*NEW* Food Allergy Treatments

For patients suffering from food allergies we offer these emerging treatment options:

SLIT (Sublingual Immunotherapy) for Food Allergies

SLIT for food allergies, consists of a protocol where very small, gradually increasing doses of the allergen are placed under the tongue (sublingually) to help the immune system become less reactive over time.

How SLIT Works for Food Allergies:

  • A liquid form of the allergen (like peanut, milk, or egg proteins) is administered under the tongue.
  • The allergen is absorbed through the blood vessels in the mouth, where over time the immune cells learn to tolerate it.
  • The allergy drops are taken daily at home, following a careful dose-escalation plan under medical supervision with your allergist.

Goal of SLIT:

To desensitize the immune system to your food allergen, that is, teaches the body so that accidental exposures to the food allergen do not cause a severe allergic reaction (like anaphylaxis). It’s not a cure, but it can significantly reduce sensitivity by increasing the amount of allergen needed to cause a reaction.

Benefits and Considerations

  • No needles or injections
  • Available for most patients of age 5 and up (eligibility individualized by the Allergist).
  • Safe – very low risk of serious reactions to the drops
  • At-home personalized treatment (convenient!)
  • Effective
  • Reducing reliance on allergy medications
  • Access to a physician in-person or via telemedicine

SLIT drops aren’t currently approved by the FDA for treating allergies. As such, the treatment will be available through a combination of an out of pocket initial fee and visits that can be billed through insurance.

If you are a candidate for drops, you will have access to a physician in-person, via telemedicine, or through an after hours phone line.

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Oral Immunotherapy (OIT)

The American College of Allergy, Asthma & Immunology (ACAAI) endorses oral immunotherapy (OIT) as a treatment option for IgE-mediated food allergies. Oral Immunotherapy is a treatment designed to desensitize the immune system of patients with food allergies by having them eat small, increasing amounts of the allergenic food and offers protection against accidental exposure.

What Happens in OIT?

The protocol has three phases:

  1. Initial Dosing visit:
    During the first visit, you will start with consuming 4 very low doses of your food allergen, separated by 30 minutes in between doses. This is the longest visit– taking approximately 4 hours.
  2. Build-Up Phase (weekly/biweekly, in clinic):
    Every month, you will return for an updosing visit– where higher doses are introduced and monitored.
  3. Maintenance Phase (daily, at home):
    The patient continues to take the highest tolerated dose daily at home to maintain desensitization, that is to keep the immune system trained to tolerate the allergen.

Goal of OIT:

To raise the threshold of reactivity, so that if the person accidentally eats a small amount of the allergen, it won’t trigger a severe allergic reaction (like anaphylaxis). In some cases, it may also allow some people to eat the food freely.

Who Is It For?

  • Mostly used in children, but also in certain adults (eligibility individualized by the Allergist.)
  • FDA-approved only for peanut allergy in kids 4–17 under the brand name Palforzia.
  • We will be offering non-FDA approved OIT to peanut, tree nuts, milk, egg

Benefits and considerations:

  • Can significantly reduce the risk of life-threatening reactions from accidental exposure.
  • Some patients can eventually free eat the food allergen.
  • Supervision: All dose increases must be conducted in a medical setting due to the risk of allergic reactions, including anaphylaxis.
  • Activity restrictions: Patients must avoid vigorous physical activity, hot showers, and hot baths for two hours after each dose, as these activities can increase the risk of a reaction.
  • Weighing risk vs. benefit: OIT requires a long-term, high-commitment effort with real-life constraints, and the risk of allergic reactions must be carefully weighed against the potential benefits.
  • Not a cure: OIT is not a cure and does not guarantee a permanent change. Patients must continue to carry epinephrine and read food labels for allergens while undergoing OIT.

Xolair (omalizumab)

Xolair is an FDA-approved biologic medication that has been in use for the last 20 years. Initially it was approved for the treatment of severe asthma, and later was approved to treat other conditions such as chronic urticaria (hives) and nasal polyps. In 2024, it was approved for the treatment of food allergy in patients aged 1 and up.

How does it work?

  • Xolair helps to reduce the risk of a severe allergic reaction from accidental exposure to a food allergen. This is wonderful to help alleviate anxiety in the real world, and offers protection against cross-contamination.
  • Xolair binds to a protein in the blood called Immunoglobulin E (IgE) that is involved in allergic reactions.
  • Injections are administered in our office every 2-4 weeks, depending on a patient’s weight and total IgE in the blood.

Goal of Xolair:

To decrease the risk of anaphylaxis from accidental exposure to food allergens. This is done by increasing the “threshold of reactivity,” meaning more of the allergen will need to be eaten to cause anaphylaxis or allergic reaction.

Benefits and Considerations

  • May be preferred in some patients with multiple food allergies
  • May be preferred for patients with significant anxiety surrounding eating their food allergen
  • This treatment is an injection – must be comfortable with needles
  • Must be approved through insurance
  • Less risk of anaphylaxis or allergic reactions than OIT
  • Not a cure– the patient must still avoid food allergens and carry an epipen at all times

Are you a candidate for one of these three food allergy treatments? Make an appointment today with our allergy experts to find out!

Glossary Definitions

Oral Immunotherapy

You might benefit from immunotherapy to help build up a tolerance to your offending triggers. Sublingual Immunotherapy (also known as Allergy Tablets) or Liquid Drops Formulations are offered to some patients who suffer from allergies to short ragweed and some grass pollen. The tablets or drops will increase tolerance to the pollen and reduce symptoms over time. For continued effectiveness, treatment may be needed for three years or longer.

Sublingual Immunotherapy

Sublingual Immunotherapy, commonly known as Allergy drops, are a method of treating allergies by placing drops underneath the tongue: a small dose of an allergen being introduced into the patient allows the body to build immunity over time. A dropper of antigens is placed under the tongue daily until the patient doesn’t experience any reactions anymore. They can be used for a wide variety of allergies in most patients from infants to adults.

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