Like many moms, I sometimes feel irrational guilt when I think back on my son’s first food allergic reaction. At some point he started refusing nut butter, and I still find ways to blame myself for not forcing him to continue eating it (because we know how well that goes with toddlers) — contradicting the advice I provide my patients.
My son was one-and-a-half when he first had an allergic reaction to cashews. It’s unsettling for any parent to see their child break out in hives, but I had the benefit of being an allergist and understood that the reaction was mild and not anaphylaxis. I also knew to quickly have him seen by an allergist for testing.
Now, years later, I feel relief watching my son eat cashews (more on that later). As an allergy mom and someone who works with allergy patients and their parents every day, I know just how anxiety-inducing food allergies can be. If your child has food allergies, here are three things I want you to know.
1. Comprehensive food allergy testing is critical
Just last week, I saw a 49-year-old patient who has spent most of his life avoiding multiple foods. As his testing later confirmed, he no longer has any food allergies — and I see this frequently. Someone will have a reaction once or at a young age, avoid the food, and it turns out they’ve outgrown it, or perhaps the allergy wasn’t there in the first place.
If you think your child might have a food allergy, get testing from a board-certified allergist and then test annually. Once we have a diagnosis, food allergies can be treated.
2. Treatment for food allergies has come a long way
Strict avoidance isn’t the only option anymore. At my practice, we offer highly personalized treatment for IgE-mediated food allergies in patients of all ages, from babies as young as 8 months to adults (our oldest patient to date is 68!). I encourage patients to begin treatment as early as possible while their immune system is the most malleable. Patients can be treated for a single food allergen or for multiple foods simultaneously, which allows for a significant improvement in quality of life in a short time, usually less than 12 months.
The first option is oral immunotherapy (OIT), which involves introducing increasing quantities of the allergen to the patient over time. After OIT, my son is now in “maintenance,” which is a protective dose and means he can eat up to four cashews daily (the quantity will vary by patient). At a minimum, OIT can protect from accidental exposures; and in the best case scenario, treatment can unlock a life free from the fear of food.
With OIT, a patient consumes the allergen every day — you can imagine how creative I’ve had to get with incorporating cashew into our family’s daily menu! Starting OIT can be scary for a patient who has had a frightening allergic reaction in the past. But the upside — aside from the obvious, his health and safety — is alleviating the anxiety of reading every single food label and living in fear that he might accidentally take a bite of a classmate’s cashew-containing snack.
Another effective treatment is an injectable medication called Xolair®. For many people, Xolair can provide strong protective benefits from a life-threatening allergic reaction — as a stand-alone treatment and alongside OIT. Although the drug has been used for asthma and other allergic diseases for more than twenty years, it was recently approved by the FDA for food allergies in 2024.
While research continues to improve and expand treatment options for food allergy patients, it's important that families are aware that they have life-changing options available now.
3. Food allergy treatment should not be one-size-fits-all
Where I practice, Latitude Food Allergy Care, our three founders are all food allergy moms. They created the largest network of food allergy clinics in the U.S. inspired by their own personal food allergy experiences. We understand how daunting it can be to navigate food allergies and that treatment is not one-size-fits-all.
As you determine what path works best for your family, consider these questions:
Understand your goal(s). Are you hoping to incorporate a food back into your child’s diet, or are you hoping to mitigate reactions?
What is realistic, logistically, for your family? In most cases, OIT requires twice-monthly appointments for 6-10 months. Evaluate how this fits into your lifestyle, but also take into account how your allergy clinic can support this process — are appointments and location accessible, is there after-hours support, are you provided with the tools you need for dosing and tracking, would you and your child feel supported and at ease throughout the process?
Maintain realistic expectations. When seeking food allergy care, be wary of overpromises of “free eating” or “curing” food allergies. If I had a magic wand, I’d choose for my son to permanently not be allergic to cashews, but I recognize that may not be realistic. While some people can over the long term test out of their allergen, we do not have a crystal ball to predict this. A realistic goal is to reduce the risk of reaction and allow for life to open up with less fear at birthday parties, summer camp, restaurants, travel, and school.
Remember that you’re doing a great job! I still occasionally feel guilt over my son’s food allergy, even if I know it’s illogical and would never place blame on another food allergy parent. Wanting what’s best for our kids and feeling responsible for their health and safety is inherent to being a parent. So I’ll tell you what I tell other parents (and try to remember to tell myself): You’re doing a great job.
You’re reading this article, doing the research, and you’re going to make the best plan for your child and your family with the information and resources available to you. You deserve to free up some brain space, reduce your worry (we do enough of that already!), and explore how the right food allergy treatment plan can help you do just that.
