Biological Therapies in IgE-Mediated Food Allergy: Narrative review

Abstract

IgE-mediated food allergy is a chronic immune-mediated condition of growing global concern, carrying the risk of severe and potentially fatal allergic reactions. For decades, clinical management rested entirely on allergen avoidance and emergency epinephrine, with no approved disease-modifying therapy available. The recent regulatory approval of omalizumab, a monoclonal anti-IgE antibody, as the first biologic licensed specifically for the reduction of multi-food allergic reactions marks a paradigm shift in this field. This literature review examines the immunological rationale for biologic intervention in IgE-mediated food allergy, synthesises the pivotal evidence from the OUtMATCH clinical trial programme, and surveys the emerging pipeline of agents currently under investigation including dupilumab and anti-alarmin therapies. The comparative evidence between biologics and oral immunotherapy is appraised, and the most pressing evidence gaps and future research priorities are identified.