“It’s a fun time to be a food allergist”—Dr. David Fleischer

Food allergy treatment is no longer just about avoidance, epinephrine, and hoping for the best. With high-dose OIT, low-dose OIT, SLIT, EPIT, Xolair, and other biologics entering the conversation, allergists now face a more practical question: what are we trying to achieve, and what approach best fits this patient and family?

On this episode, Dr. Mariam Hanna is joined by Dr. David Fleischer, section head of allergy and immunology and director of the Allergy and Immunology Center at Children’s Hospital Colorado, and professor of pediatrics at the University of Colorado School of Medicine. He walks through how dose, route, safety, family goals, practicality, and flexibility all shape the choice of therapy.

Key Points

• Low-dose OIT may offer similar protection to higher-dose protocols in some patients, making the dose question more about goals, risk, and fit.
• Protection is the first goal; clinical remission remains the harder, longer-term hope.
• Lower-dose approaches may offer practical advantages, including fewer up-doses, fewer clinic visits, and potentially fewer side effects.
• SLIT and EPIT may be useful options for families looking for more forgiving, lower-burden approaches.
• Xolair can provide protection for selected patients, but Dr. Fleischer emphasizes that it is not disease-modifying.
• Food allergy treatment is becoming a shared decision about efficacy, safety, practicality, and what the family actually wants from therapy.

With more tools in the food allergy toolbox, the future may not be one perfect protocol for everyone. It may be choosing the right therapy for the right patient, then having the flexibility to change course when life, goals, or tolerance change.

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The Allergist is produced for CSACI by PodCraft Productions