Age, Maintenance Dosing Shape MOIT Counseling in Multifood Allergy

In a follow-up interview with HCPLive, Robert A. Wood, MD, professor of pediatrics at Johns Hopkins University School of Medicine, discussed post hoc analyses from the OUTMATCH stage 2 trial suggesting age and maintenance dosing may shape individualized counseling for multiallergen oral immunotherapy (MOIT) in multifood allergy.¹

Promising Data from OUTMATCH Stage 2 Trial

OUTMATCH stage 2 randomized 117 participants with allergy to peanut and ≥ 2 additional foods to omalizumab or omalizumab-facilitated MOIT targeting a 1000 mg per-food maintenance dose, with omalizumab reaching greater intention-to-treat success (36% vs 19%; odds ratio [OR], 2.6; 95% CI, 1.1-6.3; P =.03).¹ Discontinuation reached 49% in the MOIT arm compared with 12% for omalizumab, driving much of the gap between arms.² Wood said newer analyses point toward more individualized counseling based on patient age and treatment goals.

"We've not seen a… big age difference for omalizumab, but many studies with OIT have suggested better outcomes in very young children," Wood told HCPLive. “Younger kids may also have [fewer] side effects than older children or adolescents, so there could be a distinction in the recommendations made to a family based on patient age."

Wood noted adherence often grows harder in adolescence, as daily dosing becomes burdensome even amid minor symptoms.

OUTMATCH Post-Hoc Analysis: Reaching the Full 3000 mg Dose

A post hoc subgroup analysis found participants reaching the full 3000 mg MOIT maintenance dose had greater success than those on lower doses (54% vs 24%; P =.13), though the comparison was underpowered.² Wood said dosing targets often vary by allergen and family goals.

“The goal of the family may be very different for one food versus another,” Wood said. “If a patient is being treated, say, for peanut, cashew, and walnut, where in most instances there's not a big desire to actually eat a lot of that food, they may tend toward lower doses because it's less cumbersome. If [the food allergy] is…milk, egg, and wheat, they may really be pushing harder for the goal of being able to introduce the food into the diet.”

Wood said both omalizumab and omalizumab-facilitated MOIT remain viable options requiring individualized risk-benefit discussion. He called for additional comparative and cost-benefit research to guide selection between the 2 strategies.²

Read part 1 of our interview with Wood here: Omalizumab Outperforms Oral Immunotherapy for Multifood Allergy.

Editor’s note: Reported disclosures for Wood include Genentech and Novartis Pharmaceuticals Corporation.

References

1. Wood RA, et al. Treatment of Multifood Allergy with Omalizumab or Multiallergen Oral Immunotherapy. JAMA Pediatr. 2026. doi:10.1001/jamapediatrics.2026.2910

2. Omalizumab Outperforms Multiallergen OIT for Multifood Allergy. HCPLive. https://www.hcplive.com/view/omalizumab-outperforms-multiallergen-oit-multifood-allergy. Published July 30, 2026. Accessed July 30, 2026.