Can You Reverse Food Allergies? What Experts Want You to Know
There's no way to reverse or cure a food allergy yet, but scientists are working on it. In the meantime, here are the existing, new, and coming treatments, including oral immunotherapy, that may help curb allergic reactions.
Food allergies are a serious problem. About one in 10 adults has a food allergy, according to a 2019 study, as do one in 13 children, says the Centers for Disease Control and Prevention. Allergic reactions can range from mild to potentially life threatening.
If you eat a food you are allergic to the symptoms can include itchy lips, mouth or tongue; hives; vomiting; diarrhea; swelling of the face and throat; wheezing; and even anaphylaxis, a dangerous reaction that results in a drop in blood pressure, trouble breathing, a sense of impending doom, and a loss of consciousness.
With stakes so incredibly high, millions of people—particularly the 32 million people in the U.S. with food allergies—would love a cure. But while there are treatments, ways to reduce severe reactions (that work for some people and types of allergies), and a chance that some children will outgrow an allergy, there’s no surefire way to reverse a food allergy.
“It would be amazing [but] unfortunately, we don’t have a way to do that,” says allergist David Stukus, MD, a member of the American College of Allergy, Asthma and Immunology (ACAAI). “There is no cure.”
Even without a cure, most people can manage their food allergy successfully, but it can be a risky game. Food allergies can develop at any age, one mild reaction doesn’t mean you won’t have a more severe one next time, and in some cases, they can potentially be fatal, says the American College of Asthma, Allergy & Immunology (ACAAI).
“Some people feel like they’re living with a ticking time bomb,” says Dr. Stukus.
Although there’s no cure yet, there are new treatments and even more in the works right now, in several promising directions.
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What foods most commonly cause allergic reactions?
More than 90% of reactions care caused by eight types of allergy-triggering foods, says Dr. Stukus. Those food are peanuts (which grow underground), tree nuts (like almonds, cashews, pecans, pistachios and walnuts), eggs, milk, fish, shellfish, wheat, and soy. (Learn more about the foods that cause most food allergies.)
An allergic reaction happens when your immune system mistakenly thinks something you ate or drank is toxic and overreacts by producing antibodies called immunoglobulin E (IgE).
Those antibodies are responsible for the symptoms of food allergies.
“Every single time you eat that food [that you’re allergic to], you’re going to have rapid onset symptoms, typically itching, hives, skin rash, swelling, vomiting and [potentially] a severe reaction called anaphylaxis,” says Dr. Stukus.
According to Food Allergy Research & Education (FARE), 200,000 Americans with food allergies need emergency medical care every year.
The best ways to treat an allergic reaction to food
The best way to avoid an allergic reaction is to avoid the food you are allergic to. Sound simple? It’s anything but. For one, you can have an allergic reaction to a food the first time you eat it. And it can be incredibly hard to identify an allergen in food mixtures or when ordering at a restaurant.
That said, strict avoidance of specific foods is the current standard of care, and people can do well with the right education and understanding, says Dr. Stukus. That means being really careful about ingredients, inspecting food labels and taking extra care when dining out (accidental ingestion carries the highest risk of reaction).
Everyone with a food allergy should also have an epinephrine autoinjector , sold under brands such as EpiPen and Auvi-Q, which contain a drug to stop the airways from swelling and shutting off, says the American Academy of Pediatrics.
Until recently, the best ways to manage food allergies have been an epinephrine injection to counteract an anaphylactic reaction and avoidance of the food trigger, says Chen H. Lin, MD, an allergist and immunologist with Houston Methodist Hospital.
However, the toolbox for food allergies is expanding, says Dr. Lin.
(You might be interested in dangerous myths about food allergies.)
What is immunotherapy?
There are ways to desensitize people, or reduce the severity of a person’s allergic reaction. Desensitization can be achieved via immunotherapy, an approach that’s been a staple of treatment for allergies for a century, says Dr. Stukus. “You take what you’re allergic to and give very small amounts back to the body to build up tolerance over time.”
Immunotherapy can include injecting an allergen (commonly known as allergy shots), or delivering it via tablets or drops, known as sublingual immunotherapy (more on that later). There are no allergy shots for food allergies, and allergy shots tend to be more successful for allergens like pet dander, pollen, and bee stings, although there are also sublingual immunotherapy treatments for ragweed, grass pollen, and dust mites.
Allergy shots require a serious commitment because they typically need to be done once or twice a week in a doctor’s office (in case there is a dangerous reaction), and then every few weeks after that for months at a time—and they don’t work for everyone.
With food allergies, the goal is the same: to raise the allergic person’s tolerance by exposing them to tiny but increasing amounts of the allergen.
If it’s a peanut allergy, for example, they’d first get a very small amount of peanut protein, usually in an allergist’s office or other medical setting. This would continue over a period of months with increasing but still small amounts and making sure there was no allergic reaction.
It’s intended to provide a buffer in case someone accidentally ingests the thing they’re allergic to.
A new pill helps prevent allergic reactions
The first oral immunotherapy treatment for a food allergy—a capsule called Palforzia—was approved in January 2020 for children and teenagers 4 to 17 with peanut allergies.
The goal of Palforzia, says Dr. Lin, “is to decrease the frequency and severity of an allergic reaction upon accidental exposure.” Still, he adds, it’s not a cure and you still have to be cautious, even though this is a boost to quality of life.
There is a downside. Oral immunotherapy is the best way to induce tolerance but it also has a greater risk of side effects because you’re ingesting the very thing you’re allergic to, says Dr. Stukus. And it’s a long-term therapy.
So far with Palforzia, there’s no indication you would be able to stop and keep your immunity, says the National Institute of Allergy and Infectious Diseases (NIAID).
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A skin patch may be on its way
“After Palforzia, the next immunotherapy for peanut allergy will be epicutaneous immunotherapy (a daily skin patch),” says Dr. Lin.
The Food and Drug Administration is currently reviewing a “peanut patch,” called Viaskin, for possible approval in August. That means it could reach the market this year or next, says Dr. Lin. In one study, almost half of participants achieved better protection from the allergen compared with only 12% in the placebo group
This type of immunotherapy has fewer side effects than oral immunotherapy, says Dr. Stukus, who is also associate professor of pediatrics at Nationwide Children’s Hospital in Columbus, Ohio
There are no allergy drops for food allergies yet
Sublingual immunotherapy is when tiny doses of the allergen are placed under your tongue via drops and absorbed through your mouth.
One study in the Journal of Allergy and Clinical Immunology found that two-thirds of 37 children who did 3-5 years of sublingual immunotherapy could tolerate at least 750 mg of peanut protein. Ten patients still had protection even after the immunotherapy stopped. Side effects were minor.
This method is still in development, says. Dr. Lin. There are no approved therapies right now.
“There are only limited studies evaluating the safety and efficacy of sublingual immunotherapy for food allergies and no specific product that has been developed or submitted for FDA approval,” adds Dr. Stukus.
That said, clinicians do use sublingual treatments off-label, he adds.
Probiotics are unproven for allergies
Although there’s been talk of using probiotics to help with food allergies, nothing definite has emerged.
“What we know so far is that probiotics do play a role in the gut microbiome and it might play a bigger role in early development like infancy or the perinatal period of time,” says Dr. Lin, referring to the weeks just before and after birth.
There’s a new study looking at oral immunotherapy plus probiotics which is having some success, Dr. Lin notes. “However, the probiotics dose is way more than what you can take from [current products],” he adds. And may not be an option for adults who already have food allergies or can still develop them.
Biologics hold some promise for allergies
Scientists are working with existing biologic drugs to see if they have a role to play in combating food allergies. “They target specific parts of immune pathway,” says Dr. Stukus. “They show great promise in preventing symptoms from happening but they’re not a cure.”
Researchers are looking at biologics now used for other conditions such as omalizumab (Xolair, an asthma medication), dupilumab (Dupixent for eczema), reslizumab (Cinqair, for asthma), mepolizumab (NUCALA, asthma). According to an article in Current Opinion in Allergy and Clinical Immunology, omalizumab has been studied the most in relation to food allergies.
There are also trials looking at combinations of biologics pus oral immunotherapy
One inhibiting factor? Shots can cost $1,000 each and have to be repeated every couple of weeks, says Dr. Stukus.
These treatments, existing or promised, won’t be for everybody, he adds, and some people will continue to rely on avoidance. “It’s OK for people not to choose one,” Dr. Stukus says.
Read about the challenge of living with a food allergy.
- JAMA Network Open: Prevalence and Severity of Food Allergies Among US Adults
- Centers for Disease Control and Prevention: Food Allergies
- Food Allergy Research & Education: "Fasts and Statistics."
- David Stukus, MD, member, American College of Allergy, Asthma and Immunology and associate professor of pediatrics
- Nationwide Children's Hospital, Columbus, Ohio.
- American College of Asthma, Allergy & Immunology: "Food Allergy."
- American Academy of Asthma, Allergy & Immunology: "Everything You Need to Know About Tree Nut Allergy."
- American Academy of Asthma, Allergy & Immunology: "Immunoglobulin E (IgE) Definition."
- American Academy of Asthma, Allergy & Immunology: The Current State of Oral Immunotherapy (OIT) for the Treatment of Food Allergy
- Food Allergy Research and Education: "Facts and Statistics."
- Chen H. Lin, MD, allergist and immunologist, Houston Methodist Hospital.
- Expert Opinion on Drug Delivery: "New pharmaceutical approaches for the treatment of food allergies."
- American Academy of Pediatrics: "How to Use an Epinephrine Auto-Injector."
- National Institute of Allergy and Infectious Diseases: "Few People with Peanut Allergy Tolerate Peanut after Stopping Oral Immunotherapy."
- National Institutes of Health: "Skin patch could treat peanut allergy."
- The Journal of Allergy and Clinical Immunology: "Epicutaneous immunotherapy for the treatment of peanut allergy in children and young adults."
- The Journal of Allergy and Clinical Immunology: "Long-term sublingual immunotherapy for peanut allergy in children: Clinical and immunologic evidence of desensitization."
- American College of Allergy, Asthma and Immunology: "Sublingual Immunotherapy (SLIT)."
- American College of Allergy, Asthma and Immunology: Allergy Immunotherapy
- Food Allergy Research & Education: "Biologics."
- Current Opinion in Allergy and Clinical Immunology: "Use of biologics in severe food allergies."