Food Allergy Treatment

There are increasing options available for managing food allergies. Options will depend on your child's age, specific allergies, and other allergic diseases, such as asthma. Any treatment choice will always follow a shared decision-making process.

Options available:

The default option is to avoid your known allergens and be upskilled in identifying allergens in different foods, recognising allergic symptoms, and treating allergic reactions. This is a particularly valid approach for young children allergic to food allergies that are most likely outgrown, e.g., milk and egg, or for children allergic to foods that are easier to avoid, e.g., Macadamia nut.

  • Commence OIT:  

    • Our Allergy Center of Excellence Clinics offers OIT for peanuts, milk, wheat, sesame, walnuts, almonds, and hazelnuts.

    • We continue to add allergens for treatment.

    • Access to OIT is limited worldwide, including in the UK. Frustratingly, very few NHS clinics offer OIT.

  • We offer the following OIT regimens:

    • OIT to 3 allergens (not including Palforzia, milk or wheat) simultaneously - for children <6 years of age

    • OIT to 2 allergens simultaneously - for children 6-12yr.

    • OIT to a single allergen OIT - for children older than 12 yr.

    • Palforzia (peanut) for children 4-17 years of age

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    Administer Omalizumab (Xolair)

    • administer 2-4 weekly while avoiding allergens. 

    • administer for 2-3 months before travelling to areas where your food allergen is a common ingredient in cuisines or there are language barriers…

    • administer whilst commencing multi-allergen OIT. This program will begin within ACE in 2025.

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More about Xolair (omalizumab)

Xolair (omalizumab) is approved for treating food allergies in certain patients. It works by reducing the levels of IgE, a protein involved in allergic reactions. By targeting IgE (like a sponge), Xolair helps to decrease the risk of severe allergic reactions, such as anaphylaxis, after accidental exposure to a food allergen.  It is not a cure. Xolair is the first FDA-approved treatment for food allergies that can reduce the risk of severe reactions.  Xolair can help decrease the risk of severe allergic reactions, including anaphylaxis, which can be life-threatening.  Xolair does not cure food allergies, and it is important to continue avoiding the foods you are allergic to. We offer Xolair, at The Portland Hospital.

More about OIT:

Immunotherapy is a method to reduce the sensitivity and risk of reaction to specific allergens. It has been widely used for treating hay fever, pet and house dust mite allergies, and it is now available for particular food allergens. The aim is to improve the quality of life for children and their families.

Oral Immunotherapy to food was first described in 1908 in the Lancet - ‘a case of egg poisoning’ - by a physician practicing in Harley Street (pre NHS). This report (freely available on the link above) is highly informative. It reflects the process of OIT rather well, where even very allergic patients can enjoy a rise in the threshold of the allergen to which they are allergic.

Standard care for managing food allergies has focused on avoiding allergens and facilitating the treatment of adverse reactions after allergen exposure.

An increase in the development of immunotherapy treatments for food allergy has driven our knowledge forward. Initial studies mainly focused on school-age children in whom food allergies are likely to be persistent. However, increasing evidence indicates that delivering immunotherapy for food allergies to preschool-age children may provide higher success rates. Conversely, the natural resolution of food allergies occurs primarily in these younger age groups, resulting in challenges in selecting patients who will ultimately benefit from these treatments.

Both immunotherapy and natural history studies reveal the inherent plasticity of the immune system in early life, which may be more amenable to intervention. This raises a delicate yet unknown balance between the optimal timing of intervention and waiting for the natural resolution of the food allergy.

The field of OIT to foods has enjoyed a massive leap forward thanks to the rigorous extensive international studies (Palisade & Artemis) that underpin the licensing of a peanut OIT product. These studies show us the best regimens and products for successful OIT and the associated risks and side effect profiles.

The medical supervision of incremental baked egg and milk products in allergic children is common practice in many NHS UK clinics, often using ladders, also represents a form of immunotherapy/desensitisation.

  • OIT is not curative i.e. for most allergens, ongoing therapy is required to ensure tolerance.

  • It is controversial whether OIT to baked eggs and milk ‘hurries up’ the process of developing natural tolerance to all eggs and dairy, but it has been associated with an increase in QOL in those eating these baked foods (unsurprisingly).

  • OIT seeks to raise the threshold at which a reaction would occur, rendering your child ‘bite-proof’ i.e. protected from accidental everyday exposures.

  • OIT is allergen-specific and protects only against the allergen that is eaten.

  • Mild side effects on OIT are common and usually affect the GI system.

  • More severe allergic side effects can occur, sometimes unpredictably, i.e. after months of tolerance. This can arise due to co-factors such as exercise, infections, and medication use… Emergency medication will, therefore, always be required on your person while undergoing OIT.

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Please feel free to discuss advances in the field and the potential for OIT for your child when consulting with Prof du Toit or Dr Foong.

Prof Du Toit has been an investigator on many of these trials and is actively involved in research testing other treatment modalities, e.g. Viaskin trials.