ELIMINATION DIETS AND TOLERANCE INDUCTION IN FOOD ALLERGY

Food allergy (FA) is a significant public health problem that affects both children and adults. Despite the potential for nutritional deficiencies and a reduced quality of life (QoL), elimination diets are still the mainstay treatment of both IgE-mediated and non-IgE-mediated FAs. Clinically, defining eliciting doses for allergenic foods aids in risk assessment and patient counseling. These thresholds support safer dietary management and reduce the burden of uncertainty in daily life. Enquiring About Tol-erance (EAT) and Learning Early About Peanut (LEAP) studies, which are considered landmark in FA field, have illustrated the advantages of early dietary intervention in reducing the likelihood of FA development, particularly in high-risk infants. Oral immunotherapy (OIT) has been implemented in clinical practice as a method for achieving desensitization. Over the last decade, advancements in treatment options have emerged, including the use of biologic agents. In February 2024, the Food and Drug Administration (FDA) authorized omalizumab to help prevent severe allergic reactions in individuals with IgE-mediated FAs. Omalizumab is the most extensively studied biologic in this field and can be applied either as a standalone treatment or as an add-on to OIT. Dupilumab, which blocks interleukin (IL)-4 and IL-13, also shows promise as a supportive therapy. Moreover, the introduction of antialarmins and other novel biologics further broadens the therapeutic landscape for food allergy. This chapter explores the application and challenges of elimination diets, emphasizing the importance of multidisciplinary collaboration and personalized plans to ensure nutritional adequacy. Additionally, proactive strategies for tolerance induction, including early allergen exposure and OIT, are examined as methods of reprogramming immune responses. Furthermore, the chapter examines the immunolog-ical basis of oral tolerance and the role of gut and skin barriers in allergen sensitization, highlighting the importance of timing, dose, and route of exposure. These insights collectively represent a transition from conventional allergen avoidance to immune modulation as a promising approach to the preven-tion and treatment of FAs.