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Multi OIT to Test Immune Markers After Minimum Maintenance Dose

Primary Purpose

Food Allergy

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Omalizumab
Food Flour Allergens
Sponsored by
Kari Christine Nadeau, MD PhD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Food Allergy focused on measuring Oral Immunotherapy, Omalizumab, OIT, Xolair

Eligibility Criteria

2 Years - 25 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Aged 2 to 25 years with clinical history of allergy to at least two of the following: milk and/or egg and/or peanut and/or almond and/or wheat and/or cashew and/or sesame seed and/or soy and/or pecan and/or walnut and/or hazelnut and/or shrimp and/or cod and/or salmon and
  • Sensitivity to food allergens documented by a positive skin prick test result greater than or equal to 6mm wheal diameter to each allergen or
  • ImmunoCAP IgE level >4kU/L for each allergen and
  • If female of child bearing potential, a negative urine pregnancy test before being allowed to participate in the study (week 0) and
  • A plan to remain in the study area of the research center during the trial and
  • Be trained on the proper use of the Epinephrine autoinjector and agree to follow epi training to be allowed to enroll in the study and
  • If female of child-bearing potential, willing to be compliant with a medically-approved method of contraception (please see Pregnancy section in this IND document) and
  • Agree to eliminate other known food allergens from subject's diet so as not to confound the safety and efficacy data from the study and
  • Avoid open or blinded food challenges to food allergens

Exclusion Criteria:

  • Previous anaphylactic reaction to Omalizumab
  • A history of severe anaphylaxis to food allergens that will be desensitized in this study requiring intubation or admission to an ICU, frequent allergic or non-allergic urticaria, or history consistent with poorly controlled persistent asthma
  • Unstable angina, significant arrhythmia, uncontrolled hypertension, chronic sinusitis, or other chronic or immunological diseases that, in the judgment of the investigator, might interfere with the evaluation or administration of the test drug or pose additional risk to the subject (e.g., gastrointestinal or gastroesophageal disease, chronic infections, scleroderma, hepatic and gallbladder disease, chronic non-allergic pulmonary disease)
  • An average forced expiratory volume at one second (FEV1) or peak expiratory flow rate (PEF) less than 80% predicted (moderate persistent asthma) with or without controller medication (if able to perform the maneuver) at screening, or a food challenge visit
  • Current users of oral, intramuscular, or intravenous corticosteroids, tricyclic antidepressants, or are taking a beta-blocker (oral or topical)
  • Routinely using medication that could induce adverse gastrointestinal reactions during the study
  • Refusing to sign or follow the Epinephrine autoinjector Training Form
  • Pregnant or breast feeding women
  • Unwilling to avoid other allergens outside this study
  • Concurrent/prior use of immunomodulatory therapy (within 6 months)
  • A diagnosis of eosinophilic esophagitis, eosinophilic colitis, or eosinophilic gastritis.

Sites / Locations

  • UCLA
  • Sean N. Parker Center for Allergy and Asthma Research at Stanford

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Group A (300 mg maintenance dose)

Group B (1200 maintenance dose)

Arm Description

After initial therapy with omalizumab Group A subjects will escalate their food flour allergens to 300 mg in 18 weeks.

After initial therapy with omalizumab Group B subjects will escalate their food flour allergens to 1200 mg in 18 weeks.

Outcomes

Primary Outcome Measures

Change in Allergen-specific Serum IgG4 and IgE
Change in allergen-specific serum IgG4 and IgE from baseline to Week 18 (End of Study)

Secondary Outcome Measures

Full Information

First Posted
April 7, 2017
Last Updated
April 7, 2020
Sponsor
Kari Christine Nadeau, MD PhD
Collaborators
University of California, Los Angeles
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1. Study Identification

Unique Protocol Identification Number
NCT03181009
Brief Title
Multi OIT to Test Immune Markers After Minimum Maintenance Dose
Official Title
A Phase 2 Study Multi Oral Immunotherapy in Multi Food Allergic Patients to Test Immune Markers After Minimum Maintenance Dose
Study Type
Interventional

2. Study Status

Record Verification Date
April 2020
Overall Recruitment Status
Completed
Study Start Date
July 31, 2017 (Actual)
Primary Completion Date
December 1, 2018 (Actual)
Study Completion Date
January 30, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Kari Christine Nadeau, MD PhD
Collaborators
University of California, Los Angeles

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Few studies have been conducted to optimize safety of multiple food allergen oral immunotherapy (OIT) in conjunction with Omalizumab as well as to identify the immunological mechanism(s) underlying any long-lasting effects of OIT. To address these issues in the field of food allergy research, we have designed this study to test whether: 1) Omalizumab improves the safety of multiple food allergen OIT in subjects with multi food allergies, 2) Omalizumab treatment with multiple food allergen OIT is associated with the ability to use a lower maintenance dose of each food allergens in the OIT regimen, particularly in younger subjects with food allergies.
Detailed Description
This is a phase 2 multisite study that will be conducted at two centers in the U.S. All subjects will receive oral immunotherapy for their specific food allergies (peanut, milk, egg, soy, wheat, cashew, walnut, almond, hazelnut, cod, salmon, sesame, shrimp). All participants will receive three doses of Omalizumab 4 weeks apart over 8 weeks. The subject's allergens will be introduced after receiving the third omalizumab dose. Subjects will return to clinic to escalate the dose of their allergens until 300 mg (group A) vs. 1200 mg (group B) total protein daily dose is reached. There will be equivalent allergen protein portions depending on test allergen per each subject's history. Subjects will be randomized 1:1 to either group A or group B after meeting eligibility criteria. All subjects and study personnel will be blinded to group A vs B. Food protein and powder will be obtained and prepared as per Investigational New Drug 14831 and will be in compliance with all applicable regulations. Omalizumab is approved by the European Medicines Agency (European FDA) and by the US FDA. Omalizumab will be dosed according to Genentech Dosing Omalizumab will be provided by the site.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Food Allergy
Keywords
Oral Immunotherapy, Omalizumab, OIT, Xolair

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
This is a phase 2 multi site study that will be conducted at two centers in the U.S. All subjects will receive oral immunotherapy for their specific food allergies (peanut, egg, milk, wheat, soy, cashew, walnut, almond, hazelnut, sesame seed, cod, salmon and shrimp). All participants will receive three doses of Omalizumab 4 weeks apart over 8 weeks. The subject's allergens will be introduced after receiving the third omalizumab dose. Subjects will return to clinic to escalate the dose of their allergens until 300 mg (group A) vs. 1200 mg (group B) total protein daily dose is reached. There will be equivalent allergen protein portions depending on test allergen per each subject's history. Subjects will be randomized 1:1 to either group A or group B after meeting eligibility criteria. All subjects and study personnel will be blinded to group A vs B.
Masking
ParticipantInvestigator
Masking Description
Blinded labeling (Individual dosing cups will mention a choice of two doses the participant could be assigned to). Oat flour is used as the filler to create equal volumes for all doses
Allocation
Randomized
Enrollment
60 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group A (300 mg maintenance dose)
Arm Type
Experimental
Arm Description
After initial therapy with omalizumab Group A subjects will escalate their food flour allergens to 300 mg in 18 weeks.
Arm Title
Group B (1200 maintenance dose)
Arm Type
Active Comparator
Arm Description
After initial therapy with omalizumab Group B subjects will escalate their food flour allergens to 1200 mg in 18 weeks.
Intervention Type
Drug
Intervention Name(s)
Omalizumab
Other Intervention Name(s)
Xolair
Intervention Description
All subjects will receive omalizumab, stored and prepared according to the investigator brochure. Subjects greater or equal to 4 yrs receive 150 mg. Subjects less than 4 yrs receive 75 mg.
Intervention Type
Drug
Intervention Name(s)
Food Flour Allergens
Other Intervention Name(s)
Food flours
Intervention Description
The subject's allergens will be introduced after receiving the third omalizumab dose.. Subjects will return to clinic to escalate the dose of their allergens until 300 mg (group A) vs. 1200 mg (group B) total protein daily dose is reached. There will be equivalent allergen protein portions depending on test allergen per each subject's history. Subjects will be randomized 1:1 to either group A or group B after meeting eligibility criteria. All subjects and study personnel will be blinded to group A vs B. Research staff will administer food flour to the subject orally in an age-appropriate food vehicle.
Primary Outcome Measure Information:
Title
Change in Allergen-specific Serum IgG4 and IgE
Description
Change in allergen-specific serum IgG4 and IgE from baseline to Week 18 (End of Study)
Time Frame
18 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
2 Years
Maximum Age & Unit of Time
25 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Aged 2 to 25 years with clinical history of allergy to at least two of the following: milk and/or egg and/or peanut and/or almond and/or wheat and/or cashew and/or sesame seed and/or soy and/or pecan and/or walnut and/or hazelnut and/or shrimp and/or cod and/or salmon and Sensitivity to food allergens documented by a positive skin prick test result greater than or equal to 6mm wheal diameter to each allergen or ImmunoCAP IgE level >4kU/L for each allergen and If female of child bearing potential, a negative urine pregnancy test before being allowed to participate in the study (week 0) and A plan to remain in the study area of the research center during the trial and Be trained on the proper use of the Epinephrine autoinjector and agree to follow epi training to be allowed to enroll in the study and If female of child-bearing potential, willing to be compliant with a medically-approved method of contraception (please see Pregnancy section in this IND document) and Agree to eliminate other known food allergens from subject's diet so as not to confound the safety and efficacy data from the study and Avoid open or blinded food challenges to food allergens Exclusion Criteria: Previous anaphylactic reaction to Omalizumab A history of severe anaphylaxis to food allergens that will be desensitized in this study requiring intubation or admission to an ICU, frequent allergic or non-allergic urticaria, or history consistent with poorly controlled persistent asthma Unstable angina, significant arrhythmia, uncontrolled hypertension, chronic sinusitis, or other chronic or immunological diseases that, in the judgment of the investigator, might interfere with the evaluation or administration of the test drug or pose additional risk to the subject (e.g., gastrointestinal or gastroesophageal disease, chronic infections, scleroderma, hepatic and gallbladder disease, chronic non-allergic pulmonary disease) An average forced expiratory volume at one second (FEV1) or peak expiratory flow rate (PEF) less than 80% predicted (moderate persistent asthma) with or without controller medication (if able to perform the maneuver) at screening, or a food challenge visit Current users of oral, intramuscular, or intravenous corticosteroids, tricyclic antidepressants, or are taking a beta-blocker (oral or topical) Routinely using medication that could induce adverse gastrointestinal reactions during the study Refusing to sign or follow the Epinephrine autoinjector Training Form Pregnant or breast feeding women Unwilling to avoid other allergens outside this study Concurrent/prior use of immunomodulatory therapy (within 6 months) A diagnosis of eosinophilic esophagitis, eosinophilic colitis, or eosinophilic gastritis.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kari C Nadeau, MD PhD
Organizational Affiliation
Stanford University
Official's Role
Principal Investigator
Facility Information:
Facility Name
UCLA
City
Los Angeles
State/Province
California
ZIP/Postal Code
90095
Country
United States
Facility Name
Sean N. Parker Center for Allergy and Asthma Research at Stanford
City
Mountain View
State/Province
California
ZIP/Postal Code
94040
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided
IPD Sharing Plan Description
pending
Citations:
PubMed Identifier
35014049
Citation
Sindher SB, Kumar D, Cao S, Purington N, Long A, Sampath V, Zedeck SS, Woch MA, Garcia-Lloret M, Chinthrajah RS. Phase 2, randomized multi oral immunotherapy with omalizumab 'real life' study. Allergy. 2022 Jun;77(6):1873-1884. doi: 10.1111/all.15217. Epub 2022 Jan 24.
Results Reference
derived
Links:
URL
http://med.stanford.edu/allergyandasthma
Description
Sean N. Parker Center for Allergy and Asthma Research
URL
http://is.gd/snpregistry
Description
Research Registry for the Sean N. Parker Center for Allergy and Asthma Research

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Multi OIT to Test Immune Markers After Minimum Maintenance Dose

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