Omalizumab as Monotherapy and as Adjunct Therapy to Multi-Allergen OIT in Food Allergic Participants

Inclusion Criteria:

Individuals who meet all of the following criteria are eligible for enrollment as study
participants:

   1. Participant and/or parent/legal guardian must be able to understand and provide
   informed consent and/or assent, as applicable;

   2. Peanut allergic: participant must meet all of the following criteria to minimize the
   chance that the participant will develop natural tolerance to peanut over the course
   of the study:

      1. Positive skin prick test (SPT) defined as ≥4 mm wheal greater than saline
      control) to peanut,

      2. Positive peanut immunoglobulin E (IgE), ≥6 kUA/L, at Screening or within three
      months of Screening, determined by ImmunoCap, and

      3. Positive double-blind placebo-controlled food challenge (DBPCFC), defined as
      experiencing dose-limiting symptoms at a single dose of ≤100 mg of peanut
      protein.

   3. Allergic to at least two of the six other foods (milk, egg, wheat, cashew, hazelnut,
   walnut): each participant must meet all of the following criteria for at least two of
   the six other foods to minimize the chance that the participant will develop natural
   tolerance to at least two of the six other foods over the course of the study:

      1. Positive SPT (≥4 mm wheal) to food,

      2. Positive food specific IgE (≥6 kUA/L) at Screening or within three months of
      Screening, determined by ImmunoCap, and

      3. Positive DBPCFC, defined as experiencing dose-limiting symptoms at a single dose
      of ≤300 mg of food protein.

   4. With body weight (as measured at Screening) and total serum IgE level (as measured
   within three months of Screening) suitable for omalizumab dosing;

   5. If female of child-bearing potential, must have a negative urine or serum pregnancy
   test;

   6. For women of childbearing potential, must agree to,during the treatment period and for
   60 days after the last dose of study drug:

      - remain abstinent (refrain from heterosexual intercourse), or

      - use acceptable contraceptive methods (barrier methods, or

      - oral, injected, or implanted hormonal methods of contraception, or

      - other forms of hormonal contraception that have comparable efficacy).

   7. Plan to remain in the study area of an OUtMATCH clinical research unit (CRU) during
   the trial; and

   8. Be willing to be trained on the proper use of an epinephrine autoinjector for the
   duration of the study.

Exclusion Criteria:

Individuals who meet any of the following criteria are not eligible for enrollment as study
participants:

   1. Inability or unwillingness of a participant and/or parent/legal guardian to give
   written informed consent and/or assent or comply with the study protocol;

   2. Clinically significant laboratory abnormalities at Screening;

   3. Dose-limiting symptoms to the placebo portion of the Screening DBPCFC;

   4. Sensitivity or suspected/known allergy to any ingredients (including excipients) of
   the

      - active or placebo oral food challenge (OFC) material,

      - multi-allergen oral immunotherapy (OIT), or

      - drugs related to omalizumab (e.g., monoclonal antibodies, polyclonal gamma
      globulin).

         - Note: Guidance for determination of sensitivity to excipients will be
         detailed in the study's Manual of Procedures (MOP).

   5. Poorly controlled atopic dermatitis (AD) at Screening, per the Principal
   Investigator's PI's) discretion;

   6. Poorly controlled or severe asthma/wheezing at Screening, defined by at least one of
   the following criteria:

      1. Global Initiative for Asthma (GINA) criteria regarding asthma control latest
      guidelines,

      2. History of two or more systemic corticosteroid courses within six months of
      Screening or one course of systemic corticosteroids within three months of
      Screening to treat asthma/wheezing,

      3. Prior intubation/mechanical ventilation for asthma/wheezing,

      4. One hospitalization or Emergency Department (ED) visit for asthma/wheezing within
      six months of Screening,

      5. Forced expiratory volume in one second (FEV1) <80 percent of predicted or
      FEV1/forced vital capacity (FVC) <75 percent, with or without controller
      medications (only for participants who are aged seven years or older and are able
      to perform spirometry), or

      6. Inhaled corticosteroid (ICS) dosing of >500 mcg daily fluticasone (or equivalent
      ICS based on the National Institutes of Health, National Heart, Lung, and Blood
      Institute (NHLBI) dosing chart).

   7. History of severe anaphylaxis to participant-specific foods that will be used in this
   study, defined as neurological compromise or requiring intubation;

   8. Treatment with a burst of oral, intramuscular (IM), or intravenous (IV) steroids of
   more than two days for an indication other than asthma/wheezing within 30 days of
   Screening;

   9. Currently receiving oral, intramuscular, or intravenous corticosteroids, tricyclic
   antidepressants, or beta-blockers (oral or topical);

10. Past or current history of eosinophilic gastrointestinal (GI) disease within three
   years of Screening;

11. Past or current history of cancer, or currently being investigated for possible
   cancer;

12. Previous adverse reaction to omalizumab;

13. Past or current history of any immunotherapy to any of the foods being treated in this
   study (e.g., OIT, sublingual immunotherapy [SLIT], EPIT) within 6 months of Screening;

14. Treatment with monoclonal antibody therapy, such as omalizumab (Xolair®), dupilumab
   (Dupixent®), benralizumab (Fasenra™), mepolizumab (Nucala®), reslizumab (Cinqair®), or
   other immunomodulatory therapy within six months of Screening;

15. Currently on "build-up phase" of inhalant allergen immunotherapy (i.e., has not
   reached maintenance dosing). Note: Individuals tolerating maintenance allergen
   immunotherapy can be enrolled;

16. Inability to discontinue antihistamines for the minimum wash-out periods required for
   SPTs,or OFCs;

17. Current participation in another therapeutic or interventional clinical trial or
   participation within 90 days of Screening;

18. Use of investigational drugs within 24 weeks of Screening;

19. Pregnant or breastfeeding, or intending to become pregnant during the study or within
   60 days after the last dose of omalizumab or placebo for omalizumab;

20. Has a first-degree relative already enrolled in the study; or

21. Past or current medical problems (e.g., severe latex allergy), history of other
   chronic diseases (other than asthma/wheezing, AD, or rhinitis) requiring therapy
   (e.g., heart disease, diabetes), findings from physical assessment, or abnormalities
   in clinical laboratory testing that are not listed above, which, in the opinion of the
   PI, may:

      - pose additional risks from participation in the study,

      - may interfere with the participant's ability to comply with study requirements,
      or

      - may impact the quality or interpretation of the data obtained from the study.