Selecting patients for food allergy therapy.

Background: Food allergies pose a significant burden on the daily life of individuals with food allergy, including dietary, psychosocial, and economic impact. The management of food allergy has shifted recently from previous passive avoidance approaches to current active therapeutic interventions. Objective: This article aims to discuss selection of patients with food allergies for different therapies. Methods: Published literature on risks and benefits of various therapies as well as articles on shared decision-making were reviewed for this article. Key papers are included. Results and Conclusion: In addition to the two U.S. Food and Drug Administration approved therapies currently available (for oral peanut immunotherapy and for treatment of single and/or multiple food allergies), many novel treatments are on the horizon. Alternative forms of food immunotherapy, such as epicutaneous and sublingual, as well as a variety of new biologics are under development. When selecting patients for therapy, it is important to consider multiple factors, including eligibility, age, type of food, history of life-threatening reactions, baseline quality of life, and the presence of atopic comorbidities. As the food allergy landscape becomes enriched with novel treatment modalities, choice of the appropriate therapy for each individual is more challenging. Avoidance also remains an acceptable strategy for those who prefer this approach.