Successful Oral Immunotherapy (OIT) Due to Anti-IgE Protection

<b>Background/Objectives</b>: Oral immunotherapy with peanut protein powder is difficult to initiate in patients with a very low reactivity threshold to peanuts. For this specific group, an add-on treatment with omalizumab (anti-IgE monoclonal antibody) is helpful to tolerate the initial steps. <b>Methods</b>: After failed initiation in three children, an off-label approval from the individuals' insurance was necessary for the premedication with anti-IgE ahead of a second approach at our center. Currently, the European countries have no approval from the European Medicines Agency (EMA) for the treatment of food allergies with omalizumab. <b>Results</b>: Under anti-IgE protection, our patients have restarted the oral immunotherapy without anaphylactic reactions and have reached the maintenance dose within the treatment protocol. <b>Conclusions</b>: For a few patients with initial anaphylactic reactions due to doses below the first treatment step (3 mg peanut protein powder), a premedication with omalizumab is not only safe but also reduces side effects, in particular anaphylactic reactions, and the time to reach the hundredfold higher maintenance dose (300 mg peanut protein powder).