Some kids may successfully eat trigger foods after stopping anti-allergy med, early study suggests

By Dr. Jade Cobern, Video by Will Linendoll & Sony Salzman

More than half of children in early stages of an ongoing study were able to eat a food they were allergic to one year after stopping Xolair, a medication used for some kids with food allergies.

Researchers say the results are encouraging but caution that not all children will respond the same, and this approach should only be done under medical supervision.

In the study, 60 kids who previously received treatment with Xolair for at least 24 weeks were followed for a year after stopping the drug at hospitals across the country.

According to researchers, each child was assigned three treatment plans, one per food trigger. Of these treatment plans, 82% involved kids eating a food trigger under medical guidance.

After a year, 61-70% of children successfully ate milk, egg, or wheat, while 38-56% were able to eat peanut or tree nuts.

These preliminary findings were presented by Jennifer Dantzer, M.D., a pediatric allergist at Johns Hopkins Children's Center, on Sunday, March 2 during a late-breaking symposium at the American Academy of Allergy, Asthma & Immunology and World Allergy Organization Joint Congress in San Diego.

"While the results of Stage 3 are still preliminary, the majority of the first 60 participants were able to successfully introduce allergenic foods into their diet after stopping omalizumab," Dantzer said in a Johns Hopkins press release. "Omalizumab is currently approved in the U.S. for the reduction of allergic reactions that may occur with accidental exposures. These results indicate that omalizumab may have additional uses that may be valuable for patients, but the potential risks should be recognized."

Treatment failure was linked to taste, food aversion, allergic reactions, and two cases of eosinophilic esophagitis, which led to stopping treatment. The study included peanut, cashew, egg, milk, walnut, hazelnut, and wheat.

Success was defined as eating at least 300mg of the food trigger daily. So far, there are no clear predictors that suggest which kids will be successful or not.

"What we were hypothesizing going into this stage of study is that while you still had Xolair in your system, you could be rapidly desensitized and that turned out to be the case for a majority of people, that was actually possible," Robert Wood, M.D., director of Eudowood Division of Allergy, Immunology and Rheumatology at Johns Hopkins Children's Center, who also led this study, told ABC News.

Originally approved by the Food and Drug Administration for asthma, Xolair is a lab-made monoclonal antibody that works by targeting a key allergy trigger called IgE. In February 2024, it became the first drug FDA-approved to reduce allergic reactions from accidental exposure. It is not currently FDA-approved for use while intentionally consuming allergens, but this can be done under appropriate medical guidance.

Wood explained it's believed kids who have success with this approach would need to remain "rigidly compliant with [that food] exposure that needs to be daily, or very, very close to daily, and as far as we know, needs to be maintained forever." This is also true for kids who undergo an alternative and common food allergy treatment called oral immunotherapy that can also successfully allow kids to eat some foods they are allergic to.

These two treatment options were compared against each other for the first time in a study presented at the same conference that suggests Xolair may be more successful than oral immunotherapy, but doctors say both are safe treatment options.

"The findings will inform patients' real-world treatments," Sharon Chinthrajah, M.D., a senior study author, associate professor of medicine and of pediatrics, and acting director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford Medicine, said in a Stanford press release. However, it was emphasized there's no therapy that's one-size-fits-all.

Chinthrajah said families and individuals should consider multiple factors with their doctor when creating a treatment plan based on their goals. Some may want to eat a specific food they react to, while others may focus on avoiding severe complications from accidental exposure.

The study of success eating food triggers after stopping Xolair is ongoing, so researchers are still collecting data for doctors to use making treatment plans with their patients. Parents interested in this option should talk with their child's allergy doctor to know if or when it may be possible to try.

“We and others are already using this approach for select patients with caution, recognizing that this use is not consistent with the FDA label,” Dantzer told ABC News.

Doctors say people who eat foods they are allergic to are still at risk for allergic reactions that can be life-threatening. Xolair is a type of medication that can cause a severe allergic reaction, and the injections can be painful. Doctors stress any changes to a food allergy treatment plan should not be done independently, only under medial guidance by an appropriately trained doctor.

Jade A. Cobern, MD, MPH, is board-certified in pediatrics and general preventive medicine, and is a medical fellow of the ABC News Medical Unit.