On this page:

Epinephrine for emergency treatment ^[2]
Allergen avoidance (removing food from diet) ^[3]
Food oral immunotherapy (OIT) ^[4]
Omalizumab (Xolair® or Omlyclo®) ^[5]
Epicutaneous immunotherapy (EPIT) ^[6]

Definitions and pronunciations to help you read and talk about these options:

• Allergen [ah-ler-jin]: thing that causes allergic reaction (like food)
• Anaphylaxis [anna-fih-LACK-sis]: a severe allergic reaction that needs prompt treatment with epinephrine
• Epinephrine [eh-puh-neh-fruhn]: a prescription medicine that treats anaphylaxis
• Immunoglobulin E[ih-myoo-no-GLAH-byoo-lun ee] or IgE for short: an antibody your immune system makes to attack allergens and is what triggers allergic reactions
• Oral immunotherapy [ih-myoo-no-theh-ruh-pee]: a treatment that involves eating a small amount of food allergen to help the immune system learn to tolerate the food
• Omalizumab [oh-muh-liz-uh-mab]: a prescription injection (shot) that works by blocking an immune response to food to help prevent severe allergic reactions if a person accidentally eats their allergen
• Xolair [ZOH-lair]: a brand name for omalizumab
• Omlyclo [ahm-lih-cloh]: an interchangeable biosimilar to Xolair
• Eosinophilic esophagitis [EE-oh-sin-oh-FILL-ick uh-sof-uh-JIE-tis]: a delayed type food allergy that causes swelling in the esophagus (part of your throat)
• Epicutaneous immunotherapy [eh-pih-kyoo-tay-nee-us  ih-myoo-no-theh-ruh-pee]

Epinephrine for Emergency Treatment of Severe Allergic Reactions

Epinephrine ^[7] is the first-line treatment for anaphylaxis, a severe allergic reaction.¹ It is the only medication that can stop severe allergic reactions.

Epinephrine comes in easy-to-use options to give the medicine to yourself or child. It is only available through a prescription from your doctor.¹ If you or your child have classic food allergies, you need to always have epinephrine quickly and easily available.

Resources:
Food Allergy Emergency Care Plan ^[8]
This action plan guides what to do if you or your child are having symptoms of a serious allergic reaction.

Epinephrine Options for Treating Severe Allergic Reactions ^[9]
This decision aid explains the available choices to help you decide which form of epinephrine is best for you.

Long Term Management of Food Allergies

Currently, there are 3 different options to help people lower the chances of having food allergic reactions. And another option is still being studied and not yet approved by the FDA.

What are the current options for managing food allergy?

1. Allergen avoidance ( ^[3]remove the food allergen from the diet)
2. Food oral immunotherapy ^[4] (eat small amounts of allergen with allergist’s guidance)
3. Omalizumab injections ^[5] (a medicine that helps block allergic reactions)

For all of these options, you (or your child) will still need to carry epinephrine and have it with you in case of emergency. Do not try any type of food allergy treatment at home without talking with your allergist.

It’s important to know the benefits, risks, and requirements of each of these treatment options. This information can help you make a decision about which path is right for you.

^[10]Managing Your Child’s Food Allergies ^[10]

^[8]
Food Allergy Emergency Care Plans for Children: ^[8]
Available for children under 3, children 3 and up, and translated in 12 languages

^[9]
Treatment Options for Food Allergy: A Decision Guide for Caregivers ^[9]

Allergen Avoidance: Removing Food Allergen from Your Diet to Prevent Allergic Reactions

Allergen avoidance (remove the food allergen from the diet) is the main strategy used to manage and prevent food allergies.²

It is important to avoid eating the food you are allergic to. This means knowing what you are allergic to, how to read ingredient labels, and how to prevent accidents. Avoidance is a safety measure to help manage and prevent food allergic reactions in daily life.

Allergen avoidance works immediately and can be used at any age. However, it requires long-term avoidance of the food allergen(s). Most people only need to see their allergist once a year for follow‑up. Allergen avoidance has no direct side effects, and many families feel comfortable managing the allergy through careful avoidance. However, avoiding allergens can be stressful, and accidental exposures can still happen, with a small but real chance of severe reactions, including anaphylaxis. You will need to always carry epinephrine. Only some individuals outgrow their food allergy over time, and this depends on the specific food.

A threshold is the limit of allergen that could be eaten before triggering a reaction in a person allergic to that food. An allergist-supervised oral food challenge ^[11] can find your threshold. The threshold limit may vary by person and by food allergen. For example, 5 out of 100 people with peanut allergy will have an allergic reaction when they eat 2 mg of peanut. This means 95 out of 100 people with peanut allergy can eat 2 mg of peanut without an allergic reaction. Two milligrams (mg) of peanut is a small fraction of a whole peanut. One whole peanut is about 200-300 mg. 

For milk, the threshold is different. About 5 out of 100 people with milk allergy will have an allergic reaction to 1.2 mg of milk. This means 95 out of 100 people can eat 1.2 mg of milk without having an allergic reaction. This is a very small amount of allergen. If you take a single drop of liquid and break it up into 40 different parts, one of those parts is roughly 1.2 mg. 

Food Oral Immunotherapy (OIT): Building Tolerance for the Food Allergen

Food oral immunotherapy (OIT) ^[12] is a food allergy treatment that re-trains your immune system to respond differently to food. OIT helps the body gradually desensitize (tolerate) a food allergen. It does this by slowly raising the threshold amount of food allergen you can eat before it triggers an allergic reaction.³

Successful treatment of OIT may provide “bite protection.” This means a lower chance of having an allergic reaction if someone accidentally eats a small amount of their food allergen. Some people may even be able to eat the food freely in their diet after reaching the final stage of OIT treatment program.^3,4

Most people have results within 6 to 12 months, with regular visits every few weeks to safely increase the dose, followed by routine follow-up visits. OIT works very well in young children, but it is less clear how well it works in adults.³

OIT can lower the chances of a severe reaction if a food allergen is accidentally eaten. However, side effects such as stomach aches, nausea, and vomiting are common during treatment. OIT can also cause anaphylaxis. Although it is uncommon, some people may have eosinophilic esophagitis, a delayed type of food allergy that causes swelling in the esophagus (part of your throat).³ Mild side effects can be treated and get better with time without stopping OIT, but severe side effects may need epinephrine and stopping the treatment. You will still need to avoid other sources of the allergen. If doses are missed for too long, the protection gained from OIT may drop, and stopping treatment for months may cause you to lose the protection.

Omalizumab (Xolair® or Omlyclo®)

Omalizumab ^[13] is a type of treatment called a biologic. It works by blocking the action of specific molecules that trigger allergic reactions.⁵ Brand names for this treatment include Xolair and Omlyclo.

Xolair works by attaching itself to the immunoglobulin E (IgE) antibodies to help prevent an allergic reaction. It is an anti-IgE medicine. It reduces your child’s chance of having a food allergy reaction, including anaphylaxis, if your child accidentally eats one of their food allergens.⁵

Xolair is an injectable treatment that gradually helps raise the amount of a food allergen you or your child can tolerate. Most people notice improvement in their food allergy after about 4 to 5 months, and even better results over longer use. After the first doses are given in the clinic, many people can give the shots at home, with routine follow‑up visits to track progress. Side effects are usually mild, such as redness or swelling at the injection site or occasional fever, though anaphylaxis can occur, especially early in treatment. If you take Xolair, you will still need to avoid the food allergen and carry epinephrine. If doses are missed or treatment is stopped, the protection goes away over a few months.⁵

Omlyclo (omalizumab-igec) is a biosimilar to Xolair. This means it is very similar, works just as well, is just as safe and effective, and can be used in place of Xolair when needed.⁶

Epicutaneous Immunotherapy (EPIT)

Epicutaneous immunotherapy (EPIT) is a needle‑free, patch‑based treatment that exposes your or your child’s immune system to small amounts of a food allergen through the skin. The allergen is absorbed into the outer layer of the skin. Because this layer doesn’t have blood vessels, the allergen stays local, allowing your body to learn to tolerate it.^7,8 EPIT is still being studied in clinical trials and is not approved by the FDA.

EPIT shows encouraging results, especially in children, by helping the immune system become less reactive to certain food allergens over time. A longer treatment with EPIT is associated with better allergen tolerance, but also with the occurrence of more adverse reactions. Most reactions associated with the use of EPIT are mild to moderate, but there is risk of anaphylaxis. Researchers are still learning how EPIT affects daily life and how well it works for different food allergies. Researchers also continue to weigh its potential benefits against the risk of side effects, especially for young children and people with a history of severe allergic reactions.⁸

Which Food Allergy Treatment Is Best?

Starting a food allergy therapy is a big decision. The best choice for your food allergy treatment will be the one you feel most comfortable with, and you and/or your child will stay with long-term. One of the options is to continue with allergen avoidance and not start treatment at this time. You may be able to start treatment in the future. When you are ready to decide, make an appointment with your allergist. Do not try any type of food allergy treatment at home without talking with your allergist.

For all of these treatment options, you (or your child) will still need to carry epinephrine and have it with you in case of emergency. AAFA’s Food Allergy Anaphylaxis Action Plan ^[8] provides information and instructions on how to manage an allergic reaction.

For more information about food allergy treatment please review AAFA’s Food Allergy Treatment Decision Aid ^[9]. It can help you to talk with your allergist about the best options for you or your child.