- Design
- Randomised, double-blind, double-dummy trial (OUTMATCH stage 2)
- Population
- 117 participants aged 1–55 with peanut plus ≥2 other food allergies
- Primary outcome
- Tolerating ≥4,044 mg cumulative protein of all three foods
- Effect
- 36% vs 19%; OR 2.6 (95% CI 1.1–6.3); serious AEs 0% vs 31%
Stage 2 of the OUTMATCH trial, in JAMA Pediatrics (1 October), randomised 117 people aged 1 to 55 (median age 7) with peanut allergy plus at least two other food allergies. After 16 weeks of omalizumab, they either continued blinded omalizumab or switched to multi-food oral immunotherapy (OIT) for 44 weeks.
By intention to treat, 36% on omalizumab and 19% on OIT could tolerate at least 4 g of protein from all three foods (odds ratio 2.6). But only 51% on OIT finished the study against 88% on omalizumab, and per-protocol results did not differ. Serious adverse events occurred in 31% on OIT and none on omalizumab; adrenaline was used in 37% against 7%.
For children with several food allergies, the difference is less about which works and more about which families can sustain. OIT asks for daily exposure and carries real reaction risk; omalizumab asks for regular injections and ongoing cost. Neither is a cure.
- Omalizumab and multi-food OIT reached similar protection in those who completed treatment
- OIT carried far more serious reactions and adrenaline use
- One in five stopped OIT because of adverse effects
- Cost and injection frequency of omalizumab are the main barriers to discuss
- Keep adrenaline auto-injectors and avoidance plans in place on either treatment
Why it matters
It reframes the choice as one of tolerability and adherence rather than raw efficacy.
Don't overread it
The intention-to-treat advantage mostly reflects OIT dropouts; in completers the two were similar.
The statistics, in plain English
The OR of 2.6 (95% CI 1.1 to 6.3) is significant but wide. When analysis is restricted to those who completed treatment, the difference disappears, which tells you it comes from people leaving OIT.
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