunotherapy, because it is not antigen specific. IgE can counteract an allergen if it is prevented from binding to cell receptors, regardless of the food. Xolair prevents IgE binding, decreasing symptoms. Additionally, over time, the drug reduces the amount of IgE receptors on cells, lessening the chance of a severe reaction. Oral immunotherapy can even boost Xolair’s efficacy. In the second phase of the drug’s clinical trial, they found that using Xolair in conjunction with oral immunotherapy made the latter therapy safer. 

Xolair is shown to be most effective given as an injection every 2 to 4 weeks over a long period of time. For example, in a trial conducted on children, researchers reported a high level of physical, emotional, and social functioning after four months of therapy. However, due to the regularity in which the drug must be administered, cost is a major factor in the accessibility of the drug. Although Xolair is FDA-approved, insurance is not required to cover its high cost, which is $2,900 per month for children and $5,000 per month for adults. In time, biosimilar drugs will be introduced into the market, but before then, Xolair will not be readily accessible to patients.

“Although Xolair is FDA-approved, insurance is not required to cover its high cost, which is $2,900 per month for children and $5,000 per month for adults.”

We are one step closer to providing a better quality of life for people with food allergies. The next step: make sure everyone gets access to Xolair. If prescription drug-focused policy initiatives progress in Congress, there is a chance that Xolair could be covered under patients’ health insurance plans. The people who need Xolair would be able to reap the immunotherapy benefits without having to worry about the out-of-pocket cost. Xolair has the potential to be a life-altering drug for those with severe allergies. However, this will only be a reality once we improve the accessibility.