August 04, 2025
3 min learn
Key takeaways:
- The times of passive reactive administration have handed; it’s time to be proactive.
- Sufferers could possibly add allergens to their diets with immunotherapy.
- Omalizumab can defend towards unintentional exposures.
Editor’s Notice: In Healio Allergy/Bronchial asthma’s column, “Meals Allergy: Truth vs. Fiction,” Douglas H. Jones, MD, breaks down what’s true and what’s delusion for quite a lot of matters associated to meals allergy symptoms. When you’ve got a query that you desire to answered on this column, electronic mail Jones at rmaaimd@gmail.com or Richard Gawel at rgawel@healio.com.
Meals allergy administration is shifting from passive methods — equivalent to avoidance, carrying epinephrine and hope — to proactive interventions.
Most sufferers and households are conscious of strict avoidance and emergency plans. However at this time, evidence-based instruments like oral immunotherapy, sublingual immunotherapy (SLIT) and omalizumab (Xolair; Genentech, Novartis) supply new hope for these burdened by meals allergy.
It’s time to transfer to assembly sufferers the place they’re to allow them to be guided to the place they need to go. There is no such thing as a cause a affected person shouldn’t have no less than one in every of these therapies obtainable to them in at this time’s world, regardless of the place they dwell.
Of observe, therapy choices ought to be mentioned, at size, with an allergist who has experience within the nuance of meals allergy.
Desensitization by publicity
OIT includes the day by day ingestion of small, managed quantities of a meals allergen equivalent to peanut, milk or egg with incremental will increase over time. The objective is to lift the brink of reactivity so the affected person can tolerate unintentional exposures or finally devour the meals freely and often.
This strategy decreases allergen-specific IgE, will increase IgG4 by blocking antibodies, reduces mast cell and basophile activation and induces T regulatory cells.
Medical phases embody preliminary dose escalation, which is predicated within the clinic and extremely supervised; a buildup part with weekly to month-to-month dose will increase; and a upkeep part, with day by day long-term dosing at house.
OIT is best for single meals allergens, however works for a number of meals allergens as effectively.
There’s an FDA-approved product, Palforzia (Peanut [Arachis hypogaea] Allergen Powder-dnfp, Stallergenes Greer), for peanut OIT, however it’s not essential.
A overwhelming majority of allergists use actual meals, in response to a survey performed by the Meals Allergy Help Staff, a nonprofit devoted to the therapy of meals allergy symptoms comprising greater than 144 practices that conduct OIT.
Even when dosing and exposures are minimized, OIT can result in sustained unresponsiveness. Sufferers can use OIT till they attain a stage the place they are often protected in unintentional exposures, or they will progress till they will eat the meals freely with out restrictions on how a lot they devour or once they devour it.
There are dangers and issues, nevertheless. Gastrointestinal discomfort, oral itching and gentle allergic reactions are frequent. There is also a threat for eosinophilic esophagitis. OIT requires excessive household dedication and adherence as effectively.
Security with simplicity
SLIT delivers small quantities of allergen beneath the tongue, normally in liquid type, the place the affected person holds it for 1 to 2 minutes earlier than swallowing it or spitting it out.
The antigen is introduced through oral Langerhans and dendritic cells, selling native and systemic immune tolerance. It has decrease allergen exposures than OIT, with much less threat for systemic reactions.
SLIT is much less potent than OIT in elevating reactivity thresholds, however it’s higher tolerated. It’s particularly useful for youthful youngsters or households who’re threat averse.
Using SLIT is rising amongst allergists. It may be achieved with actual meals or business extracts (off-label). Minimal systemic reactions have been reported, and its security profile is great.
Sufferers nonetheless must keep away from allergenic meals except they’ve been utilizing SLIT for an prolonged time period and have been correctly challenged by an allergist, or except they’ve accomplished a bridge to OIT.
Biologic increase or standalone desensitizer
Omalizumab is a monoclonal antibody that binds to free IgE, stopping its interplay with mast cells and basophils. In 2024, the FDA accredited it for IgE-mediated meals allergy in sufferers aged 1 to 55 years with a number of meals allergy symptoms.
It may be used as a monotherapy to extend reactivity thresholds with out meals dosing, though sufferers nonetheless must keep away from allergenic meals. It’s perfect for sufferers with a number of meals allergy symptoms, high-risk sufferers and households who’re OIT-intolerant. Additionally, it has been used off-label as an adjunct to OIT.
Research equivalent to OUtMATCH have proven that omalizumab alone considerably raised response thresholds. Additionally, omalizumab permits simultaneous desensitization to a number of meals.
When it comes to security, omalizumab is effectively tolerated total with uncommon threat for anaphylaxis, as with its use for bronchial asthma and urticaria. Dosing is subcutaneous, each 2 to 4 weeks, based mostly on weight and IgE stage.
The underside line
In case you are a affected person or have sufferers with persistent meals allergy — or households emotionally fatigued by the burden of avoidance — now could be the time to think about immunotherapy referrals or no less than start the dialog.
With instruments equivalent to OIT, SLIT and omalizumab, allergists will help households transfer past avoidance towards empowerment, safety and improved high quality of life.
Allergists now have a menu to choose from by way of meals allergy therapies and might individualize care in order that the suitable therapy is chosen for the suitable affected person on the proper time and that call is made collectively with the households.
Sufferers who’re uncertain the place to begin can go to myimmunenetwork.com.
For extra data:
Douglas H. Jones, MD, FAAAAI, FACAAI, is cofounder and CEO of World Allergy Immune Community, board licensed by the American Board of Allergy and Immunology. He will be reached on Instagram @drdougjones.
