Treatment of food allergy: Immunotherapy, omalizumab, or both

Food allergy is a common disease which has substantial impacts on the quality of life of patients and their families, and all reactions have the potential for causing life-threatening anaphylaxis. Food allergic individuals currently have 2 FDA approved therapeutic options available to them aside from life-long allergen avoidance: oral immunotherapy (OIT), and omalizumab. OIT for food allergy has been extensively studied in clinical trials and currently provides the greatest level of protection, however it also has a high burden of treatment. Studies suggest that more successful OIT outcomes may be attained with earlier intervention; however, early OIT presents its own challenges. Omalizumab, recently FDA-approved, is a biologic targeting immunoglobulin E, a major driver of allergic reactions. In contrast to OIT, omalizumab monotherapy offers a low treatment burden therapeutic option that provides a safety net against reactions to accidental ingestion to multiple allergens. Additionally, omalizumab has also been investigated as an adjunct to OIT, improving the speed and safety of single or multi-allergen OIT. Here we discuss the clinical use of these therapeutic options and provide a guide for shared decision-making between patients and physicians about what therapeutic option might be more appropriate.