TREATMENT GUIDE
Avoidance: the standard approach
Still the standard of care
Every treatment sits on top of it
Epinephrine always stays close
Reviewed by Hunter Smith, MD · Last reviewed October 2026
IN SHORT
Avoiding the foods that trigger allergic reactions remains the standard of care for food allergy.
Continued avoidance without treatment may be the best choice for many people. No current treatments for food allergies are cures. Nearly all patients with food allergy must continue to carry epinephrine, and limit accidental exposures to food allergy triggers.
Why avoidance is still the foundation
Treatment sits on top of avoidance
Every existing food allergy treatment sits on top of avoidance rather than replacing it. Because food allergy treatment is not a cure, all patients with food allergy must continue carrying epinephrine and avoiding their triggers.
The right question
An appropriate question for patients is not avoidance versus treatment, rather whether to add a treatment to current safety plans.
Choosing avoidance is not a failure
For many people, avoidance alone remains the right answer. If the allergy is to a food that is easy to avoid, does not cause anxiety or significant burden, if reactions have been mild, or if the commitment or cost required of treatment does not fit your family right now, choosing continued avoidance is not a failure.
Doing it well
Epinephrine
Epinephrine is the only treatment for anaphylaxis.
Antihistamines do not treat it.
Carry two doses.
Symptoms may not go away completely or may come back after getting better, so a second dose may be needed.
Check expiration dates a few times a year.
Set a reminder to replace your epinephrine before it expires.
Use epinephrine early.
Waiting to see whether a reaction improves is the most common mistake, and hesitation is more dangerous than using it unnecessarily.
Explore new and emerging options.
An epinephrine nasal spray was approved by the FDA in 2024 for people weighing at least 66 pounds, and later for children weighing 33 to 66 pounds. It is given as a single spray into one nostril. It also lasts about 24 to 30 months, compared with 12 to 18 months for auto-injectors. Additional forms of epinephrine, such as a dissolvable strip that goes under the tongue, may also be released soon.
An emergency plan
Ask your allergist for a written plan that says what symptoms mean what, when to use epinephrine, and who to call. Give copies to school, family and anyone who looks after your child. Review it every year. As your child gets older, review the plan together so they know what to do in an emergency.
Labels and eating out
Read labels every time, including on products you have bought before.
Manufacturers change recipes.
“May contain” or “processed on shared equipment” warnings are voluntary and not standardized.
Ask your allergist how to weigh them for your situation.
When eating out, speak to someone who can check the kitchen, not just the server.
The unspoken cost of avoidance
As all families with food allergy know, avoidance has costs that do not show up in a trial, including the cost of constant vigilance. Families describe checking labels dozens of times a day, anxiety about birthday parties and school trips, and children who become fearful of food.
If your family feels overwhelmed by these costs, they are worth raising with your allergist. They are a legitimate concern to get support for on its own. If food allergy is affecting your child’s confidence or your family’s daily life, say so at your next appointment. Many practices offer referrals to dieticians, psychologists, and others who can help.
When it might be worth reconsidering avoidance
Your child is between one and four years old.
This is when immunotherapy works best, and has shown the highest possibility of remission.
Reactions are happening despite careful avoidance.
The allergy is to a food that is difficult to avoid, like milk, egg or wheat.
Anxiety about food is limiting your child’s life more than the allergy itself.
A life change is coming — school, university, travel — where you will have less control over food.
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