Mahboobeh Mahdavinia, MD, PhD, a board-certified allergist/immunologist from The University of Texas Health Science Center at Houston

Mahboobeh Mahdavinia, MD, FAAAAI, PhD

 carries some chance of resolution, even peanut allergy, historically considered unlikely to resolve, according to Mahboobeh Mahdavinia, MD, PhD, a board-certified allergist/immunologist from The University of Texas Health Science Center at Houston.¹ Mahdavinia said the message for practicing allergists is straightforward: discuss the possibility of resolution at diagnosis regardless of allergen, and recheck IgE levels or offer an oral food challenge at least yearly, since a year or 2 of surveillance can change a family's dietary reality.

Egg Ladder Protocol Remains Underused Despite Safety Data

Mahdavinia said early, unpublished follow-up data from a subset of the FORWARD cohort suggest yearly surveillance may meaningfully raise peanut resolution rates above the 3.8% seen at initial enrollment, though the finding has not yet been published or peer-reviewed. The latest FORWARD data reported that resolution rates varied greatly by allergen: 35% for milk, 32% for soy, 27% for wheat, 3.8% for peanut, and 3.5% for shellfish. 

The analysis also identified socioeconomic and racial disparities in food allergies, with resolution lower in Black or Hispanic children and children with lower household income, lower parental health literacy scores, and higher area deprivation index. 

A separate area of focus for Mahdavinia's group is an egg ladder protocol being presented as an abstract at the 2026 American College of Allergy, Asthma & Immunology (AAAAI) conference in Phoenix. She said the graded, at-home introduction protocol is published and freely available but rarely used in practice, largely because of the counseling burden it places on clinicians and families.

"It's not a pill to prescribe. It's lots of talking," Mahdavinia said.

The first visit alone can take close to an hour, she said, and providers need full confidence in the protocol before introducing it, since hesitancy is easily picked up by anxious parents managing reactions at home.

Mahdavinia said her group is preparing 6 additional food-specific resolution papers covering milk, egg, fish, shellfish, and tree nut allergy, alongside milk and egg ladder abstracts for the same AAAAI meeting. FORWARD is led by principal investigator Ruchi Gupta, MD, with Mahdavinia serving as a site PI.²

“This [FORWARD] project is really working on how to help [the] resolution of food allergy,” Mahdavinia said. “We are grateful to [Gupta] for her leadership. That's why we can get to do all these beautiful studies.”

Socioeconomic, Racial Disparities Linked to Food Allergy Resolution

Racial Gap in Food Allergy Resolution Traced to Access, Not Biology

Closing the Food Allergy Resolution Gap Needs More Than Specialist Access

Editor’s note: Reported disclosures for Mahdavinia include Eli Lilly and Company, GENZYME CORPORATION, Blueprint Medicines Corporation, Regeneron Healthcare Solutions, AstraZeneca Pharmaceuticals LP, Takeda Pharmaceuticals U.S.A., Inc., Grifols USA, CSL Behring, Pharming Healthcare, Inc., Novartis Pharmaceuticals Corporation, and Paratek Pharmaceuticals.

Dileep A, Bilaver LA, Warren C, et al. Factors associated with outgrowing food allergies: insights from a large food allergy cohort. 

Derman C. Race, income, and health literacy tied to food allergy resolution. HCPLive. Published August 17, 2026. Accessed August 31, 2026. 

https://www.hcplive.com/view/race-income-health-literacy-food-allergy-resolution

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Mahboobeh Mahdavinia, MD, says a published, safe at-home protocol for resolving egg allergy is rarely used because of the counseling time it demands.

 will require addressing follow-up frequency rather than initial specialist access, according to Mahboobeh Mahdavinia, MD, PhD, a board-certified allergist/immunologist from The University of Texas Health Science Center at Houston.

 spoke with Mahdavinia on the new FORWARD analysis, examining resolution rates in 1359 children with physician-diagnosed IgE-mediated food allergy. Resolution rates varied widely by food: about a third of milk (35%), soy, (32%) and wheat (27%) allergies resolved in children, compared to under 4% for peanut (3.8%) and shellfish (3.5%).

Food allergy resolution occurred more frequently in White versus Black and Hispanic children. The study also revealed that food allergies were less likely to resolve in families with lower household income and parental health literacy scores and a higher area deprivation index.

All 4 sites in the FORWARD registry are based in cities with established healthcare systems, and every enrolled child had been evaluated by an allergist at least once and carried insurance, most often Medicaid.¹ Mahdavinia said this ruled out a lack of specialist access as the primary driver of the resolution gap her team identified between White children and Black and Hispanic children.

 The deciding factor instead appeared to be how consistently families returned for the annual reevaluation needed to document resolution.

"There are a lot of other things around the social network of the child, not just the insurance or knowing the doctor, contributing to these factors,” Mahdavinia said.

Why Follow-Up, Not First Access, Drives the Food Allergy Resolution Gap

Mahdavinia said resolving a food allergy typically requires repeat evaluation, often annually, to reassess IgE levels or pursue an oral food challenge. She pointed to broader social barriers, including difficulty making appointments and lacking a parent with the flexibility to manage a family calendar around specialist visits, as more likely explanations than insurance status alone.

Mahdavinia said she has observed the same pattern in her own clinic, where a subset of patients accumulates the most missed appointments despite having open access to be seen.

“Despite my busy clinics, I always [leave] spots open if my patients need to come at any time, and they're a group of patients that do not take that advantage of that,” she said. “It's a lot about the attitude around the care and maybe being more welcome that needs to be fixed.”

What Would Actually Close the Food Allergy Resolution Gap

 had insurance and had seen an allergist at least once, ruling out initial specialist access as the main driver of the food allergy resolution gap.

Mahdavinia said inconsistent annual follow-up is the deciding factor separating families who document resolution from those who do not.

Social barriers such as appointment logistics and family scheduling capacity, rather than insurance status, appear to drive missed follow-up visits.

Mahdavinia said closing the gap will require systematic annual reevaluation built into food allergy programs, paired with proactive education and reminder outreach for families who miss appointments. She described her own clinic's practice of calling patients who miss a yearly visit to reinforce its importance but acknowledged many practices lack the staff to sustain that kind of outreach. Allergy is not a high-margin specialty, she said, making it difficult for private practices to add dedicated staff for follow-up outreach without broader systemic support.

Mahdavinia was clear the disparity does not stem from differential clinical decision-making. Asked whether socioeconomic or demographic factors influence how often a clinician schedules reevaluation or offers an oral food challenge, she said clinicians operate under the same ethical obligation to every patient regardless of background.

“We're not going to ever treat people differently, manage them differently, [or] give them appointments differently based on that,” she said.

Dileep A, Bilaver LA, Warren C, et al. Factors associated with outgrowing food allergies: insights from a large food allergy cohort. 

Mahdavinia M. Socioeconomic, Racial Disparities Linked to Food Allergy Resolution. HCPLive. Published August 27, 2026. Accessed August 28, 2026. 

https://www.hcplive.com/view/socioeconomic-racial-disparities-linked-food-allergy-resolution

Mahboobeh Mahdavinia, MD, says annual follow-up, not initial specialist access, is the missing piece in food allergy resolution disparities.

 more frequently than Black and Hispanic children across all common allergens in the FORWARD cohort, including peanut, milk, wheat, soy, and shellfish. Lower household income, lower parental health literacy, and higher area deprivation index (ADI) were independently associated with lower odds of resolution.

The finding is part of a broader analysis of FORWARD, a multicenter registry enrolling children aged ≥ 12 years with physician-diagnosed IgE-mediated food allergy at sites across the US.¹ Investigators used multivariable logistic regression to model resolution against race and ethnicity, household income, parental health literacy scores (HLS), and ADI, a block-group-level measure of socioeconomic deprivation.¹ In an interview with 

, investigator Mahboobeh Mahdavinia, MD, from the McGovern Medical School at UT Health Houston, said the pattern reflects unequal access to care rather than biological differences between racial groups.

"The more research we do, [we see] human race is just 1 race,” she said. “Race, as we speak about it, is a social construct, and the differences we see are all about access [and] socioeconomy, factors we can provide and manage which impact health."

Why Parent-Reported Data May Undercount Resolution

Mahdavinia said part of the disparity reflects discovery of resolution rather than a true difference in biology. This analysis relied on parent-reported data collected at enrollment, and families without regular follow-up may not know a food allergy has resolved unless a clinician rechecks IgE levels or offers an oral food challenge.

 Families with closer follow-up, particularly those enrolled in structured graded oral introduction protocols known as allergy ladders, are more likely to have documented resolution.

Mahdavinia said her group is presenting an abstract at the 2026 American Academy of Allergy, Asthma & Immunology (AAAAI) annual meeting on ladder outcomes, reporting 0 anaphylaxis events and most children on ladder protocols tolerating baked or cooked forms of egg and milk. Parents in these families can report resolution with confidence, she said, while parents without comparable access to specialist care and structured protocols have no equivalent information to report.

A second, prospective phase of the FORWARD series will incorporate direct food challenges rather than parent reports alone, Mahdavinia said. This will provide real-time confirmation of resolution independent of family access to follow-up care.

Area Deprivation Index Explains the Racial Signal

White children reported resolution of food allergy more often than Black and Hispanic children across all common allergens in FORWARD.

Higher area deprivation index and lower household income were independently associated with lower odds of resolution.

Mahdavinia said the disparity reflects unequal access to specialist follow-up and structured desensitization protocols, not biological differences between racial groups.

A planned prospective phase of FORWARD will use oral food challenges to confirm resolution status, addressing a limit of parent-reported data.

When Mahdavinia's team examined race as an initial signal, they modeled ADI to test whether the pattern reflected a demographic factor or a social one. ADI is a validated composite measure of socioeconomic deprivation calculated at the census block-group level, a finer geographic unit than zip code. Higher ADI describes a residential area with less economic and social investment, and it was independently associated with lower odds of food allergy resolution in adjusted models.¹

Mahdavinia said living in a higher-ADI area limits a family's ability to purchase specialized allergen-containing foods used for graded introduction, restricts access to structured cooking and baking approaches, and reduces access to routine allergy follow-up visits. Household income functioned as a second, independent metric in the same models and pointed toward the same conclusion.

“[These findings] validate that it’s not biologic,” she said. “It's really how the environment around that child is to help them resolve the food.”

Watch part 1 of our interview with Mahdavinia here:

 Socioeconomic, Racial Disparities Linked to Food Allergy Resolution

Race, income, and health literacy tied to food allergy resolution. HCPLive. 

Mahboobeh Mahdavinia, MD, says racial gaps in food allergy resolution reflect access to care, not biology.

A multicenter cohort study of 1359 children with 

found resolution rates varying sharply by allergen, from 35% for milk to 3.8% for peanut, with socioeconomic disadvantage, lower parental health literacy, and racial and ethnic disparities associated with lower odds of resolution.¹

The findings come from FORWARD, a multicenter observational registry enrolling children aged ≤12 years with an IgE-mediated food allergy across multiple US sites.¹ Prior cohort work established broad patterns, showing milk, egg, and wheat allergies tend to resolve, while peanut, tree nut, shellfish, and fish allergies tend to persist, without clarifying which patient and family-level factors drive resolution within a given allergen. The new analysis is among the largest to model socioeconomic and demographic predictors of food allergy resolution directly.

"This data gives us guidance for counseling," investigator Mahboobeh Mahdavinia, MD, PhD, a board-certified allergist/immunologist from The University of Texas Health Science Center at Houston, told 

 "When a child tests positive for egg allergy, there is always a but, meaning we can try to resolve it, and most likely the child will not grow up with an egg allergy. When it is peanut, it is a different conversation."

Food Allergy Resolution Rates by Allergen in FORWARD

FORWARD enrolled 1359 children with physician-diagnosed IgE-mediated food allergy, using caregiver surveys collected at enrollment alongside electronic health record data.¹ Investigators compared demographic and clinical characteristics between children who reported resolution of ≥ 1 food allergy and those who did not, then built multivariable logistic regression models adjusting for race and ethnicity, household income, parental health literacy scores (HLS), and area deprivation index (ADI).¹

Resolution rates diverged widely by allergen. Milk allergy resolved in 35% of children, soy in 32%, and wheat in 27%, while peanut allergy resolved in only 3.8% and shellfish allergy in 3.5%.¹ Mahdavinia attributed the gap to a combination of biology and management practice.

She explained that milk and egg proteins break down more readily with heat, enabling graded oral introduction through home-based "ladder" desensitization protocols. Both milk and egg are harder to eliminate entirely from a household, creating incidental low-level exposure; this is less likely to happen with peanut, tree nut, shellfish, or fish. She also said that the age of allergen introduction, rather than the age of allergy onset, may also shape the likelihood of eventual resolution.

Socioeconomic and Racial Disparities in Food Allergy Resolution

Which food allergies are most likely to resolve in children?


Milk, soy, and wheat allergies resolved far more often than peanut or shellfish allergy in the FORWARD cohort, at 35%, 32%, and 27% versus 3.8% and 3.5%, respectively.

What factors are associated with lower rates of food allergy resolution?


Lower household income, lower parental health literacy, higher area deprivation index, and Black or Hispanic race and ethnicity were independently associated with lower odds of food allergy resolution in adjusted models.

How should clinicians counsel families about outgrowing a food allergy?


Clinicians can tailor expectations by allergen, noting milk and egg allergy carry a meaningfully higher chance of resolution than peanut or shellfish allergy, while considering socioeconomic barriers a family may face in accessing desensitization strategies.

White children reported resolution of food allergy more frequently than Black and Hispanic children across all common allergens studied.¹

“I don't think they're biologically different,” Mahdavinia said. “Honestly, the more and more we do research, [the more the] human race is just one race. Race…is just a social construct.”

In adjusted models, children who did not resolve any of the 9 common food or food-group allergies were more likely to come from families with lower household income, lower parental HLS, and higher ADI, a composite measure of neighborhood-level socioeconomic disadvantage.¹ The study reported that socioeconomic disadvantage, parental health literacy, and racial and ethnic disparities were independently associated with a lower likelihood of food allergy resolution in this cohort.¹

Derman C. Race, Income, and Health Literacy Tied to Food Allergy Resolution. HCPLive. Published August 17, 2026. Accessed August 27, 2026. 

Articles

Mahboobeh Mahdavinia, MD, PhD, discusses new FORWARD data showing peanut and shellfish allergies resolve far less often than milk, soy, or wheat.