Eating away at food allergy

Food allergy (FA) is a significant public health concern, with its prevalence rising globally and greatly affecting the lives of patients and their families. The increasing burden on healthcare systems and the impact on quality of life underscore the need for better understanding and management strategies. The dual-allergen hypothesis suggests that early skin exposure to allergens increases sensitization risk, while early oral exposure and sustained ingestion of foods promote tolerance While diet is not the only factor in FA development, eating allergenic foods early and often can profoundly prevent FA despite other risk factors such as eczema. Treatment approaches vary by a number of factors including patient preference. Avoidance remains an option, but tailored avoidance, such as allowing denatured food products with milk and egg is now commonplace. Food immunotherapy approaches via multiple routes and doses are becoming more available. Immunotherapy can result in marked reductions in food reactivity which may be sustained for weeks or months or even longer off treatment for some patients. Biologics are also being more widely offered to increase the amount of food that can be safely ingested to facilitate immunotherapy. With the current approaches, treatment at a time of low IgE formation, often associated with younger age, may be the most effective for remission, but older ages may benefit from the increase in the threshold of reactivity that food-based treatments can provide.