Personalized Food Allergy Care Gains Momentum, With Christopher Brooks, MD

Food allergy care is evolving rapidly, with increasing recognition that management extends beyond strict avoidance and emergency preparedness to include proactive, individualized strategies. A more personalized approach to risk reduction is reshaping conversations between clinicians and patients. At the same time, misconceptions about food allergy testing and diagnosis continue to create challenges across specialties, particularly as more patients seek answers about suspected reactions and long-term management strategies.

In recognition of Food Allergy Awareness Month, HCPLive spoke with Christopher Brooks, MD, an allergy and immunology physician at The Ohio State University, about how advances in food allergy research are translating into clinical practice and where gaps in care remain. Brooks discussed the importance of individualized treatment decisions, the expanding role of omalizumab, and why food challenges remain an underused but critical tool in confirming true food allergy diagnoses.

Drawing from both academic research and day-to-day patient care, Brooks also highlighted differences between pediatric and adult food allergy management, including the ongoing effort to make emerging therapies safer and more effective for adults. He emphasized the need for greater education across primary care and other specialties, particularly around the limitations of blood testing and the importance of avoiding unnecessary dietary restrictions or treatment burden in patients who may not actually have a food allergy.

HCPLive: How does practicing at an academic medical center and your involvement in research shape the way you approach food allergy management compared to what community-based allergists might be doing day-to-day? What do you wish were translated more quickly into general practice?

Brooks: One big area is being involved with fellows and…their education and working with a lot of different people that are on that cutting edge of [research].

From a food allergy standpoint, there's been a lot of avoidance of the food…and not really thinking about some of the nuances of it. Because I'm working with a lot of people [who] have a lot of cutting-edge knowledge in that area, [it] helps us to have a more personalized approach.

HCPLive: Food allergy prevalence has been climbing for decades. From your vantage point in both the clinic and research, do you think clinicians across specialties, such as primary care, GI, and pediatrics, are equipped to have the right conversations with patients today?

Brooks: Some primary care providers are, and some aren't. Primary care providers are well-equipped to have conversations with patients if they have…really good knowledge of what testing can do for [patients], like blood testing. If a patient has a concern for a food allergy, but there's a positive but low positive blood test, that doesn't necessarily mean they have a food allergy. Really, we need to do a food challenge. Some primary care doctors understand that, and some don't.

HCPLive: Omalizumab is now FDA-approved as a risk-reduction therapy for food allergy, and there's growing interest in combining it with OIT. How are you thinking about sequencing these therapies in your practice? Who is the right candidate for combination versus monotherapy?

Brooks: [It] is really helpful to meet [patients] where they are. There are some patients that the best management for them is avoidance of a food [if] they don't want to take an injection. There's others [whose] biggest…goal is to prevent severe reactions or decrease the risk of cross-contamination. [Other patients] do want to have the food in their diet…that's where combining or doing oral immunotherapy for them could be a good option. There might be patients [who] are at higher risk of allergic reactions based on the history and maybe you might combine the two [treatments]. There can be a limitation of combining therapies, as you might not get coverage for [the] patient, and that might be...why you can't do both.

In the adult world, we do a lot of omalizumab, but oral immunotherapy is much safer and more effective in kids.

HCPLive: What does the pipeline look like for patients managing four or five allergens at once, and what's still a major unmet need?

Brooks: Omalizumab is one we would probably jump to earlier for patients’ multiple food allergies because [this drug] often [has] more an impact on their quality of life. They might have a greater risk of cross-contamination just because there's more allergens there.

As far as oral immunotherapy goes, or other types of immunotherapies for food allergy…sometimes you're just figuring out which food is the most impactful for them. For example, if someone has an allergy to peanuts and to multiple tree nuts, but they're never going to eat tree nuts, you might just treat for peanut for example, and…do classical avoidance for tree nuts if it's not an important part of their diet.

HCPLive: Beyond what's already approved or in late-stage trials, what data or research direction are you watching most closely right now that does not get a lot of attention?

Brooks: As a mainly adult allergist, I think there's amazing work being done in pediatric food allergy and a lot of advancements like epicutaneous patches on the skin [and] oral immunotherapy. We even found a way to make it as safe or as effective [in] an adult, so I think what I'm really looking forward to is more advancements in allowing these great advancements for pediatric food allergy care to then be moved toward the adult world, whether that's with combining omalizumab with some of these treatments or different protocols.

HCPLive: If you had to name one thing you do in your clinic that you think more allergists or even primary care providers should adopt, what would it be?

Brooks: Doing food challenges [in the clinic]. There's no test that tells us 100% someone has a food allergy.

Something really interesting [came out of work at] Nationwide Children's [Hospital]. When they were enrolling [children] for immunotherapies, [about] half of them were passing the food challenge. They actually weren't food-allergic to start with.

I think making sure that patients truly are allergic before they go into these time-consuming treatments [is important] because many may not have a food allergy.