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Uncovering the Truth About Food Allergies - Diagnosis Journey (Part 2) with Dr. Farrah Khan and Dr. Tom Chaco
Join Dr. Doug Jones, Dr. Farrah Khan, and Dr. Tom Chaco in Part 2 of this food allergies series on The Immune Edit Podcast. Discover treatment options like avoidance, Xolair, oral immunotherapy (OIT), and sublingual immunotherapy (SLIT), with pros, cons, and paths to food freedom. Vital guidance for families tackling allergies.
January 14, 2026
15 Minutes
Welcome to Part 2 of Episode 25 on The Immune Edit Podcast, hosted by Dr. Doug Jones. Joined by allergists Dr. Farrah Khan and Dr. Tom Chaco, this segment dives into food allergy treatment options beyond diagnosis. From avoidance strategies to advanced therapies like Xolair, oral immunotherapy (OIT), and sublingual immunotherapy (SLIT), discover pros, cons, and personalized approaches to managing food allergies effectively. Ideal for families seeking freedom from fear and practical immune health solutions.
Introduction to Food Allergy Treatment Options
Dr. Doug Jones: Welcome to the Immune Edit. I'm Dr. Doug Jones. If your immune system feels like the enemy or you're just tired of not feeling like yourself, this space is for you. Welcome back. This is part two of a three-part series on all things food allergies.
In our first episode, we went over key points from reaction to diagnosis, some of the nonsense tests that steal your money, and the limitations of the real tests. Once you get that diagnosis, you move into potential treatment options. Hopefully, you're not with an allergist living in the last century who's not offering food allergy treatment yet. We want to dive into that.
Dr. Farrah Khan: That's still like 90% of allergists, just so you know.
Dr. Doug Jones: I know. There's a whole bunch that need to retire. I probably just offended 90% of our field, which is not a new thing for me.
Dr. Tom Chaco: You're not wrong. Get with the times. Step up the game. We don't need to drop our game to match you—raise yours.
Dr. Doug Jones: As we move into treatments, I have a passion and mission to bring treatment to patients: educate allergists, educate people so they feel comfortable doing it, or offer a menu so people have access to care and aren't living in fear anymore.
What Are the Current Food Allergy Treatment Options?
Dr. Doug Jones: What treatment options are currently available? What's on the food allergy treatment menu? I'll start with the first one because it's an oldie but a goodie: avoidance and carrying your EpiPen. That is still an option and works for some people.
Dr. Farrah Khan: That's not a treatment though. That may be a management option. That's not a treatment.
Dr. Tom Chaco: Semantics. I think that's very reasonable. Besides carrying your epi, I think Neffy is also a good option—I'm not paid or sponsored. The nasal epinephrine spray is a reasonable option.
Dr. Doug Jones: So, to summarize: avoidance and carrying an epinephrine device, whether it's an injector or a spray, and hope nothing bad happens. That's management option number one. Let's go to number two on the menu.
Dr. Tom Chaco: Xolair is an option that's out there.
What Is Xolair and How Does It Work for Food Allergies?
Dr. Doug Jones: For those who don't know about Xolair or Omalizumab, what is that?
Dr. Tom Chaco: Xolair is a monoclonal antibody. It's an injection you get once a month or every two weeks to help protect from accidental food allergy exposure. It's FDA approved, so that's an option you might see commercials about, and it's available.
Dr. Doug Jones: It protects against accidental exposures. Patients still have to avoid the offending food, but it may provide protection against those "may contain" aspects.
Dr. Farrah Khan: Are there other potential uses of Xolair? You could use it in conjunction with oral immunotherapy to help OIT go smoother. That's off-label, but there are trials showing it enhances safety, efficacy, and speed as an adjunct.
Dr. Doug Jones: These are discussions people need to have with their allergist and the proper approach. Hopefully your allergist discusses oral immunotherapy too, which is our third option.
What Is Oral Immunotherapy (OIT) for Food Allergies?
Dr. Doug Jones: Describe oral immunotherapy to me as though I know nothing.
Dr. Tom Chaco: Oral immunotherapy is where we microdose allergen—let's go with peanut. We slowly introduce peanut into your diet under the threshold to cause reactions, ideally. We allow your body to tolerate over time. That takes intervals of coming in and introducing, either in the office or at home, to develop tolerance. We have data on multiple foods.
Dr. Farrah Khan: The language I use in clinic with parents: Xolair gives protection, but it's not retraining your immune system to tolerate the allergen. My big pro for OIT is it teaches your immune system to tolerate and unmark the allergen as dangerous.
Dr. Doug Jones: When we think about OIT, you can get accidental bite protection at lower doses than we thought five or 10 years ago. We don't need to get to six grams of peanut to retrain it. But when you talk about free eating or food freedom, people think, "I'm just gonna do OIT and then have whatever I want, whenever I want."
Is Oral Immunotherapy a Cure for Food Allergies?
Dr. Farrah Khan: That part is confusing for parents, caregivers, and patients trying to figure out if this is the right option.
Dr. Tom Chaco: People always ask about food freedom and cure. You did a post saying it's not a cure. Is oral immunotherapy a cure? It depends on the age group. For younger kids, we probably are reversing and curing. But in an 18-year-old with peanut allergy for 17 years, we still can reverse it.
Dr. Doug Jones: I'll give an example. I created a shrimp protocol years ago for my nurse in her thirties, shrimp allergic with multiple epi-requiring reactions. We took her through OIT. She had mouth surgery and went weeks on liquid diet without dosing. Basophil activation tests were negative. We challenged her off-dose and proved she was likely cured, even in adulthood.
Dr. Tom Chaco: We shifted her to dosing to prevent recurrence. Don't give up on adults or older children. But caveat: a study in New England Journal called the Cafeteria Study gave older elementary kids OIT. It's not just age—it's sensitivity and total IgE. If a 12-year-old has peanut IgE of 3 or 4, I could reverse it. But if 50-70, protect from accidents, probably not reverse.
As kids get older, IgE tends to go up, so we think older teens with IgE like 50-100 can't reverse. But age isn't the only thing—it's sensitivity. Don't say older and no go.
Do You Still Need to Avoid Foods After OIT?
Dr. Doug Jones: There's a myth that with OIT, you still live a life of avoidance. Is that myth or fact?
Dr. Tom Chaco: I know where that myth comes from—no, it's not. It depends on the food, situation, goal. Some avoid for protection from accidents—fine. For some foods, we introduce into the diet. The majority I aim for that.
Dr. Doug Jones: What can be done with it? Not what every person wants—it's individualized. What is the potential? Is it possible for a person to eat peanut freely, however they want? Yes. Is it probable for an 18-year-old with IgE over 100? Absolutely.
Dr. Tom Chaco: I disagree. I have hundreds of patients that can eat whatever they want.
Dr. Doug Jones: Taking gaps of months or years without consuming?
Dr. Farrah Khan: That's not what I'm saying. You can get to eating whatever peanut product you want after treatment. But people think OIT is discrete: do OIT, then off for years, then eat with food freedom. Nobody gives that recommendation.
Even if cured, you're not told to never eat it. Like LEAP early introduction: continue 1-2 times a week to prevent recurrence. But they can eat whatever on top—that's food freedom.
Dr. Tom Chaco: I get what you're saying. We can reverse peanut and eat liberally, no matter the number. Most with super high numbers, that's not the goal—some have issues getting there. Is it possible? Sure. But for an 18-year-old with peanut IgE over 100, I typically don't tell them that's the goal. If they push, maybe, but I aim lower.
Dr. Doug Jones: Over eight years of data, numbers don't predict success or failure. We have as much success with high numbers as low—in dropout rates and all.
Dr. Tom Chaco: You're better at data. The PALFOR data is skewed—they took super allergic people, up to high doses, had higher adverse effects. If peanut over 50-100 and trying 2-3 grams regularly, more problems. Risk versus reward.
Dr. Farrah Khan: We're saying the same with nuance. The discussion shows confusion patients might have. At the end, same thing in different ways.
Dr. Tom Chaco: It's about patient goals with their OIT doctor. Do they want free eat? For milk, aim liberally; egg, at least baked; peanut, babies or young—free eat; older—protect from accidents. Shared decision making: what would I do for my kid? Options are out there.
Dr. Doug Jones: Spot on. For a child with five allergies, goals per food may differ: incorporate milk, eggs, wheat freely; peanuts—protection due to aversion. Discussions are critical: where patient is, goals per food. Potential: incorporate without avoidance if wanted. Beauty of OIT—disease modifying; Xolair not.
What Is Sublingual Immunotherapy (SLIT) for Food Allergies?
Dr. Farrah Khan: Quick on sublingual immunotherapy (SLIT)—it has a niche. Advantages and disadvantages.
Dr. Farrah Khan: I'm team OIT. SLIT uses much smaller doses, unlikely to free eat. It's low-dose OIT to safer spot. OIT is safe and effective with right allergist—not dilute water or super high doses. Nice way to do OIT for good benefits.
Dr. Tom Chaco: In infants/toddlers, SLIT is basically OIT—they can't hold under tongue. Call it slow OIT. For toddler, SLIT is OIT anyway.
Dr. Farrah Khan: Babies/toddlers do OIT well—like champs, no taste/texture aversions like older patients.
Dr. Tom Chaco: Take home: 3-4 and under, OIT or call SLIT—same. For teens or high, SLIT for accident protection—not opposed. Depends. Milk/egg, SLIT dosing easier.
For teenager wanting protection without OIT recommendations/activity restrictions—busy—nice for protection. Most my teens/college/athletes wanting protection: 1-2 Mighty Me puffs (5-10mg proteins)—SLIT doses. Easy, quick. Swallow? OIT. Dissolve under tongue? SLIT. $30, done.
Great solution—reasonable, realistic, individualized. It's food—not like a drug. OIT is giving food—cheap, natural, works. Compare to Xolair.
Dr. Doug Jones: Didn't mention patch—talking currently available.
Dr. Tom Chaco: Brewing for decade—too much money not to come out.
Dr. Doug Jones: Don't want to talk patch today—different conversation.
Pros and Cons of Food Allergy Treatment Options
Dr. Doug Jones: Quick summary: top pros/cons of treatments.
Dr. Farrah Khan: Avoidance plus epi plus hope: cheap, works, good option. Downside: accidental exposure can be severe depending on threshold.
Dr. Tom Chaco: Pros of avoidance: lots of fear, but reaction rates low. Avoidance fine.
Dr. Doug Jones: Pros/cons of Xolair?
Dr. Tom Chaco: Pros: taste aversions/don't want eat, won't comply with regimen. Cost effectiveness? Shared decision making—cost to system.
Dr. Farrah Khan: Why don't you like shared decision making? Paternalistic?
Dr. Tom Chaco: 100%. For vacation/Paris two weeks—protect accidents—cost to put on Xolair? Or study abroad—get Xolair there? $60,000.
Dr. Farrah Khan: Not saying PRN as-needed Xolair. When BTK inhibitors out—not cheap—how use for hives? Studied food allergies. Use as kind of... Option.
Dr. Doug Jones: For right patient, Xolair as treatment. FDA approved. First doses office, then home inject. Good for milk, potentially with OIT.
Dr. Farrah Khan: Especially off-label with OIT—milk/egg tougher, more reactions/side effects. Integral in diet.
Dr. Doug Jones: Used lot with salvage therapy—struggling in OIT.
Dr. Tom Chaco: Usually don't start—issues in OIT on milk, consider Xolair.
Dr. Doug Jones: Option—menu. Whole OIT program not reasonable, but truncate to four months—difference. Busy adult—makes possible otherwise.
Dr. Doug Jones: Pros/cons of SLIT: cheap protection, easy, less restrictive. Con: no food introduction—big con, especially milk/egg. Con: not much different than low-dose OIT.
Dr. Doug Jones: Pros/cons of OIT?
Dr. Farrah Khan: Pros: potentially reverse allergy. Cons: adverse effects—one eosinophilic esophagitis. Unmasks symptoms—watch for. Not 100% risk-free, even with good allergist. Risk low, not zero.
Dr. Tom Chaco: Pros: natural foods. Allows long-term tolerance. Potentially incorporation—inclusion, kid have milk/ice cream. Finite—once done, introduce diet. Cost effective—endpoint on cost. Natural—not expensive vs biologics.
Dr. Doug Jones: Thank you for lively discussion on treatment options—this concludes part two. Thank you for tuning in. We'll see you next time on The Immune Edit.
This show is separate from my clinical practice at Global Allergy Immune Network. This show represents my opinions and my guests' opinions. Neither myself nor the show endorses the views or statements of my guests. This show is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional.
This show is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. It's important to have someone in your corner who is a trained and licensed healthcare practitioner who can help you make changes, especially when it comes to your health.
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