The management of food allergies has changed over the last several decades, from primarily food avoidance, with its deleterious effect on quality of life (QOL) for patients and families, to the more widespread use of oral immunotherapy and anti-IgE monoclonal antibody (mAb) therapy. The effective treatment of food allergies can positively impact QOL for both patients and their families.

In my opinion, food allergies probably have the greatest impact on QOL of all the atopic diseases. Fear of food allergies in children can significantly negatively impact QOL for the whole family, causing constant anxiety and worry, including about potential reactions. Treatment can improve QOL because it empowers patients and families by doing something rather than waiting for a reaction to happen or for children to potentially outgrow the allergy.

Several treatment options, including oral immunotherapy, omalizumab, investigational epicutaneous immunotherapy, and investigational sublingual immunotherapy, now offer choices to patients with food allergies. And other drugs are coming, including other anti-IgE mAbs that may potentially be given at longer dosing intervals. These anti-IgE mAbs could be valuable for older children and teenagers who may want protection without the restrictions of daily immunotherapy. Immunotherapy requires a lot of work, and, while I think that the rewards outweigh the risks in these patients, we want more choices that are easy to use.

With effective treatment for food allergies, peace of mind and QOL improve. For affected infants and toddlers, effective treatment will allow them to never know that they had a food allergy, if properly managed. For older children, effective treatment may allow them to expand their food choices or possibly eat in restaurants with increased peace of mind. With the availability of effective treatments, parents are empowered to seek treatment for their children at an earlier age, when it seems to work more quickly and effectively, instead of waiting to see if they outgrow the food allergy at, for example, 4 or 6 years of age.

A treatment’s effect on QOL in food allergy treatment trials depends on how the study is conducted and when QOL is assessed. For example, a low QOL assessment at the beginning of a study may not be positively impacted if patients do not know what treatment they are receiving or the treatment effect, although good QOL surveys and questionnaires have been developed for adults and children with food allergies.

Food avoidance without treatment remains an option for patients with food allergies, but, in my experience, more children and their families want treatment. Food avoidance becomes especially difficult for teenagers in high school or starting college, and, in those circumstances, I may suggest treatment with something like omalizumab because the patient and their parents may have a better QOL knowing that the patient is being protected while away. New therapies, including BTK inhibitors and vaccines, are also being studied in food allergies. I really think that we can improve the QOL of patients and their families with these treatments, especially with more choices and treatment options becoming available.