Early introduction to a range of foods, including potential allergens, remains the best way to help prevent food allergies in infants and young children, and options for treatment are in the pipeline, according to an expert panel convened by the FDA in February 2026.

The panelists discussed potential causes and risk factors for food allergies, the latest research on treatments and best practices, and how clinicians can respond to concerns and advise families on prevention and management.

Data from the CDC show that the number of children in the US with food allergies increased significantly in recent decades. Approximately 8% of children in the US have documented food allergies, and 40% of these can cause life-threatening reactions, based on data reported in Pediatrics.

Recognizing Risk Factors

Many aspects of food allergies are not fully understood, said Gideon Lack, MBBCH, MA, FMedSci, professor of pediatric allergy at King’s College London, London, England.

“What we do know is that babies require early exposure through the gastrointestinal tract to achieve tolerance,” of different foods, he said. Experts also know that the epidemic of food allergies has been concurrent with an epidemic of dry skin and eczema, he noted.

The landmark LEAP study, published in 2015 by Lack and colleagues, showed that infants at high risk for peanut allergy did not develop the allergy after regular consumption of peanut products. The study, and subsequent studies, indicate that early exposure to foods will elicit a protective immune response instead of an allergic reaction.

Why Early Exposure?

An important point is that many children outgrow their food allergies naturally, said Ruchi Gupta, MD, MPH, professor of pediatrics and medicine at Northwestern University, Chicago. The numbers of children who outgrow allergies is increasing as a result of new treatments and targeted early exposure, she said.

“We want to be careful about medicalizing food allergies,” Gupta said. “If your family is eating a certain food, don’t fear introducing it [to young children],” she said.

The Skin Connection

Even mild-to-moderate eczema is the strongest risk factor for food allergy in early life, and infants with these conditions should have early, proactive exposure to all foods, rather than delaying their introduction, said Corinne Keet, MD, PhD, professor of pediatric allergy/immunology at The University of North Carolina School of Medicine at Chapel Hill.

Up to 20% of infants with moderate-to-severe eczema in the first year of life develop food allergy, but even dry skin or skin barrier defects, even without visible eczema, have been associated with an increased risk for allergy, Keet said. In a 2021 study, Keet and colleagues found that, although a family history of allergic diseases increases one’s risk for food allergy, family history is a less significant risk for food allergy than eczema. Other risk factors that have not been consistent across studies include cesarean delivery, early exposure to antibiotics, being the first child, and not having pets, she said.

Keet is involved in the current SUNBEAM (Systems Biology of Early Atopy) study, supported by the National Institute of Allergy and Infectious Diseases (NIAID), which is designed to better understand the mechanisms of food allergy and environmental factors affecting risk.

Controlled Exposure

Oral immunotherapy (OIT) is potentially disease-modifying and helps patients build a safety net against an allergen exposure, said Michelle Huffaker, MD, clinical assistant professor of medicine at Stanford University, Emeryville, California, and director of clinical and translational medicine for the Immune Tolerance Network, a research organization funded by the National Institutes of Health (NIH) and NIAID.

Food allergy is diagnosed based on an allergic reaction following ingestion of the food; in OIT, small doses are given to retrain the immune system to stay calm, Huffaker said. OIT involves some risk since patients are ingesting allergens, but most side effects associated with OIT are temporary and mild-to-moderate, mainly involving the skin and gastrointestinal tract, she said.

Researchers are finding that for peanut allergy treatment in particular, starting early matters, said Huffaker. In the IMPACT study, 71% of children aged 1-3 years with peanut allergy who were randomized to peanut OIT effectively achieved remission. An additional takeaway was the greater effectiveness seen in younger patients, Huffaker noted. “Starting therapy early, while the immune system is still flexible, offers the best shot at achieving remission from peanut allergy,” she said.

Immunotherapy Alternatives

Although OIT can be effective for treating food allergy, only about 15%-20% of pediatric offices are able to offer immunotherapy, said Edwin Kim, MD, associate professor of pediatrics at The University of North Carolina at Chapel Hill, and director of the UNC Food Allergy Initiative.

OIT requires additional staff and training, space and time for the visits, and has limited reimbursement, Kim said. Safety is also a concern because severe allergic reactions may occur after the treatment, he added. Sublingual treatment involves application of drops under the tongue once daily, with exposure to approximately 1/75th of a peanut kernel, said Kim.

However, other options being studied include a patch applied to the patient’s back once daily, with an even smaller exposure. In the EPITOPE study, published in The New England Journal of Medicine in 2023, Kim and colleagues randomized children aged 1-3 years with peanut allergy to a daily skin patch containing peanut protein at a dose of 100 μg or 250 μg, or a placebo patch daily for 12 months. The peanut patch was superior to placebo in sensitizing the children to a peanut challenge, the researchers found. Data from another phase 3 study, VITESSE, showed similar results in children aged 4-7 years, according to manufacturer DBV Technologies, which plans to seek FDA approval for the patch in this population later in 2026.

Even if a food allergy remission is not permanent, treatment that keeps progression at a reasonable level “feels like a win,” Kim said.

Advocacy for Allergen Awareness

The expert panel discussion also included comments from Sung Poblete, CEO of the nonprofit organization FARE (Food Allergy Research & Education). Poblete highlighted the need for better disclosure of ingredients on food labels, especially the often-used “may contain” precautionary label, which is not sufficient to reassure those with severe food allergies.

The panel plans to draft a white paper to summarize the discussion, according to the moderators. Questions for future discussions include whether more study of the microbiome would be helpful, and more examination of potential root causes, which may include cesarean section delivery, bottle feeding vs breastfeeding, early use of antibiotics, and the role of ultraprocessed foods, said current FDA Commissioner Martin Makary, MD, MPH, who convened the panel.

In addition, the FDA has opened a docket for public comment on the topic of food allergies, available until April 25, 2026.

Lack disclosed serving as an advisor to DBV Technologies and being a DBV shareholder; he also disclosed receiving speakers fees from DBV, Novartis, ALK, and Aravax.

Gupta disclosed receiving research support from NIH, FARE, Sunshine, Genentech, Novartis, and Abbott, serving as an advisor for FARE, Genentech, DBV, Kaleo, OWYN, Bryn Pharma, and ARS, and an ownership interest in Yobee Care. Keet disclosed funding from NIH, but no commercial conflicts of interest. Kim disclosed receiving consulting work for multiple companies including ALK, Allergen Therapeutics, Cellergy Pharma, DBV Technologies, and Genentech.