Until recently, children with severe food allergies only had one option: avoid the foods they were allergic to at all costs. For these children, even the smallest exposure to foods like peanuts, tree nuts, and milk can cause life-threatening anaphylaxis that can only be treated with quick access to an EpiPen.
“Avoidance can work,” said Robert Wood, a pediatrician at the Johns Hopkins University School of Medicine, however, “there’s a huge impact on day-to-day life and quality of life.”
For the past several years, Wood has been conducting a large clinical trial to test if a common asthma medication can treat children with multiple severe food allergies, and maybe even allow them to eat small portions of these foods again.
There’s a huge impact on day-to-day life and quality of life.
- Robert Wood, Johns Hopkins University School of Medicine
The drug, an injectable biologic medication called omalizumab, or Xolair, works by targeting and binding immunoglobulin E (IgE), an antibody that triggers a release of histamine and other chemicals in the body when exposed to an allergen (1,2).
In early 2024, Wood and his team published the first results of the trial, which found that omalizumab worked better than a placebo (3). Last month, at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress, Wood and his colleagues showed that omalizumab also treated multi-food allergy better than oral immunotherapy (OIT), the only other treatment available for children with food allergies (4).
They found that 36 percent of study participants treated with omalizumab could tolerate two grams or more of peanut protein plus two other food allergens by the end of the treatment period, compared to 19 percent of patients who received OIT.
This improvement may not be because omalizumab is a more effective treatment, though, the researchers said. Rather, it may be due to how well children tolerate each of these therapies. “The biggest limitation was the dropout rate in those study participants on the oral immunotherapy,” Wood said.
People must take the OIT drug daily for it to be effective, and it can have negative side effects including anaphylaxis and abdominal pain. Rarely, it can also cause a disease called eosinophilic esophagitis, an inflammatory condition of the esophagus.
Due to these complications, Wood said that only about half of the people in the OIT group were able to complete the trial. When the researchers reanalyzed the data, excluding the participants who dropped out of the trial, they found that omalizumab and OIT actually had similar effectiveness.
According to Abigail Lang, an attending physician at the Ann & Robert H. Lurie Children’s Hospital of Chicago, who was not involved in the study, this research demonstrated that both therapies could be good choices for children and families with severe food allergies.
“Probably omalizumab is easier to do and has less side effects, and maybe is better tolerated,” Lang said. “But if you can get through and push through OIT, that's also a really good option.”
The best option for each child might depend on the severity of their allergy, how often they are willing to take medication, the cost of treatment, and other factors. Lang pointed out that a new omalizumab biosimilar medication was also just approved, which may help bring down the price of the medication.
“In the food allergy space, we used to have nothing,” she said. “Now we have some really good progress.”
References
- Casale, T.B. et al. A practical guide for implementing omalizumab therapy for food allergy. J Allergy Clin Immunol 153, 1510-1517 (2024).
- Anvari, S. et al. IgE-Mediated food allergy. Clin Rev Allergy Immunol 57, 244-260 (2019).
- Wood, R.A. et al. Omalizumab for the treatment of multiple food allergies. N Engl J Med 390, 889-899 (2024).
- Wood, R. et al. Treatment of multi-food allergy with omalizumab compared to omalizumab-facilitated multi-allergen OIT. J Allergy Clin Immunol 155, AB444 (2025).
