Discover the latest treatments for food allergies.

There’s good news for patients who suffer from food allergies with recent advancements in treatments.

Board-certified in Allergy and Immunology, Isma Shah, MD gave us an overview of the latest treatments and how you can find relief at ENT & Allergy of Delaware.

What’s changed in food allergy treatments recently:

Previously, food allergy treatment consisted of avoidance of trigger foods with any accidental ingestions treated with epinephrine (epi) injections. Food allergy treatment has thankfully progressed quite far in recent years with the advent of oral immunotherapy (OIT) and a biologic injection called Xolair

Oral immunotherapy (OIT) consists of giving patients allergic to a specific food(s) small amounts of the trigger food(s) to induce tolerance of the food allergen. This is not a food allergy cure but can help patients eat more of a food they are allergic to and ensure that a higher dose of the food is needed for an allergic response. There is only one FDA approved OIT treatment which is specifically for peanut allergy; however, many allergists practice OIT for other foods as well (tree nuts, egg, cow’s milk, sesame, etc.).

Xolair obtained FDA approval last February for patients aged 6 months and older with a food allergy diagnosis. This is a safe injection that has been studied for many years for patients with asthma or hives. Xolair is a great option for patients who may have difficulty avoiding their food allergy triggers or who are going to a new environment, such as younger kids starting school or daycare or teenagers going to college.

Is there a difference in treatments for a patient who has multiple food allergies vs. a patient who has one food allergy?

Overall, patients with one food allergy or multiple food allergies have the same options for treatment:

Dietary avoidance
Oral immunotherapy (OIT), or
Xolair injections

Regardless of the amount of food allergies a person has, the treatment options are the same, but OIT/Xolair may be a better option for people with multiple food allergies as it can be harder to practice dietary avoidance of multiple foods.

How should you know if you/your child has a food allergy or food intolerance?

Food reactions include both allergy or intolerance. The main difference is that a food allergy reaction will occur with each and every ingestion of the food regardless of the amount ingested.

About food allergies:

Food allergy reactions, also known as IgE-mediated allergic reactions, include the following symptoms:

A rash known as “hives” - typically very itchy and disappears within a few hours,
Trouble breathing, and/or
Immediate episodes of vomiting.

Food allergy reactions typically occur within a few hours of eating the food. They are typically treated with oral antihistamines (allergy pills) if a mild reaction or epi pens if a severe reaction.

About food intolerance:

Food intolerance symptoms mainly include stomach upset such as bloating and diarrhea. These symptoms typically get worse as a greater amount of the food is eaten. One common example is lactose intolerance – dairy products cause bloating/diarrhea but eating or drinking lactose free products or using LactAid resolves symptoms.) Allergy pills and epi pens do not treat these reactions.

History taking by an Allergist is the best way to differentiate these symptoms. Unfortunately, food allergy testing is not 100% accurate and is not recommended unless there is concern for a food allergy. There is no FDA approved testing for food intolerances.

Treatments ENT & Allergy of Delaware uses to treat food allergies:

ENT & Allergy of Delaware has a variety of options to treat food allergies.

Food allergy testing is the first step.

Our allergists will perform routine allergy testing and if there is a suspicion that a patient may have outgrown an allergy, we perform oral graded food challenges. This consists of patients coming in to eat their trigger foods under physician supervision in a safe environment. These challenges are especially important to perform as testing may not be accurate. Challenges are recommended prior to starting any patient on OIT or Xolair.

When dietary avoidance is not enough:

For patients who have not outgrown their food allergies or are unlikely to, we offer OIT and Xolair as options for patients from whom dietary avoidance is not enough. Both OIT and Xolair will not cure a patient of their food allergies but can make it safer for patients to experience new environments (daycare, restaurants, college, international travel) where they may be exposed to unlabeled food allergens by increasing the amount needed to be eaten to cause a reaction. This protects patients against any accidental exposures.

How Xolair works (how it is taken and best candidates):

Xolair is a biologic injection that has been on the market for many years for patients with asthma and hives. It was approved this February 2024 for food allergy.

Dosing - Dosing is based on weight and a lab result for the total allergy antibody level (IgE). It can be every two weeks or every 4 weeks depending on the IgE level and weight.
Administration - It is an injection that can be administered in the office or at home. One side effect that was noted in trials includes anaphylaxis, or an allergic reaction. The first three injections are administered in the office with a two-hour monitoring period. An epi pen is still required for patients with food allergy to carry around in case of accidental exposure, even if a patient is on Xolair.

Does insurance cover Xolair?

There is broad insurance coverage for Xolair. Prior authorizations may be needed for approval but are completed by your Allergist’s office using prior testing/results/history. The amount of coverage is dependent upon individual insurance plans.