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Food Allergy & Anaphylaxis: Treatment Options

Food allergies can be life-altering and may even trigger anaphylaxis—a severe, potentially fatal reaction. Early detection and proper management are vital, with treatment options ranging from epinephrine to immunotherapy and Xolair. While no single approach fits everyone, understanding these options is the first step. Below, you’ll find an overview of each course of action and how to manage food allergies safely.
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Food Allergy & Anaphylaxis: Treatment Options

Common Food Allergens

Food allergens are specific proteins found in certain foods that trigger allergic reactions in sensitive individuals. While over 170 foods have been identified as potential allergens, the majority of food allergies are caused by a smaller subset of foods commonly referred to as the "Big 9." These allergens are responsible for most severe allergic reactions and are required to be clearly labeled on packaged food products in many countries.

The Big 9 Food Allergens

Milk

Common in children, though many outgrow it by adulthood. Found in dairy products like cheese, yogurt, and butter.

Eggs

Often present in baked goods, mayonnaise, and some vaccines. Egg allergy is also frequently outgrown in childhood.

Peanuts

One of the leading causes of severe allergic reactions, often found in snacks, candies, and sauces.

Tree Nuts

Includes almonds, walnuts, cashews, pistachios, and hazelnuts. Tree nut allergies are usually lifelong.

Soy

Found in soy milk, tofu, edamame, and processed foods. Commonly used as a food additive or emulsifier.

Wheat

Linked to many processed foods, wheat allergies differ from celiac disease, which involves gluten intolerance.

Fish

Includes species like salmon, tuna, and cod. Fish allergies often develop in adulthood and are usually lifelong.

Shellfish

Includes crustaceans (e.g., shrimp, crab, lobster) and mollusks (e.g., clams, mussels, squid). Shellfish allergies are common and often persist throughout life.

Sesame

A rising allergen globally, found in sesame seeds, oil, tahini, and some bread products.

Other Notable Allergens

While not part of the "Big 9," certain foods like mustard, celery, lupin, and corn can also trigger allergies in some individuals.

Cross-Reactivity

Some individuals may experience cross-reactivity, where proteins in certain foods resemble those in other allergens. For instance, people allergic to birch pollen might also react to raw apples or carrots, a condition known as Oral Allergy Syndrome (OAS).

Understanding these common allergens and their potential presence in food products is essential for individuals with food allergies and their caregivers. For those unsure of their specific triggers, local allergy clinics or online specialists like Curex can perform testing and guide you toward safe dietary choices.

Causes and Symptoms of Anaphylactic Allergy

A food allergy occurs when the body’s immune system mistakenly perceives a particular food (or a substance within it) as harmful and mounts an immune response. In people with a food allergy, the immune system creates Immunoglobulin E (IgE) antibodies that target specific proteins in the offending food. When these individuals consume, touch, or even inhale the allergenic food, these antibodies recognize the food proteins and trigger the release of chemicals—histamine being a prime example—which then bring about the symptoms of an allergic reaction.

Food allergy symptoms vary in severity and often emerge within minutes to a couple of hours after exposure. These symptoms may include:

  • Skin reactions: Hives, eczema flare-ups
  • Gastrointestinal issues: Nausea, vomiting, diarrhea
  • Respiratory problems: Nasal congestion, coughing, shortness of breath
  • Oral symptoms: Swelling or itching of the lips or tongue
  • Cardiovascular signs: Dizziness, rapid heartbeat tongue

If you notice two or more of these symptom types occurring together, this may indicate anaphylaxis, requiring immediate treatment (e.g., an epinephrine injection) and a call to emergency services.

If you suspect a mild food allergy, seek guidance from a local allergist or an online provider like Curex. Curex can help identify the specific allergen(s) and recommend an appropriate management plan.

Why are Food Allergies Becoming More Prevalent?

Experts continue to investigate the reasons behind the apparent rise in food allergies, and current research points to a variety of contributing factors:

Hygiene Hypothesis

According to this theory, today’s cleaner environments may lead to less exposure to everyday germs, thereby causing the immune system to overreact to harmless substances, including food proteins.

Bloomfield SF, Rook GA, Scott EA, Shanahan F, Stanwell-Smith R. Time to abandon the hygiene hypothesis. Nature Reviews Immunology. 2016; 16: 659.

Dietary Changes and Industrialization

Shifts in eating patterns, lack of dietary diversity, and the rise in Dietary Changes industrialized food production may be increasing our exposure to potential allergens. Modern eating patterns and reduced dietary variety weaken our microbiome and immune defenses. Additionally, pediatric guidance that once recommended avoiding allergens has limited the development of natural immunity.

Sicherer SH, Sampson HA. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. Journal of Allergy and Clinical Immunology. 2018; 141(1): 41-58.

Increased Use of Antibiotics

Growing evidence indicates that the widespread use of antibiotics can disrupt the gut microbiome. This disruption may contribute to immune dysregulation and a higher risk of developing food allergies.

Stokholm J, Sevelsted A, Bønnelykke K, Bisgaard H. Maternal propensity for infections and risk of childhood asthma. Pediatr Allergy Immunol. 2017; 28(8): 779-784. (Though focused on asthma, studies on microbiome health echo similar concerns for food allergies.)

Improved Awareness and Diagnostic Tools

Better access to allergy testing and heightened awareness among both healthcare professionals and the public have led to more frequent, accurate diagnoses.

Turner PJ, Gowland MH, Sharma V, et al. Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992–2012. J Allergy Clin Immunol. 2015; 135(4): 956–963.

Food Allergy Testing Options

In-Office Skin Prick Testing (SPT):

Skin prick testing involves placing a small amount of the suspected allergen on the skin and then lightly pricking it to introduce the allergen. If an individual is allergic, a localized reaction (e.g., redness, itching, swelling) typically appears within minutes. Although this method offers quick results and the ability to test multiple allergens in one session, there is a potential risk of anaphylaxis, so it must be done in a medical setting equipped to handle emergencies.

IgE Blood Testing:

Measuring IgE levels against specific allergens is another reliable way to identify food allergies, with three common options for sample collection: visiting a local lab where a professional will draw your blood, using an at-home phlebotomy service where a certified provider collects a sample in the comfort of your home, or utilizing a self-collection device for a finger-prick test that you mail to a testing center. Each approach offers unique benefits—such as convenience, flexibility, or professional oversight—and can help confirm a food allergy diagnosis so you can take appropriate steps to manage your condition.

Oral Food Challenge (OFC):

Often considered the gold standard for diagnosing food allergies, an oral food challenge involves consuming gradually increasing amounts of a suspected allergen under close medical supervision. Healthcare professionals carefully monitor for any signs of an allergic reaction, ready to intervene if necessary. Although this method provides definitive confirmation, it carries a higher risk of anaphylaxis and should only be performed in a properly equipped clinic.

Difference between food allergies and sensitivity

While the terms “food allergy” and “food sensitivity” are sometimes used interchangeably, they refer to different types of adverse reactions and involve distinct physiological mechanisms.

A food allergy is an overreaction of the immune system—often, but not always, IgE-mediated—to a specific protein in a food. Common triggers include peanuts, tree nuts, shellfish, and dairy.  Can include hives, swelling, vomiting, difficulty breathing, and in severe cases, anaphylaxis.  Because of the immune system’s involvement, even small amounts of the allergen can cause serious reactions.

A food sensitivity is typically used to describe non-immunologic reactions. These responses are not driven by IgE or other immune pathways but can still cause symptoms. Examples include lactose intolerance (due to lactase enzyme deficiency) and certain reactions to food additives.

Symptoms may include bloating, gas, headaches, or fatigue. Symptoms are usually not life-threatening and often dose-dependent, meaning larger quantities of the offending food are needed to trigger a reaction.  Unlike allergies, food sensitivities generally do not involve a systemic immune response and do not carry a risk of anaphylaxis.

Food Sensitivity Testing & Diagnosis

IgG testing has gained popularity in recent years as a way to detect potential food sensitivities. However, most experts and major allergy organizations caution against relying on IgG test results due to high rates of false positives. The presence of IgG antibodies often reflects exposure to a specific food rather than a genuine sensitivity or intolerance.

Instead, the gold standard for diagnosing food sensitivities is an elimination diet. Under medical supervision, individuals remove suspected foods from their daily meals and carefully monitor any changes in symptoms. After a set period, they gradually reintroduce each food item to determine whether it triggers a reaction. This method provides more accurate, individualized insight into true food sensitivities than current IgG-based testing approaches.

Treatment Options for Food Sensitivities

Treatments for food sensitivities aim to manage symptoms by identifying triggers, modifying the diet, and addressing any underlying issues with digestion or gut health.

Once sensitivities have been diagnosed (see above), it is generally recommended to avoid the food in question.  While strict avoidance (as in food allergy) is not always necessary, limiting problematic foods to a level that doesn’t trigger symptoms can help maintain a balanced diet. For lactose intolerance, you can take lactase enzyme supplements.  Sometimes symptom medications may help provide relief, like antispasmodic medications may be recommended to help control digestive symptoms.

Lastly, there is some evidence suggesting that improving the diversity of gut bacteria can help reduce sensitivity symptoms. That may be accomplished with probiotics and prebiotics. Also, because stress can exacerbate gastrointestinal issues, interventions such as mindfulness, cognitive behavioral therapy (CBT), or yoga may be beneficial.

Reference: Ford AC, Lacy BE, Talley NJ. Irritable bowel syndrome. Lancet. 2017; 389(10066): 1288–1298.

Treatment Options for Food Allergies

Managing food allergies typically involves a combination of strict avoidance, emergency preparedness (particularly with epinephrine), the use of biologics like Xolair, and, for those seeking a potential cure, immunotherapy.

  • Emergency Preparedness
    • Epinephrine Auto-Injector: Individuals at risk of severe reactions (anaphylaxis) are typically prescribed an epinephrine auto-injector (e.g., EpiPen). They should carry it at all times and know how to use it.
    • Action Plan: Patients, family members, and caregivers should be familiar with signs of anaphylaxis (e.g., hives, wheezing, throat swelling) and be prepared to administer epinephrine and call emergency services when necessary.
    • Antihistamines and Bronchodilators: While these medications (e.g., Zyrtec, Albuterol) can help alleviate mild symptoms or additional breathing issues, they are not substitutes for epinephrine in a true anaphylactic emergency.
  • Xolair for food allergy
    • Biologics: Xolair (omalizumab) is an FDA-approved injectable treatment that reduces the severity of food-allergic reactions by targeting IgE, the antibody responsible for allergic responses.
  • Immunotherapy
    • Oral Immunotherapy (OIT): Under close medical supervision, patients consume gradually increasing amounts of the allergen to build tolerance. Although effective, frequent side effects—including anaphylaxis—lead many to discontinue treatment. Those who continue typically need in-person visits every two weeks.
    • Sublingual Immunotherapy (SLIT): A small dose of allergen extract is placed under the tongue daily to desensitize the immune system over time. Compared to OIT, SLIT generally has a superior safety profile and can be administered at home. Its highly diluted doses often result in fewer side effects, and studies report high completion rates alongside significant improvements in tolerance.
    • Epicutaneous Immunotherapy (EPIT): A skin patch containing small amounts of the allergen is applied to modulate the immune response. This approach has less real-world data and remains the least studied option.

      Reference: Chang Y-S, Trenga CA. Treatment of Food Allergy: An Overview of Immunotherapy Approaches. Curr Allergy Asthma Rep. 2019;19(6):29.

Children may outgrow certain allergies and adults can develop new ones.  So it may be helpful to conduct periodic retesting and carefully monitor symptoms during exposure.

Epinephrine Options: EpiPen, Auvi-Q, Adrenaclick, Neffy, and Compounded Epinephrine

Carrying an epinephrine option is essential for anyone at risk of anaphylaxis. Below are some common choices:

EpiPen

The most widely recognized auto-injector, featuring a straightforward, single-step design.

Auvi-Q

Notable for its compact size and voice instructions, which can make it easier to administer.

Adrenaclick

Functions similarly to other auto-injectors, though insurance coverage and availability may differ.

Neffy

A nasally administered form of epinephrine.

Compounded Epinephrine

Specially prepared by certain pharmacies to meet specific patient needs.

Xolair (Omalizumab) for Food Allergy

Xolair (omalizumab) is an injectable medication indicated for use in individuals aged 1 and older to help manage food allergies. It does so by blocking a key component of the body’s allergic response, thereby lowering the likelihood of severe reactions. This makes Xolair especially beneficial for individuals undergoing oral or sublingual immunotherapy as they work on gradually increasing their tolerance.

However, it’s important to note that Xolair is not a cure for food allergies. It is often quite expensive—up to $60,000 per year—and requires biweekly injections. Furthermore, Xolair does not alter the underlying disease process, meaning long-term use may be necessary unless the patient undergoes allergy immunotherapy. Lastly, Xolair should not be used as an emergency treatment: patients must still carry an epinephrine auto-injector (e.g., EpiPen) for acute allergic reactions.

Oral Immunotherapy (OIT) for Food Allergy

Oral immunotherapy typically involves consuming small, gradually increasing amounts of the allergen under medical supervision. Over weeks or months, the immune system may become more tolerant to the allergen. A recent clinical trial in the New England Journal of Medicine showed that OIT can help reduce the likelihood of severe reactions in children with peanut allergies. While highly effective for some, OIT does require strict adherence to the regimen and ongoing maintenance doses.  In most practices, OIT treatment is prepared on-site by healthcare providers using off-the-shelf ingredients (such as peanut flour), which can introduce inconsistencies and limit quality control.

Sublingual Immunotherapy (SLIT) for Food Allergy

Sublingual immunotherapy (SLIT) involves placing a small dose of allergen extract under the tongue daily, allowing it to be absorbed into the bloodstream through the oral mucosa. Over time, this gradual exposure helps desensitize the immune system to the allergen, reducing the severity of allergic reactions.

Unlike OIT, SLIT is prepared by specialized pharmacies (e.g., Allergychoices) using pharmaceutical-grade allergenic extracts to create highly precise treatment sets, ensuring greater accuracy and quality control.

Advantages of SLIT over Oral Immunotherapy (OIT)

  • Superior Safety Profile:
    SLIT generally has fewer and less severe side effects compared to OIT. The risk of anaphylaxis, a major concern with OIT, is significantly lower with SLIT because the allergen doses are much smaller and delivered in a controlled manner. This makes SLIT a safer option for individuals who may not tolerate the higher doses used in OIT.
  • Convenience and At-Home Administration:
    Unlike OIT, which often requires frequent in-clinic visits (every 1–2 weeks) for dose escalation and monitoring, SLIT can be administered at home after an initial consultation and training. This flexibility is particularly appealing for patients with busy schedules or limited access to an allergy clinic.
  • Reduced Gastrointestinal Side Effects:
    OIT is associated with gastrointestinal issues, such as abdominal pain, nausea, or vomiting, as patients consume increasing amounts of the allergen. SLIT bypasses the digestive system, minimizing these side effects while still effectively desensitizing the immune system.
  • Lower Risk of Dropout:
    Studies show that SLIT has higher completion rates compared to OIT. The less invasive nature of SLIT, combined with its safety and convenience, makes patients more likely to adhere to the treatment plan.
  • Applicable to a Broader Population:
    SLIT has been used extensively with adults but is also well suited for children, individuals with severe allergies, or those who have experienced adverse reactions during OIT. Its gentle approach allows a wider range of patients to participate in immunotherapy.
  • Fewer Lifestyle Restrictions:
    OIT requires careful timing of doses, often necessitating patients to remain at rest for several hours post-dose to avoid triggering a reaction during physical activity. SLIT does not impose these restrictions, offering greater flexibility in daily life.

Clinical Evidence Supporting SLIT

Research published in JAMA Network Open and other leading journals has shown that SLIT is effective in increasing allergen tolerance, particularly for children and adults with peanut, milk, egg, and other common food allergies. Participants in these studies reported fewer severe reactions and a higher quality of life compared to those undergoing OIT.

Kim EH, et al. Open-label study of the efficacy, safety, and durability of peanut sublingual immunotherapy in peanut-allergic children. J Allergy Clin Immunol. Published online February 17, 2023.

How SLIT Works With Curex

Curex user having an online consultation with a clinician.

Initial Consultation

Patients consult with an allergist to identify their specific allergens through testing. Curex can use existing test results or order new in-lab or at-home tests.

Customized Treatment Plan

A personalized allergen extract is prepared in a highly diluted by #1 allergy immunotherapy pharmacy Allergychoices

Daily Dosing

The patient places the extract under the tongue and holds it there for 1-2 minutes before swallowing. This process is repeated daily.

Gradual Desensitization

Over time, the immune system becomes less reactive to the allergen, reducing the risk of severe allergic reactions during accidental exposure.

Ideal Candidates for SLIT

SLIT is especially suited for:

Patients seeking a safer, less invasive alternative to OIT.

Individuals with a history of severe reactions to allergens.

Those who prefer at-home treatment to minimize clinic visits.

Ideal Candidates for SLIT

SLIT at Curex

At Curex, we offer personalized SLIT treatment plans tailored to your specific allergies and lifestyle. Our board-certified allergists provide ongoing support to ensure your safety and progress throughout the program. If you’re interested in learning more, sign up for our Free Webinar, where a clinical expert will explain SLIT in detail and answer your questions.

Next Steps

If you’re unsure of the best course of action for managing your food allergy, consider joining Curex’s free Food Allergy Webinar hosted by our team of clinical allergists. This session will cover available treatment options, including those offered through Curex, and help you determine the best path forward. To sign up, simply fill out the form below.

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