Food Allergy Treatment Options: Finding the Right Fit for You

Introduction

Hi, welcome back to another episode. It’s great to be with you and I’m excited today to talk about various treatment options for food allergy. So, so many times, uh, what we hear is like, what is gonna be the right treatment for the right patient at the right time? And a lot of times when people would first ask me about, uh, what treatment they should do.

Um, they were often focused on products and protocols and finding that right product and that right protocol and how can we take every single person and fit them into this certain protocol with a product.

Moving Beyond One-Size-Fits-All

But what I found through the years, ‘cause I’ve been doing this a long time, is it’s not always the, the product and the protocol’s, the easy part.

But what we really wanna do is individualize this and make this fit. Not a one size fits all, but what’s the size that can fit The one meaning how can we individualize this? How can I meet you where you are, and then take you to where you want to go, depending on your goals and what’s important to you.

And that may not be the same for every person. You know? What we want to do is try and normalize life for people.

Defining “Normal” for Each Patient

And people will say, well, what’s normalized mean? Great question. That’s really not for me to define. That’s for the people, the patients to define. It’s their life, not mine, it’s theirs. What’s normal for them.

What would be most beneficial for them? My job is to be fluent in every single opportunity that’s out there and all the treatment options so that I have them at my fingertips so that I can implement that in the right patient at the right time, in the right situation, and get them to where they want to go, depending on their history.

Goals Can Differ for Each Food

So that’s really what we wanna focus on. And the thing that’s crazy is like even among, if you look at one person, just one person who may have a list of four foods they’re allergic to, the goals may not even be the same for every food. Because we have taste aversions, we have our diets, we have our culture.

Well, what’s important to that particular patient? Well, there are certain foods that are very prominent. In certain cultures and not so prominent in other cultures. So who are we to define for that? And so it really does come down to the patient and what’s important to them.

Individualized Protection vs. Full Tolerance

So some patients, if they have a list of four foods, they may want on one or two foods, for instance, just to be protected from a cross contamination or, or an accidental exposure.

But on the other two or three foods that they’re allergic to, they wanna, may wanna fully incorporate that into their diet. So we want to approach not only each individual as an individual, but also each of the foods as such, and say what’s gonna help you the most. So let’s kind of dive into this for a little bit.

Be Prepared, Not Scared

First and and foremost, with food allergy treatment, I always say the key to this is be prepared, not scared. And what I mean by that is no matter what you’re doing, no matter how you’re approaching it. Just be prepared and how can you be prepared by being educated, by having a correct understanding of your allergies, of your situation so that you are comfortable and confident?

I always tell people this, we wanna be like the military where we’re prepared for worst case scenarios. Not necessarily most likely, but worst case, because when we’re prepared, we feel empowered. We can have less fear with it. So be prepared, not scared.

The Old Model: Avoidance Only

Now, in the case of food allergy, for years and years and years, it was all about just avoidance. Avoid the food, read the labels, carry your epinephrine injector, and hope that nothing happens. That’s okay.

But what if you’re allergic to 5, 6, 7, 8 foods? And you’re having to do that and your diet’s limited and calories are restricted, and you may have nutrient deficiencies in a small child because they can’t get the calories because they have to avoid so many things.

The Burden of Avoidance

That becomes a problem. And so, and the risk of accidental ingestion is quite high every year, you know, for families. And so they always live in kind of that fear and carry that burden of what if. And that burden can be quite massive.

When I started food allergy treatment years and years ago, it was about a product and a protocol and getting that person to eat the food safely.

But one of the most enlightening eye-opening aspects that I found through doing this more than the physical aspect, it was the psychosocial aspect that was making the biggest impact in people.

The Emotional Transformation

You know, I started seeing patients where they would not look me in the eye where they were. They were just felt very isolated, would not communicate.

And through the course of the program, I would see personalities emerge not only for the patient but also the parents as that burden was being lifted and taken off. They could relax a little bit and you would see them start smiling, conversant, engaging and, and that stress was so apparent. And then as that goes away, it’s incredible what happens to people.

And that was probably the most eye-opening. But also one of the most beautiful things that I observed as we started food allergy treatment was just, I didn’t know the extent of the burden that patients were carrying. Until it was gone.

Oral Immunotherapy (OIT)

Years ago, we started off with something called oral immunotherapy. What does that mean? Oral, meaning you take it orally.

Immunotherapy means you’re cha, it’s a therapy that’s gonna change the immune system. So it’s actually having that impact on the immune system in a very beneficial way.

That probably took hold the quickest and the earliest and was the most prominent early on.

Sublingual Immunotherapy (SLIT)

Now there’s something that’s emerging—it’s been around a while too—but it’s just starting to gain a lot of evidence and prominence. It’s called sublingual immunotherapy.

So again, a therapy that’s changing the immune system, but it’s delivered under the tongue. There are different parts of the immune system that get activated when you deliver something under the tongue versus swallowing it.

Both work and there’s pros and cons to each.

Oral Immunotherapy: How It Works

With oral immunotherapy, typically we start off with both sublingual and oral. We start off with microscopic amounts of the actual food that the person’s allergic to, and then in a very systematic, methodical way, we increase that dose under monitored conditions, under the direction of an expert allergist.

We can take them from microscopic amounts to actual foods, eventually consuming that food safely.

They can either reach protection from accidental exposure or full tolerance to freely incorporate the food into their diet.

Sublingual Immunotherapy: How It Works

With sublingual immunotherapy, the doses are lower and the process slower, but it’s extremely safe.

It’s ideal for people who want protection from accidental exposure but don’t necessarily want to eat the food regularly.

In some cases, sublingual immunotherapy can serve as a bridge to oral immunotherapy—offering a gentler start for sensitive patients.

Comparing Safety and Restrictions

Sublingual immunotherapy has strong safety data—many studies report zero use of epinephrine during treatment.

Oral immunotherapy carries a slightly higher risk for reaction, and exercise restrictions for a few hours after dosing.

Both are effective; the right choice depends on patient preference, goals, and medical context.

Injectable Therapy: Omalizumab (Xolair)

There also is an injectable medication that was FDA approved for food allergy called Omalizumab (Xolair).

The current FDA-approved use:

• Given every 2–4 weeks depending on weight and labs
• For patients aged 1 year and up with severe or multiple food allergies
• Provides protection against accidental exposures but requires continued food avoidance

Omalizumab can also be used in conjunction with oral immunotherapy to make the process faster and safer.

Whole Foods vs. Pharmaceutical Products

There is an FDA-approved peanut capsule for oral immunotherapy.

However, studies show real foods can be used effectively for both oral and sublingual immunotherapy.

More than 95% of allergists performing OIT in the U.S. use commercially available foods, not pharmaceutical-grade products.

This allows treatment for non-peanut allergens—like milk, egg, wheat, tree nuts, sesame, and others—without exclusion or unnecessary cost.

The Power of Food to Heal

It’s amazing to see how food itself—used strategically—can retrain the immune system.

Something once life-threatening can become life-restoring. That transformation is what makes this work so powerful.

Choosing the Right Treatment

Which treatment should you do? That depends on your goals, medical history, and lifestyle.

Right patient, right treatment, right time.

If you’re struggling to find an allergist who offers multiple options, look into us.

We provide both in-person and telehealth care across most of the U.S., and even collaborate internationally with other allergists.

The Immune Edit

The immune edit here today is knowing you have choices and options.

If you don’t think you have any, reach out to me. Leave a comment, let’s see what we can create together.

Tune in next time on The Immune Edit.

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