Food allergy now has real treatments, and finding them starts with the right allergist

Key takeaways

• In a federal trial of children who reacted to peanut and at least two other foods, about 67% of those given omalizumab (Xolair) could eat the protein in roughly 2.5 peanuts with at most a mild reaction, compared with under 7% on placebo¹.
• A board-certified allergist has passed a proctored exam from the American Board of Allergy and Immunology after at least two years of accredited fellowship, on top of certification in internal medicine or pediatrics⁵⁶⁷.
• Specialist allergy societies in Britain and in Australia and New Zealand say hair analysis, muscle testing, electrodermal devices and IgG food panels can’t diagnose food allergy⁸⁹.
• A 2023 U.S. guideline says to give epinephrine at the first sign of suspected anaphylaxis, and to call 911 if the reaction is severe, doesn’t clear quickly and fully, or returns or worsens¹⁰.
• Epinephrine now comes in generic auto-injectors and a needle-free nasal spray, and in many states your pharmacist may swap in a generic unless the prescription says not to¹²¹⁴.

In February 2024, the Food and Drug Administration (FDA) approved an injection to make accidental bites of problem foods less dangerous¹. In the trial behind it, about two in three children on the drug could eat the protein in roughly 2.5 peanuts and have, at most, a mild reaction. On placebo, fewer than 7 in 100 could¹.

A month later, the Australasian Society of Clinical Immunology and Allergy (ASCIA), the allergy specialists’ group for Australia and New Zealand, updated its list of allergy “tests” it does not recommend. The list runs from hair analysis and muscle testing to a product called VoiceBio⁸.

In allergy, proven and unproven care can sit side by side. Online kits that test hair or a spot of blood are sold to shoppers, too, and ASCIA strongly advises against them⁸.

If you’ve felt brushed off by a doctor, a test that names your triggers in one visit can feel like being heard. That frustration deserves a real answer. The advances of the last few years, from peanut treatment for toddlers to epinephrine you don’t inject, are FDA-approved medicines¹³¹². Using them well takes a qualified clinician.

This guide covers how to check an allergist’s training, which tests are validated, what food allergy treatment looks like now and how to be ready for a severe reaction.

“Board certified” in allergy has a specific meaning

Allergists who call themselves board certified are certified by the American Board of Allergy and Immunology (ABAI). It’s a joint board of the American Board of Internal Medicine and the American Board of Pediatrics, and it sets its own standards independently⁶.

The path is long. To sit for the ABAI exam, a doctor must already hold current certification in internal medicine or pediatrics⁷. They also need at least 24 straight months of full-time training in an accredited allergy and immunology fellowship, plus sign-off from their program director and an unrestricted medical license⁷. Most fellowships take two to three years⁷.

The exam itself is secure and proctored. Doctors must pass it within seven years of finishing fellowship, and the board doesn’t recognize the term “board eligible”⁵. So if someone describes themselves that way long after training, ask what it means.

The board keeps records of who is certified and who is keeping up with ongoing certification, and it shares those names with the public⁶. Society directories, such as the American Academy of Allergy, Asthma & Immunology’s “Find an Allergist” tool, are a good place to start a search⁶. Confirm the certification with the board itself.

Your primary care clinician still matters. Epinephrine is available only by prescription, and your regular clinician can write one¹⁴. And a diagnosis needs more than a test result. ASCIA says it takes your medical history plus reliable testing, reviewed by a qualified doctor⁸.

Tests that measure your allergy, and tests that can’t

Allergy testing that works looks for IgE, the antibody behind classic allergic reactions. The list of validated options is short⁸:

• Skin prick tests, which place a tiny amount of a suspected allergen in the skin.
• Blood tests that measure IgE aimed at a specific allergen.
• Food or drug challenges, where you take measured doses of the suspected trigger under medical supervision.

None of these is meant to stand alone. A positive result means the most when it fits what happened to you⁸.

The unvalidated list is longer. The British Society for Allergy & Clinical Immunology (BSACI) calls a long run of methods “not valid diagnostic tests for any type of food allergy”⁹. Among them are hair analysis, muscle testing (kinesiology), electrodermal devices such as Vega machines, bioresonance, iridology and IgG blood tests⁹.

ASCIA’s list overlaps and adds pulse testing, reflexology and the Alcat test⁸. IgG food panels have their own article in this library, so this is the short version: both societies list them as unvalidated⁸⁹.

Treatments get the same scrutiny. Some practitioners offer “allergy elimination” methods, such as NAET, short for Nambudripad’s Allergy Elimination Techniques. ASCIA lists allergy elimination techniques among approaches it does not recommend⁸.

Why it matters goes beyond wasted money. The society warns that unproven tests can lead to misdiagnosis and costly, sometimes dangerous diets⁸. In children, needless food avoidance can mean poor growth, food anxiety and malnutrition⁸. The worst case runs the other way: a test can miss a real food allergy and raise the risk of anaphylaxis, the severe, whole-body reaction⁸.

Food allergy treatment has moved past “just avoid it”

Avoiding the food and carrying epinephrine are still the base of food allergy care. Two FDA-approved treatments now add a layer on top: they aim to raise the amount of food it takes to trigger a reaction¹³.

Peanut oral immunotherapy. Palforzia is a measured peanut protein powder, taken by mouth every day in rising doses. The FDA first approved it in January 2020 for ages 4 to 17 and extended it to toddlers aged 1 to 3 in July 2024³.

In the toddler trial, called POSEIDON, children built up over about 22 weeks to 300 milligrams of peanut protein a day, then kept taking it for about six months³. At the final food challenge, 73.5% of the 98 children on Palforzia could handle at least 600 milligrams of peanut protein, compared with 6.3% of the 48 on placebo⁴. By our math, that’s about 735 versus 63 children per 1,000.

It isn’t free of side effects. Treatment-related side effects hit 75.5% of children on the powder and 58.3% on placebo, mostly mild to moderate⁴. The drug’s maker at the time, Aimmune Therapeutics, then part of Nestlé Health Science, ran the trial. Nestlé sold Palforzia to Stallergenes Greer in September 2023³.

Omalizumab for several foods. Xolair, an injection, was approved on February 16, 2024, for people 1 and older with IgE-mediated food allergy¹. Shots come every two to four weeks¹.

OUtMATCH, the trial behind the approval, enrolled 177 children and teens plus 3 adults at 10 U.S. sites. Every participant reacted to peanut and to two or more other foods¹. For those other foods, the bar was at least 1,000 milligrams of protein²:

• Egg: 67% on the drug versus 0% on placebo.
• Milk: 66% versus 10%.
• Cashew: 41% versus 3%.

The National Institutes of Health sponsored and paid for the trial. Genentech and Novartis, which market the drug together, supplied it, and Genentech gave additional support¹.

Neither treatment is a cure. Palforzia is used along with a peanut-avoidant diet, and Xolair users keep avoiding their problem foods¹³. Neither is approved to treat a reaction once it starts¹³.

Two related subjects have their own articles. Our piece on early peanut introduction covers prevention in babies, and our rhinitis article covers allergy shots and tablets for pollen and dust mites.

Your instincts about your body deserve a fair test

Many natural-health readers distrust a quick prescription, and that instinct has a place here. Oral immunotherapy rests on a patient, almost old-fashioned idea: tiny daily amounts of the food itself, raised step by step over months³.

That’s working with the body, not against it. But it starts from a confirmed peanut allergy and carefully measured doses, not a guess³⁴.

Your own observations are the most valuable thing you bring. Write down what you ate, how soon symptoms began and what they looked like. A qualified allergist will build the testing around that history, not around a printout⁸.

Epinephrine comes first, and whether to call 911 depends on how fast it works

In late 2023, a joint task force of the two U.S. allergy societies updated its anaphylaxis guidance¹⁰. Two points stand out.

First, give epinephrine at the first sign or symptom of suspected anaphylaxis¹⁰. You don’t need to wait until the reaction meets formal diagnostic criteria¹⁰.

Second, calling emergency services may not be needed right away if epinephrine brings a fast, complete and lasting recovery, and more epinephrine and medical care are close at hand¹⁰. That was a conditional recommendation based on very low-certainty evidence¹⁰. It’s a plan to make with your allergist in advance, not a decision to improvise during a reaction. The guideline says training on an auto-injector should include whether and when to call 911¹⁰.

Reactions can come back. A pooled analysis covering 2,890 adults found a median rate of 6.5% for a second wave, called biphasic anaphylaxis, with individual studies ranging from 0.4% to 20%¹⁰. By our math, that median works out to about 65 people in 1,000. The guideline says a return is unlikely when the first reaction wasn’t severe and the person stays symptom-free through an hour of observation¹⁰.

The task force was paid for by the two allergy societies, and its members weren’t paid for the work¹⁰. HealthDay reported that several authors disclosed financial ties to drug companies¹¹.

A needle-free option. The FDA approved neffy, a 2-milligram epinephrine nasal spray, on August 9, 2024, for adults and children who weigh at least 66 pounds¹²¹⁴. It became the first U.S. epinephrine treatment for anaphylaxis that doesn’t use a needle¹².

A 1-milligram version for smaller children followed in March 2025, at first only for ages 4 and up¹³. In March 2026, the maker announced that the FDA had dropped that age floor. The smaller dose now goes by weight alone: 15 kilograms up to just under 30, or about 33 to 66 pounds¹³.

Four studies supported the first approval. They enrolled 175 healthy adults, none of them in the middle of a reaction, and found blood epinephrine levels similar to those after an auto-injector or a syringe shot¹². If a reaction isn’t easing, a second spray goes in the same nostril¹².

Instructions differ by device. The spray’s prescribing information asks doctors to explain when to get emergency help, Allergic Living reported, while long-standing auto-injector labels tell users to head straight to an emergency room¹².

Epinephrine costs and the school question

Most auto-injectors carry a 12- to 18-month expiration date, so the cost comes back every year or so¹². You have more choices than you may think¹⁴:

• Generic auto-injectors. These include an authorized generic of EpiPen, a Teva generic and an authorized generic of Adrenaclick. Auvi-Q has no generic.
• Pharmacy swaps. In many states, pharmacists may substitute a generic unless the prescriber writes “DAW” (dispense as written) or “do not substitute.”
• Maker programs. Manufacturers of Auvi-Q, EpiPen and neffy run assistance programs for patients who qualify; the nasal spray’s program may provide it at no cost.

Prices and coupons change often, so ask your pharmacist what you’ll pay. One practical edge for the spray: the 2-milligram version has a 30-month shelf life¹².

Schools have changed, too. Most states have passed laws that let schools stock epinephrine that isn’t prescribed to any one student¹⁴. Many states are looking at similar rules for places such as summer camps, amusement parks and movie theaters¹⁴. If your child uses the nasal spray, ask the school which devices its stock includes.

Children may need more than one set of devices, such as one for school and one for after-school care¹⁴.

Labels got one allergen longer. The FASTER Act, signed on April 23, 2021, made sesame the ninth food allergen that must be named in plain language on U.S. packaged-food labels, starting January 1, 2023¹⁵. It was the first allergen added to the 2004 federal allergen labeling law¹⁵.

The allergy care checklist

Use this to judge a new clinic, test or treatment.

Step	What qualified care looks like	Red flags
Choosing a clinician	ABAI certification you can confirm, or a primary care clinician who refers you567	“Board eligible” claims long after training; credentials you can’t check5
First visit	A careful history: what you ate or touched, how fast symptoms came, what they looked like8	A diagnosis from a hair sample, muscle strength or a handheld device89
Testing	Skin prick or IgE blood tests chosen to fit your story; a food challenge done under medical supervision8	Panels promising dozens of “sensitivities”; IgG food panels; mail-in hair or blood-spot kits89
Treatment talk	A clear avoidance plan, plus whether Palforzia or omalizumab fits your case13	Promises to “eliminate” an allergy; no plan for what happens if the test missed something8
Emergency plan	An epinephrine prescription, training on when and how to use it, and a plan for whether and when to call 9111014	No discussion of a second dose or of when to get emergency help10
Follow-up	Advice to carry epinephrine at all times if you’re at high risk, and a talk about whether you need more than one device10	Advice to drop epinephrine after an unproven test or treatment, which could leave a real allergy unprotected8

How strong is the evidence?

Approach	Rating	What it rests on
Skin prick or IgE blood tests read with your history	Strong evidence	Listed as evidence-based by allergy societies8
Supervised food challenge	Strong evidence	Evidence-based when done under medical supervision8
Omalizumab raises reaction thresholds for several foods	Strong evidence	An NIH-funded randomized trial and FDA approval12
Palforzia raises the peanut threshold in children	Strong evidence	A randomized toddler trial and FDA approvals; side effects are common34
Nasal spray works as well as a shot during a real reaction	Promising but early	Approved on blood levels in healthy adults, not tested in people having a reaction12
Holding off on 911 is safe after a fast, complete, lasting response to epinephrine, with backup nearby	Promising but early	Conditional guideline advice based on very low-certainty evidence10
“Allergy elimination” treatments such as NAET	Not enough evidence	Listed by ASCIA as not evidence-based8
Hair analysis, muscle testing, electrodermal tests, bioresonance, IgG panels	Evidence says no, or unsafe	Called not valid for diagnosis by two allergy societies89

Questions readers ask

The bottom line

Allergy care is better than it was even five years ago. Children allergic to peanuts and other foods now have treatments that raise the amount it takes to trigger a reaction, and families who fear needles have a nasal spray.

Those advances come through qualified care: a clinician whose training you can check, tests that measure the allergy itself and an emergency plan written before you need it. Hair, muscle and device tests can’t deliver that, and the cost of a wrong answer can be a missed allergy.

Keep exploring: supplements and autoimmune disease.

Related reading

• Testing decides what helps a stuffy nose, since not every one is an allergy
• IgG food tests mostly show what you eat, not what hurts you
• Parents were told to delay allergy foods, and the research said the opposite
• What the letters after a practitioner’s name mean
• Case reports tie spirulina to autoimmune flares, so vet any supplement first

Sources

1. Arkansas Children’s. “FDA-Approved Food Allergy Treatment” (news release on omalizumab approval and the OUtMATCH trial). February 29, 2024. archildrens.org
2. Pharmacy Times. “Data From OUtMATCH Study Show Benefits of Xolair for Common Food Allergies” (on Wood RA, Togias A, Sicherer SH, et al., “Omalizumab for the Treatment of Multiple Food Allergies,” New England Journal of Medicine, 2024). February 27, 2024. pharmacytimes.com
3. Stallergenes Greer. “FDA approves U.S. pediatric indication extension for Palforzia oral immunotherapy for the treatment of peanut allergy” (company press release). July 30, 2024. origin.stallergenesgreer.com
4. Contemporary Pediatrics. “Palforzia Receives Expanded Label to Treat Toddlers With Peanut Allergy” (on the POSEIDON trial, NEJM Evidence, 2023). July 30, 2024. contemporarypediatrics.com
5. American Board of Allergy and Immunology. “Become Certified.” ABAI, accessed October 2026. abai.org
6. American Academy of Allergy, Asthma & Immunology. “American Board of Allergy and Immunology (ABAI).” AAAAI, accessed October 2026.)
7. National Jewish Health. “About the American Board of Allergy and Immunology” (fellowship information sheet). Accessed October 2026. nationaljewish.org
8. Australasian Society of Clinical Immunology and Allergy. “Evidence-Based Versus Non Evidence-Based Tests and Treatments” (patient FAQ). ASCIA, content updated March 2024. allergy.org.au
9. British Society for Allergy & Clinical Immunology. “Other Tests” (food allergy investigations). BSACI, last modified January 2022. bsaci.org
10. Golden DBK, Wang J, Waserman S, et al. “Anaphylaxis: A 2023 Practice Parameter Update.” Annals of Allergy, Asthma & Immunology, 2023 (AAAAI-hosted copy). aaaai.org
11. Gotkine E. “Updated Guidelines Issued for Management of Anaphylaxis.” HealthDay, December 26, 2023. healthday.com
12. Allergic Living. “FDA Approves Neffy Epi Nasal Spray for Severe Allergic Reactions.” August 9, 2024. allergicliving.com
13. Campbell P. “FDA Removes Age Requirement for Epinephrine Nasal Spray, Now Based on Weight Alone” (on an ARS Pharmaceuticals announcement). HCPLive, March 27, 2026. hcplive.com
14. Kids With Food Allergies, a division of the Asthma and Allergy Foundation of America. “Epinephrine Devices for Anaphylaxis.” Updated January 2025. kidswithfoodallergies.org
15. Food Allergy Research & Education (FARE), patient advocacy nonprofit. “With the Stroke of President Biden’s Pen, FASTER Act for Sesame Labeling Becomes Law” (news release). April 23, 2021. foodallergy.org