Managing Food Allergies: New Treatments Are Changing the Game

Food allergies can significantly impact daily life. And while avoidance remains the cornerstone of management, there are new ways of managing symptoms that are game changers. “These three treatment options are expanding the ways in which people struggling with food allergies can stay safe and keep their symptoms in check,” says Lauren Whalen, a certified physician assistant at Schweiger Dermatology & Allergy. While none of them are cures, they all offer an additional layer of protection and can improve overall quality of life.

Xolair: A Leap Forward

For patients with severe, persistent allergies that don’t respond well to conventional therapies, Xolair (omalizumab), a monoclonal antibody, “works by targeting and inhibiting immunoglobulin E (IgE), a key player in allergic reactions,” explains Whalen. “By binding to IgE, Xolair prevents it from attaching to mast cells and basophils, thereby reducing the release of histamines and other inflammatory mediators responsible for allergic symptoms.” Clinical studies have shown promising results, particularly in reducing the frequency and severity of allergic reactions, including anaphylaxis.

Who’s It Good For?

Anyone who has experienced life-threatening reactions or is considered high risk can benefit from Xolair. “While it’s not a cure for food allergies, it represents a significant step forward in the management of this condition,” she says. “It’s important to note that treatment with Xolair requires careful evaluation and ongoing monitoring by an allergist.”

Not all patients are suitable candidates for this therapy, and potential side effects, such as injection site reactions must be considered. “Nevertheless, for those who meet the criteria, Xolair can offer hope and improved safety for those living with severe food allergies,” adds Whalen. “In my practice I’ve been able to experience firsthand the positive benefit that Xolair has had on both my patients as well as their families,” she shares. “I believe it will improve the quality of life for many who are affected by the daily struggle of food allergies.”

Sublingual Immunotherapy: Expanding Its Reach

Traditionally used for environmental allergies, sublingual immunotherapy (SLIT) involves placing a small amount of allergen under the tongue, allowing the immune system to gradually build tolerance. “I believe this approach could revolutionize how we treat food allergies, particularly for patients with severe reactions to allergens such as peanuts, tree nuts or shellfish,” says Whalen.

Clinical trials that use SLIT for food allergies demonstrate that patients can achieve desensitization, meaning they can tolerate higher amounts of the allergen without experiencing severe reactions. Whalen recommends SLIT therapy for patients as young as three years of age.

How It Works

The therapy typically involves a daily dose of the allergen, starting with a very small amount that gradually increases. This controlled exposure helps retrain the immune system to respond differently, potentially transforming how patients navigate their food allergies. Importantly, SLIT may also reduce the risk of accidental exposure and enhance quality of life for many individuals and families.

However, it’s crucial to recognize that SLIT is not a cure but a form of treatment that requires commitment and monitoring. Potential side effects, such as oral irritation or gastrointestinal discomfort, should be discussed thoroughly with patients. “Ongoing research is essential to better understand long-term outcomes and optimal protocols for various allergens,” says Whalen. “As we continue to explore this innovative therapy, collaboration among allergists, patients and researchers will be vital to harnessing the full potential of SLIT in managing food allergies effectively.”

Oral Immunotherapy: Reducing Risk

Unlike medications that treat symptoms, oral immunotherapy (OIT) targets the root cause of the food allergy by modifying the body’s response to allergens. “It’s a process where patients gradually consume increasing amounts of an allergenic food under medical supervision with the amount slowly increased over time,” explains Whalen. “The goal isn’t necessarily for someone to eat large amounts of the food regularly but to reduce the risk of a severe reaction in case of accidental exposure.”

It’s a Process

OIT requires a meticulous, tailored approach. It begins with a series of allergy tests to determine the patient’s specific sensitivities and potential risk factors. Once a baseline is established, the therapy starts with an “up-dosing” phase, where patients consume minuscule amounts of the allergenic food — often less than a milligram. Over weeks or months, this dose is gradually increased in a controlled clinical setting. Once the patient reaches a maintenance dose, they continue consuming this amount daily at home to sustain the desensitization effect.

“The potential benefits of oral immunotherapy are significant,” notes Whalen. “For many, it offers a sense of freedom and security that was previously unattainable.” The risk of severe reactions from accidental exposure can be reduced, allowing patients and their families to worry less about cross-contamination in food. “For children, this can mean a more normalized life experience, where they can safely participate in activities like birthday parties or school lunches without constant fear of an allergic reaction,” she says.

Unfortunately, this therapy is not suitable for everyone. “OIT carries risks, including potential adverse reactions during the up-dosing phase, which is why the initial phases of treatment are conducted in a medical setting with emergency care readily available,” says Whalen. The decision to pursue OIT must be made in consultation with a skilled allergy provider, who will evaluate your medical history, the severity of the allergy and your overall health.

Lauren Whalen, PA-C, is a certified physician assistant at Schweiger Dermatology Group. She has spent years training under a board-certified allergist and immunologist and has been a practicing allergy provider since 2018. Lauren treats a wide range of conditions including but not limited to food, drug and environmental allergies. She has a particular passion for pediatric food allergies and has many years of experience treating food allergies with oral immunotherapy and sublingual immunotherapy.