Clinical outcomes in food allergy: Implications for patients, clinicians, and health systems

Food allergy prevalence continues to rise, with increasing recognition of its psychosocial burden and impact on health systems. As new therapeutic options emerge, outcome assessment in food allergy has expanded to include desensitization, remission, safety, quality of life, and healthcare utilization. However, heterogeneity in outcome definitions and measurement approaches limits cross-study comparability and complicates the interpretation of treatment benefit. This review examines current concepts and evidence related to remission and clinically meaningful outcomes in IgE-mediated food allergy. We summarized key definitions, including desensitization and sustained unresponsiveness, and reviewed the epidemiology and predictors of natural and treatment-induced remission. Data from allergen immunotherapy and biologic therapy trials are discussed, with emphasis on variability in durability of response and patient factors associated with remission. We also reviewed outcome domains beyond oral food challenge metrics, including immunologic markers, patient-reported outcomes, safety, and health system-level measures, highlighting their respective strengths and limitations. Finally, we discussed ongoing challenges in outcome standardization and the importance of harmonized, patient-centered outcome assessment to support clinical decision-making and translation of research into practice. Improved alignment of clinical, immunologic, and patient-reported outcomes will be essential to accurately characterize therapeutic benefit and guide the evolving management of food allergy.