Update on Diagnosis and Management of Food Allergies

Along with epinephrine, omalizumab also has shown efficacy for severe allergies, according to Dr. Calhoun, although it currently is not FDA-approved as treatment for food allergies, is expensive, and must be given by injection.

Various approaches to desensitize people to specific food allergies in current use and on the horizon may offer the best treatment approach as they are geared to prevent an allergic reaction altogether. These include immunotherapy delivered either orally, sublingually, or by injection.

Injection immunotherapy has been shown to desensitize people to particular food allergens, but, according to Dr. Reisacher, despite its efficacy it is associated with an unacceptably high rate of systemic reactions.

Oral immunotherapy also has shown efficacy against some of the most common food allergies, he said, but it remains unknown whether it confers only temporary desensitization or permanent tolerance.

Sublingual immunotherapy, which also has shown efficacy in trials, may turn out to be the most effective treatment for food allergies, according to Dr. Calhoun. It has the potential for protecting food-allergic patients from severe reactions following accidental exposure to a food, she said.

Both sublingual and oral immunotherapy for food allergies are currently used in the United States only in highly supervised research settings.

For Dr. Reisacher, one of the most exciting treatment approaches on the horizon is the use of genetically modified antigens. The genetically modified antigen could potentially make a safer injection immunotherapy to food, and if we could make this safer it may be the holy grail for food allergy management, he said.

A further potential benefit of this treatment approach is the potential for developing foods that are hypoallergenic, he said.

Use of traditional Chinese herbs is another treatment under investigation, with some data in mice showing efficacy in protecting against anaphylaxis.

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