A nationwide clinical trial led by Stanford Medicine researchers has found that some children and young adults with multiple food allergies can safely consume full servings of foods that previously triggered allergic reactions while receiving targeted medical treatment. Published July 27, 2026, in JAMA Pediatrics, the stage 2 trial found that about one-third of participants receiving omalizumab successfully completed food challenges involving common allergens such as peanuts, tree nuts, wheat, milk, and eggs. The study compared continued treatment with the injectable antibody medication omalizumab with multi-allergen oral immunotherapy that was initially facilitated by omalizumab.
Food allergies pose a widespread and stressful health challenge, affecting roughly 8% of U.S. children and 10% of adults. For children, managing allergies can be particularly daunting because common triggers are found throughout standard diets, and approximately 40% of children with food allergies react to more than one food. Traditionally, families have relied primarily on strict avoidance to prevent potentially life-threatening reactions, making school lunches, birthday parties, restaurant dining, and other everyday activities a source of persistent anxiety.
To address this burden, researchers examined omalizumab, a medication that binds to immunoglobulin E, or IgE, the antibody involved in allergic reactions. In February 2024, the US Food and Drug Administration approved omalizumab for reducing allergic reactions, including anaphylaxis, following accidental exposure to one or more foods. Patients taking the medication must still continue avoiding their allergens.
The new trial went further by testing whether continued omalizumab treatment or multiallergen oral immunotherapy could raise patients’ reaction thresholds enough to allow them to consume substantially larger quantities of foods that had previously triggered reactions. Oral immunotherapy involves consuming carefully measured amounts of allergen protein each day, beginning with very small doses and gradually increasing them under medical supervision.
The trial included 117 participants ranging in age from 1 to 29, with a median age of 7. All had a peanut allergy and allergies to at least two additional foods. Participants initially received omalizumab before being assigned either to continue the medication or to transition to multiallergen oral immunotherapy.
By the conclusion of the year-long trial, 36% of participants assigned to continued omalizumab successfully completed food challenges that included a 2,000-milligram serving of protein from each of three allergenic foods. In comparison, 19% of participants assigned to the oral-immunotherapy group achieved the same outcome.
The difference between the groups was driven largely by the higher withdrawal rate among participants undergoing oral immunotherapy. That treatment required daily dosing and a greater time commitment and was associated with more adverse events, treatment discontinuations, and reactions requiring epinephrine.
Treatment completion was therefore an important factor in interpreting the results. Among participants who were able to remain on the assigned therapy, those receiving oral immunotherapy achieved outcomes comparable to those receiving omalizumab alone.
“For people who could comply with the combined treatment approach, they were as successful as the patients using omalizumab alone,” said senior author Sharon Chinthrajah, MD, professor of medicine and pediatrics and co-director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford Medicine.
She added that “it will be important for our team to better understand the reasons people discontinued treatment so we can tailor each approach.”
Despite the differences in completion rates and safety profiles, the findings provide physicians and families with additional evidence for choosing among treatment strategies based on their goals, medical circumstances, and willingness to accept the demands associated with each therapy.
“This study is very encouraging because it shows that we have treatment choices for our patients that are safe and not too burdensome,” said co-author Sayantani Sindher, MD, a clinical associate professor of medicine.
Researchers emphasized that treatment goals can vary significantly from one patient to another. Some families may hope to incorporate previously avoided foods into a child’s regular diet, while others may simply want greater protection from reactions caused by accidental exposure.
The study ultimately supports a more personalized approach to food-allergy management rather than a single treatment strategy for every patient.
“We have demonstrated that there are multiple paths to living a safe life with food allergies,” Chinthrajah said.
Factors such as needle phobia, asthma, eczema, treatment burden, safety concerns, and changing personal goals may all influence which approach is most appropriate. The findings may help physicians better tailor treatment plans that balance medical safety, lifestyle preferences, patient comfort, and the level of protection each family hopes to achieve.
[For a mother’s perspective of a child with severe food allergies undergoing treatment with omalizumab, see the podcast below.]
