Food allergy impacts approximately 10% of adults and 8% of children in the United States based on a survey from 2018 [1] with evidence of increasing prevalence over the previous decade [2]. Parent-reported food allergy is even higher at 11% for children although non-IgE-mediated conditions accounted for a portion of the reported allergies [1], [3]. Food-induced allergic reactions can progress to anaphylaxis, a life-threatening reaction, that requires treatment with epinephrine and emergency care. In fact, recent survey data demonstrates that 1 in 10 food allergic individuals received treatment for food-induced allergic reactions in the emergency department in the preceding twelve months and 1 in 3 have received treatment in the emergency department for a food-induced allergic reaction at some point in their lifetime [1], [4]. There is increased risk for severe allergic reactions with peanut, tree nuts, shellfish, and fish allergies [4], as well as for adolescents and young adults [1]. Individuals with food allergy, especially those with multiple food allergies, report a lower quality of life than their non-allergic peers [1]. In addition to impairment in quality of life, there is a significant economic burden associated with food allergies. The estimated annual economic cost of food allergy is estimated to be $24.8 billion with direct medical costs including hospitalizations, office visits, and emergency department visits accounting for $4.3 billion [5].

Although the mainstay of treatment for food allergy has been avoidance and management of allergic reactions with epinephrine and/or oral antihistamines, there has been increased research into potential immunomodulatory therapies to induce desensitization, and ultimately, sustained unresponsiveness (SU). Several different forms of immunotherapy have been studied in the treatment of food allergy including sublingual immunotherapy (SLIT), epicutaneous immunotherapy (EPIT), and oral immunotherapy (OIT) with the FDA approving Palforzia, a peanut OIT product, for management of peanut allergy in individuals 4 to 17 years old. This paper will briefly review the proposed mechanisms underlying the pathogenesis of food allergy and the prevention of food allergy through early allergen introduction. The majority of this review will discuss the induction of SU as the goal for management of food allergy with a focus on OIT, as well as potential adjunct therapies to OIT.