Up to 8% of children have at least one food allergy, and as much as 86% of these children are allergic to more than one food, notes Johns Hopkins pediatric allergist Robert Wood, who is the principal investigator of a recent study offering new insights on available treatments.

The study shows that omalizumab, an injectable drug approved by the Food and Drug Administration (FDA) for food allergies, performed better than oral immunotherapy. The new work builds on a 2024 landmark study led by Wood, which found that omalizumab, previously approved to treat asthma and other allergic conditions, was highly effective in preventing reactions in patients with a severe food allergy. Published in The New England Journal of Medicine, that research led to FDA approval of omalizumab for treatment of food allergy, including for patients as young as 1 year old.

Prior to the study, management of food allergies mostly relied on avoidance, and emergency treatment with epinephrine when an accidental exposure occurred. Another approach to treating food allergies in the U.S. has been oral immunotherapy, during which gradually increasing doses of a food allergen are eaten to reduce the allergic response to it.

In the latest study, published in a special supplement to the Journal of Allergy and Clinical Immunology, researchers compared omalizumab with oral immunotherapy. The team found that 36% of patients treated with omalizumab could tolerate 2,000 milligrams of peanut protein and two other food allergens without an allergic reaction, compared to 19% of patients treated with oral immunotherapy. In addition, omalizumab resulted in fewer patients dropping out of the study due to adverse events.

“This is the first time we’ve been able to directly compare these two treatments for multiple food allergies, and our study shows omalizumab was superior to oral immunotherapy,” says Wood, director of the Eudowood Division of Allergy, Immunology and Rheumatology at Johns Hopkins Children’s Center. “This is an important distinction for clinicians who are weighing which treatment to recommend to their patients.”

A subsequent phase of the study found that patients may be able to introduce allergenic foods into their diets after curtailing the medicine.

“While the results of stage III are still preliminary, the majority of the first 60 participants were able to successfully introduce allergenic foods into their diet after stopping omalizumab,” says Johns Hopkins pediatric allergist Jennifer Dantzer, first author of the stage III research.