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 allergists, Dr. Amrish Patel, Dr. Mohamad Tawila, Dr. Abdul Bahrainwala, and Dr. Sunjay Modi present us with an overview of the latest treatments and how you can find relief at Allergy & Asthma Associates of Michigan.

What’s changed in food allergy treatments recently?

Previously, food allergy treatment consisted of avoidance of trigger foods, with any accidental ingestions treated with EpiPen/Auvi-Q/Neffy (or epinephrine) and/or antihistamines. Food allergy treatment has thankfully progressed quite far in recent years with the advent of food oral immunotherapy (OIT) and a biologic injection called Xolair.

Oral immunotherapy (OIT) consists of giving patients allergic to a specific food(s) in small amounts of the triggering food(s) to induce tolerance to the food allergen in the form of desensitization. Although commonly thought of as a food allergy cure, OIT helps patients raise their threshold of allergic response to a food. There is only one FDA-approved OIT treatment, which is specifically for peanut allergy, known as Palforzia; however, many allergists practice OIT for other foods as well (tree nuts, egg, cow’s milk, sesame, etc.).

Xolair (or Omalizumab) obtained FDA approval in February 2024 for patients aged 6 months and older with a food allergy diagnosis. This injection has been studied for many years for patients with asthma or hives, hence, it has many years of safety data. Xolair is a great option for patients who may have had multiple episodes of food-induced anaphylaxis, for those patients who have significant food reactions to cross-contaminated foods, and/or those who have multiple food allergies. Younger children starting school or daycare, or younger adults going off to college, would greatly benefit from Xolair for food allergy. 

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:

1. Dietary avoidance and, in the case of food allergy-induced anaphylaxis, the use of epinephrine

2. Oral immunotherapy (OIT), or

3. Xolair therapy
   

Regardless of the number 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 discussed previously, as it can be harder to practice dietary avoidance of multiple foods.

Of note, there is also a new epinephrine for anaphylaxis. Neffy 2 mg (intranasal epinephrine) was first approved on August 9th, 2024, for patients who weigh 30 kg (66 pounds) or more. Recently, Neffy 1 mg was approved for children who weigh 15 kg (33 pounds) or more and are 4 years of age or older. This is a very exciting new course of treatment as well as it offers a non-invasive treatment for anaphylaxis. Please ask our clinicians in the clinic about this new option.

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

Food reactions include both allergy and 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, which usually occur within an hour upon ingestion:

• A rash known as “hives” - typically very itchy and disappears within a few hours,

• Angioedema, which can include lip, tongue, airway, or facial swelling

• Trouble breathing, wheezing, and/or a cough

• Immediate episodes of vomiting or diarrhea

• Drop in blood pressure and/or tachycardia

Food allergy reactions are typically treated with oral antihistamines (allergy pills) if a mild reaction or epinephrine if a severe reaction occurs in the form of anaphylaxis. In our clinic, we provide patients and complete guidelines on when to use allergy medication versus epinephrine.

What is food intolerance?

Food intolerance symptoms mainly include stomach upset, such as bloating and diarrhea, but also can include a myriad of nonspecific symptoms. 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 epinephrine do not treat these reactions. There is no FDA-approved testing for food intolerances.

Treatments Allergy & Asthma Associates of Michigan uses to treat food allergies:

Allergy & Asthma Associates of Michigan 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 will perform graded food challenges. This consists of patients coming into clinic to eat their trigger foods under physician supervision in a safe environment. If patients are able to complete the food challenge without reaction, they are considered allergy-free to the specific food in question.

When dietary avoidance is not enough: For patients who have not outgrown their food allergies or are unlikely to, we offer Xolair as an option for patients for whom dietary avoidance is not enough. We are also looking to add an OIT program to our clinic. Neither OIT nor Xolair will 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 and reduces the stress and anxiety associated with food allergy.

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 in 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 2- 4 weeks, depending on the IgE level and weight.

• Administration – It is an injection that can be administered in the office. One side effect that was noted in trials includes anaphylaxis, or an allergic reaction. The first three injections are administered under supervision and observed in the office. An EpiPen is still required for patients with food allergies 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 our providers using prior testing/results/history. The amount of coverage is dependent upon individual insurance plans.