Omalizumab or Oral Immunotherapy for Food Allergy, With Robert Wood, MD

Stage 3 data from the OUtMATCH trial established that both omalizumab and multi-food oral immunotherapy (OIT) enabled successful dietary consumption of allergenic foods in more than 60% of dietary consumption (DC) plans at 12 months with no significant differences between groups — but the tolerability gap separating the 2 treatments remains a central factor patient decision making.

HCPLive sat down with Robert A. Wood, MD, Chief of the Eudowood Division of Pediatric Allergy and Immunology at Johns Hopkins Children's Center and Professor of Pediatrics at the Johns Hopkins University School of Medicine in Baltimore at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2026 Annual Meeting held in Philadelphia, Pennsylvania, from February 27 to March 2, where he presented the latest data from OUtMATCH, to learn more.

Of 81 eligible OUtMATCH participants, 80 qualified for DC plans following mOIT (n = 29) or omalizumab (n = 51), covering 83 and 139 individual allergen DC plans respectively. Success was defined as consuming a median of ≥300 mg/day of allergenic food at both 3 and 6 months by daily diary, with additional study team evaluations across all 12 months. By daily diary, DC success rates across all foods were statistically equivalent between groups at both 3 months (post-mOIT 77% vs. post-omalizumab 66%; P = .10) and 6 months (65% vs. 63%; P = .77), with peanut-specific outcomes following the same pattern (P = .43 and P = .80, respectively).

Study evaluations told a consistent story across all 12 months — success rates tracked closely between arms at every timepoint (post-mOIT: 90%, 82%, 75%, 67%; post-omalizumab: 91%, 82%, 69%, 63%; P range = .44–1.00) with no differences on individual allergen analysis (P range = .13–1.00). Among the 52 participants who maintained DC plans for all three foods through 12 months (n = 22 post-mOIT; n = 30 post-omalizumab), adverse event rates were similar — 86% (19/22) post-mOIT and 93% (28/30) post-omalizumab — with 2 serious adverse events during the open feeding transition from mOIT and 1 case of eosinophilic esophagitis post-omalizumab.

Wood discussed the practical treatment decision framework he applies in clinic, where omalizumab's ability to block all IgE-mediated reactions regardless of the specific trigger gives it a meaningful advantage for multi-food allergic patients over OIT protocols that require daily consumption of each individual allergenic food. OIT remains competitive for patients with a single dominant allergy, particularly peanut, where an FDA-approved product exists, but no FDA-approved multi-allergen OIT product currently exists, adding regulatory and practical complexity.2,3

“With the oral immunotherapy, we know from all kinds of different studies that some patients will have reactions to the treatment. The reactions can be very trivial, or they can be enough that it's impossible to continue the treatment. So when we're sort of balancing the risk versus benefit,” Wood said.

Looking ahead, Wood was direct that no meaningfully new options are likely within 4 to 5 years as next-generation approaches remain in early-phase investigation, while the 10-year horizon, with potentially up to 10 distinct treatment options in the pipeline, promises to fundamentally reshape how clinicians and families navigate food allergy management together.

Wood’s disclosures include Aimmune, ALK, DBV Technologies, FARE, Genentech, NIAID, Novartis, Regeneron, Siolta, and Aravax.

References

1. Chinthrajah RS, Lanser B, Leung D, et al. Evaluation of dietary consumption feasibility following treatment with multi-food oral immunotherapy or omalizumab in OUtMATCH. Presented at: AAAAI 2026 Annual Meeting, February 27-March 2, Philadelphia, Pennsylvania. Abstract #L22

2. Smith T. FDA Approves Omalizumab as First Treatment of 1 or More Food Allergies for Children, Adults. Article. HCPLive. February 16, 2024. https://www.hcplive.com/view/fda-approves-omalozumab-first-treatment-of-1-or-more-food-allergies-for-children-adults

3. FDA. PALFORZIA. Updated August 1, 2024. https://www.fda.gov/vaccines-blood-biologics/allergenics/palforzia