With Palforzia Gone, Here Is Another Option: How Xolair Protects Against Food Allergy Reactions

Key Takeaways

• With Palforzia now discontinued, Xolair (omalizumab) remains an FDA-approved, currently available option specifically for reducing the risk of serious reactions from accidental exposure to one or more foods, in patients age 1 year and older.
• Xolair works differently than oral immunotherapy. It does not desensitize a patient to a specific food the way OIT does. Instead, it lowers overall allergic reactivity, making a severe reaction from accidental exposure less likely.
• In the pivotal OUtMATCH trial, significantly more patients on Xolair were able to tolerate small amounts of peanut, milk, egg, and cashew protein without a reaction compared to placebo.
• Patients on Xolair must continue strict avoidance of their allergenic foods and continue carrying epinephrine. It is a protective safety net for accidental exposure, not a green light to intentionally eat the food.

A different kind of option for a moment when families need one

With Palforzia's discontinuation this summer, a lot of families managing peanut allergy have understandably been asking what options remain. Oral immunotherapy using standardized peanut protein is still one path forward, but it is not the only FDA-approved option available right now. Xolair, a medication originally developed for asthma and later approved for chronic hives and chronic sinusitis with nasal polyps, received a fourth FDA approval in 2024 specifically for reducing allergic reactions in patients with one or more food allergies.

It works through a fundamentally different mechanism than oral immunotherapy, and understanding that difference matters for deciding whether it is the right fit for a given patient.

How Xolair actually works for food allergy

Lowering reactivity, not building tolerance to a specific food

Xolair is an injectable antibody that binds to and reduces free IgE, the antibody responsible for driving allergic reactions. By lowering overall IgE activity, it raises the threshold needed to trigger a reaction across multiple food allergens at once, rather than building tolerance to one specific food the way oral immunotherapy does through repeated, gradually increasing exposure to that particular food.

What the clinical trial showed

The FDA approval was based on the Phase 3 OUtMATCH trial, which found that a significantly higher proportion of patients on Xolair, ranging from age 1 to 55, could tolerate small amounts of peanut, milk, egg, and cashew protein without a reaction compared to those on placebo. This kind of protection against accidental exposure, rather than complete desensitization, is the specific benefit this medication offers.

The way I explain the difference to families is that oral immunotherapy is about training the immune system to tolerate a specific food you're deliberately exposing it to, while Xolair is more like raising the floor across the board, so an accidental trace exposure is less likely to turn into a severe reaction. For some families, especially those managing multiple food allergies at once, that broader protection is genuinely the better fit.

— Dr. Robert Tamayev, MD, PhD, Allergy Asthma

Important limitations to understand

Xolair does not replace food allergen avoidance. Patients on this treatment are still instructed to strictly avoid the foods they are allergic to, and to continue carrying epinephrine at all times, since Xolair is not an emergency treatment and does not eliminate allergy risk entirely. It is also given as an ongoing injection, typically every two to four weeks, based on body weight and baseline IgE levels, which is its own form of treatment commitment, just a different one than the daily dosing OIT requires.

Who this may be a good fit for

This option is often considered for patients managing multiple food allergies at once, since it can offer protection across several allergens simultaneously rather than requiring a separate desensitization process for each one. It may also be a reasonable choice for families who found the escalation phase or daily dosing commitment of oral immunotherapy difficult to sustain, or who are specifically looking for a lower-risk safety net against accidental exposure rather than the ability to intentionally eat a previously allergenic food.

When to book a visit

Consider scheduling a visit if you were previously on Palforzia and are weighing your next steps, if you are managing multiple food allergies and want to understand whether broader protection makes more sense than pursuing OIT for each one individually, or if you simply want a clear, current comparison of the food allergy treatment options actually available today.

Disclaimer: This content is educational and does not substitute for medical advice. Always consult your physician for personal medical questions.