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The mainstay of treatment for patients with IgE-mediated food allergy is avoidance and preparedness for accidental exposures with self-injectable epinephrine and a personalized allergy action plan. Oral allergen immunotherapy (OIT) for peanuts was approved by the U.S. FDA in 2020, but most patients' allergies return when it is stopped. In addition, patients who use OIT actually have more allergic reactions and need for epinephrine from the peanut powder itself than do patients who just avoid peanuts. Now, in February 2024, the FDA has approved the anti-IgE monoclonal antibody omalizumab to reduce food allergy severity or block reactions after accidental ingestions; this drug also is approved for asthma, chronic urticaria, and nasal polyps.
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