Innovative Approaches in Food Allergy Treatment: From Asthma Drugs to Biologics

Initially an asthma drug, zileuton targets leukotriene production, potentially preventing allergic reactions. As demonstrated in a Northwestern study on Zileuton and food-allergy pathways, in mouse models, the same pathways that ease asthma symptoms might mitigate food allergies. These findings are hypothesis-generating; clinical trials are needed before any changes to practice.

There are currently no professional guidelines recommending zileuton for food allergy; any future protocol changes would depend on positive clinical trial results and subsequent guideline updates.

Yet, the conversation doesn’t end with zileuton. Another axis of this evolving trajectory is highlighted by the approval of omalizumab to reduce allergic reactions from accidental exposure to one or more foods in patients aged 1 year and older with IgE‑mediated food allergy, to be used alongside allergen avoidance. This biologic represents the first FDA‑approved medication for IgE‑mediated food allergy to reduce reactions from accidental exposure to one or more foods.

Practically speaking, pediatricians and allergists face the task of incorporating omalizumab effectively. Clinicians should integrate omalizumab in accordance with its label alongside allergen avoidance. Depending on patient factors and clinician judgment, it may be used alone for risk reduction or in combination with strategies such as OIT where evidence supports.

Looking ahead, both zileuton and omalizumab point to a potential shift in allergy care, but real-world implementation will hinge on costs, access, safety monitoring, and long‑term data—and for zileuton, the evidence remains preclinical with human studies pending.

Key takeaways

• Repurposing research (zileuton) remains preclinical in animals, while omalizumab is FDA‑approved to reduce reactions from accidental exposure in patients aged 1 year and older with IgE‑mediated food allergy.
• Omalizumab should be used alongside allergen avoidance; its role relative to oral immunotherapy and other strategies is evolving and patient‑specific.
• Patient selection, shared decision‑making, and adherence to label and guidelines are central to implementation.
• Access, cost, and the need for long‑term effectiveness and safety data will shape how broadly these options are adopted.