Oral immunotherapy for multiple food allergies

At least one-third of children in the United States with food allergy have more than one allergy. Compared to individuals with a single food allergy, those with multiple allergens have increased burden of disease, as multiple foods can put them at risk for an allergic reaction following accidental ingestion. Oral immunotherapy (OIT) has shown promise and is now FDA approved to desensitize children with peanut allergy. OIT has also shown promise as a therapy for those with multiple food allergies, both alone and in combination with biologic therapies, including the most studied biologic—Omalizumab. OIT can be done simultaneously with multiple foods with comparable safety to single allergen OIT. Pilot studies have shown that adjunctive therapy with omalizumab can increase rates of successful desensitization in multi-food OIT, increase speed of desensitization to high maintenance doses, and reduce associated symptoms. Multi-food OIT with and without omalizumab has also been shown to improve quality of life measures in participants and caregivers. Additional potential therapies such as other biologics targeting the Th2 response, cross desensitization of allergens, and early prevention may be part of the multi-faceted approach for our food allergic patients.