Food Allergy and Anaphylaxis Treatment

Building habits to avoid food allergens is a great way to keep your baby safe — and at the end of the day, it’s enough. Some families may choose to take additional steps and discuss the different food allergy treatments with their healthcare team. On this page, learn more about the different treatments and medications that may come up during your baby’s food allergy journey, including:

• Oral immunotherapy, or OIT
• Baked eggs or milk
• Biologic therapies like Omalizumab or Xolair

Even with these new treatments, it’s important to remember that epinephrine is the only medication that can stop anaphylaxis, a serious allergic reaction. That’s why it’s important to always keep epinephrine with you, and make sure you and your child’s caregivers know when and how to use them. Acting fast with epinephrine can save a life.

For information on preventing food allergies from developing, check out the Early Introduction page.

With new treatments and careful planning, families have more ways than ever to help their children live safely and confidently with food allergies.

Types of food allergy treatments 

Food allergy treatments can help your child’s body become less sensitive to food allergens.

• Oral immunotherapy (OIT): Helps the body gradually get used to the allergen.
• Biologics: This injectable medication keeps the body from overreacting to a food allergen.
• Baked egg or milk: Some children can safely eat eggs or milk if they are in baked goods — this can help build tolerance to non-baked forms.

Other types of treatments help you manage the allergy or treat severe reactions if they happen.

• Emergency care: Epinephrine is used right away during a serious allergic reaction.

Every allergic reaction is different. Talk to your doctor about which treatment might be right for your child.

Oral immunotherapy (OIT)

Food allergy oral immunotherapy is a long word (often called OIT) for a type of treatment that helps build tolerance to common food allergens. In other words, it helps your baby slowly get used to the allergen. The goal is to make the immune system less likely to cause a severe allergic reaction if they are accidentally exposed to even a small amount. It works by giving a tiny amount of a known food allergen to your child, then gradually larger amounts until a maintenance dose is reached. This helps desensitize the child to the food allergen.

Food allergy OIT must always be done with a trained healthcare provider. Do not attempt it on your own! OIT is a relatively newer treatment, and not all doctors offer it. It is usually done at special allergy centers that have experience with this therapy.

Two main types of OIT:

• Clinic-based OIT (not FDA-approved). Some allergy practices offer OIT for other common food allergens, such as cow’s milk, egg or tree nuts. The process is the same: your child is given small, increasing amounts of the food allergen until a maintenance dose is reached.
• FDA-approved OIT for peanut allergy. Palforzia is for children ages 1-17 with a confirmed peanut allergy. Unfortunately, it is being discontinued as of July 2026. It comes as a special peanut protein powder. Palforzia is designed to help build tolerance to peanut and can help reduce the risk of a severe reaction if a child eats a peanut by accident, but it does not cure the allergy.

Baked milk or egg for building tolerance

Some children with milk or egg allergies can safely eat baked foods like muffins, waffles, or cookies that contain these ingredients. This is great news for many families, as these are often highly asked for pantry items! Baking at high heat changes the proteins in milk and egg. This can make the milk and egg products less likely to cause an allergic reaction.

Food allergy research shows that:

• Children with a confirmed milk or egg allergy may become more tolerant if they eat baked forms regularly.
• The immune system may learn to accept these foods over time.
• Some children may even outgrow the allergy completely.

Baked milk or egg protocols are not the same as oral immunotherapy (OIT). Baked food is not given in a set daily dose. It uses real, baked food like home-baked goods. Discuss the baked milk/egg process with a doctor to determine whether your child can have it. Your child may need to undergo allergy testing (skin test/blood test or oral food challenge) before adding baked forms of milk or eggs.

An allergist may recommend using what’s called a milk ladder or egg ladder. These are step-by-step plans that start with milk- or egg-based foods baked at high heat (like muffins). The next rung moves on to foods that are cooked at lower heat (like pancakes or scrambled eggs). Each step in the ladder is taken only if the previous step is safely tolerated.

Biologic therapies

Some young children with food allergies have very strong reactions to even tiny amounts of certain foods. For these children, new treatments called biologics may help. Omalizumab (Xolair®) is an FDA-approved biologic medication for the treatment of food allergies. It is for children 1 years of age and older at risk for severe symptoms.

What is omalizumab?

• Omalizumab is given as an injection to treat a child’s food allergy.
• It works by blocking a substance in the body called IgE. IgE plays a major role in allergic reactions.
• By lowering IgE, omalizumab can help calm the immune system and reduce allergic responses in case of an accidental exposure.

Omalizumab does not cure food allergies. Your child will still need to avoid their allergens and carry epinephrine for emergencies.

Omalizumab and oral immunotherapy

Some doctors now use omalizumab together with oral immunotherapy (OIT) for most food allergies. This is called adjunct therapy. Research shows that using both treatments can make it safer and more effective for children with severe or multiple food allergies.

How does omalizumab help?

• Improves desensitization: When combined with OIT, omalizumab helps children tolerate higher amounts of the food allergen. They may reach the maintenance dose faster.
• Reduces allergic reactions: Children using both treatments had fewer allergic reactions, including severe allergic reactions like anaphylaxis, during OIT.
• Supports sticking with treatment: Families were more likely to stay on track because the process was smoother and safer.

What you need to know about OIT with omalizumab:

• This is not an FDA-approved therapy.
• Your child must still avoid the allergen during treatment.
• This is not a cure.
• Children still need to carry epinephrine at all times.
• Not all allergists offer OIT, and it may not be right for every child.

Implementing food allergy treatment safely

Now that several treatment options for food allergies exist, families might want to figure out the best choice for their child.

Note: Parents and caregivers of babies or toddlers with food allergies should always carry epinephrine, even if their child is undergoing OIT or biologic therapy.

When considering a food allergy treatment for your child, seek out the guidance of a food allergy specialist such as an allergist. These doctors are able to properly test your child for food allergies. They can help you decide whether your child should go on a treatment.

When looking for an allergist, use trusted resources like the ACAAI’s Find an Allergist tool or the AAAAI’s Find an Allergist tool.

First-line treatment for an anaphylaxis emergency

Even when you try your best to avoid food allergens and start on a new treatment, accidental exposures can still happen. That’s why it’s important to know the signs and symptoms of a serious allergic reaction in infants. And be ready to act fast. Parents and caregivers of food-allergic babies or toddlers should always carry epinephrine, even if their child is undergoing OIT or biologic therapy.

If your baby has an anaphylactic reaction, use the emergency plan you developed with your child’s healthcare team. This plan will tell you exactly what to do in an emergency. It should explain when to give a first and second dose of epinephrine, call for an ambulance, or go to the hospital or ER. This plan can be based on shared decision-making, a process in which you and your doctor decide together which treatment is best.

What is epinephrine?

Epinephrine is the medicine form of adrenaline. It is the treatment of choice for anaphylaxis, which is a severe allergic reaction.

Epinephrine acts on many parts of the body where allergic reactions are happening, including the skin, lungs, heart, and blood vessels. It also works directly on allergy cells, called mast cells and basophils. It helps stabilize these cells, making it less likely that they will keep releasing chemical messengers called histamine, leukotrienes, and platelet-activating factor. These chemical messengers cause the symptoms we see, including swelling, itching, trouble breathing, and changes in blood pressure or fast heartbeat. Epinephrine helps shut that process down.

It also helps keep fluid inside the blood vessels, supports blood pressure, relaxes the lungs to make breathing easier, and reduces swelling in the airway.

So overall, epinephrine works in many places in the body and helps stop the reaction at its source, not just the symptoms.

Multiple types of epinephrine products are available. Epinephrine auto-injectors are approved for infants and toddlers, and the appropriate dose is based on their weight.

Instructions for using an epinephrine auto-injector

• When giving epinephrine, lay your baby flat on the back or hold in your lap while keeping the legs stretched out in front.
• Do not stand or carry your baby upright when giving the medication, as this can cause a sudden drop in blood pressure.
• Inject the epinephrine into the outer thigh muscle. You can give the shot through clothing if needed.
• If you’re worried about hitting bone, gently pinch the thigh to create a soft area and inject the medicine into the muscle.
• Hold the epinephrine auto-injector in place for 3-10 seconds, or follow the instructions on the medication label.

If you’re unsure how to use the device, ask your healthcare provider for a demonstration. Most auto-injectors come with a trainer device so you can practice and feel confident.

During the anaphylaxis episode, keep your baby lying down, with legs raised if possible. This can help the blood flow back to the heart and vital organs. If your baby is vomiting or having trouble breathing, hold the body upright or turn on the side.

When to seek emergency care?

Not all allergic reactions require emergency medical care, but all cases of anaphylaxis need epinephrine fast. If your baby’s symptoms get better after a first dose of epinephrine, you may not need to go to the hospital or emergency department. But you should continually monitor your baby’s symptoms during and after the reaction, including after giving epinephrine.

Call for emergency medical help or go to the hospital or clinic if…

• symptoms return or worsen after the first dose of epinephrine;
• your baby has severe anaphylaxis;
• symptoms do not go away promptly or completely after the first dose of epinephrine;
• a second dose of epinephrine is needed.

After the case of anaphylaxis is resolved, schedule a follow-up appointment with your child’s healthcare team. You may need to discuss what happened and make a change to your child’s anaphylaxis action plan.

What to do if your baby is showing symptoms but you’re not sure it’s anaphylaxis? The best approach is to still give epinephrine right away. The medication is unlikely to cause harm if it is not really needed. But if it is needed, delaying treatment could be dangerous.

How do you stop anaphylaxis without epinephrine?

You cannot fully stop anaphylaxis without epinephrine. If your baby is having anaphylaxis and you do not have epinephrine with you, call 911 right away. Do not wait to see if symptoms get better on their own. Anaphylaxis can get worse quickly and become life-threatening if untreated.

While you wait for emergency help to arrive…

• Lay your baby flat or on the side.
• If there’s vomiting, turn your baby on the side to help keep their airway clear.
• Stay with your baby and keep calm as much as possible.

After the emergency, talk with your child’s healthcare team about getting an epinephrine prescription so you are prepared in the future.

Early allergen introduction

Early Introduction is about preventing a food allergy from developing, rather than preventing a food allergy reaction like anaphylaxis. Unlike treatments, Early Introduction is done right when your baby is ready to start solids. In these cases, your baby probably doesn’t have a diagnosed food allergy yet (or only has one, such as egg). Research shows that giving your baby common food allergens between 4-6 months of age can help prevent food allergies. More details can be found on the early allergen introduction page.

Questions & answers (Q&A) on food allergy treatments for babies & toddlers

Food allergy therapies and emergency treatment for allergic reactions may feel overwhelming. What’s best for your young child? Check out answers to some common questions we’re asked about food allergy treatment for babies and toddlers.