If you're a parent in Burbank, Glendale, Pasadena, or anywhere across Los Angeles trying to understand your child's food allergy treatment options, you've probably run into the same three names over and over: oral immunotherapy, Xolair, and Palforzia. Different clinics promote different ones. Different research studies seem to point in different directions. And the marketing language can make all three sound like the single right answer.

They're not interchangeable. Each works through a different biological mechanism, was approved by the FDA in a different way, fits different patient profiles, and is designed to produce a different kind of outcome. At the Los Angeles Food Allergy Institute, we offer all three — Xolair, traditional OIT, and Palforzia — which is part of why this comparison post is worth writing. Clinics that only offer one option tend to present that one option as the answer. We're in a position to be honest about when each is the right fit and when it isn't.

This guide walks through the three treatments across nine practical dimensions families care about. By the end, you should have a much clearer sense of which conversation to have during your first consultation.

The Three Treatments at a Glance

Before getting into the side-by-side detail, a quick orientation on what each one actually is.

Oral Immunotherapy (OIT)

OIT is a desensitization process. The patient consumes very small, precisely measured amounts of the food they're allergic to, with the dose gradually increasing over months under clinical supervision. The immune system slowly learns to tolerate the food. The patient continues a daily maintenance dose to keep that tolerance going. OIT has been used by allergists for decades and is supported by extensive published research. For most foods — peanut without Palforzia, tree nuts, milk, egg, wheat, soy, sesame — OIT uses compounded food protein and is considered "off-label," which has implications for insurance.

Xolair (omalizumab)

Xolair is a monoclonal antibody administered as a subcutaneous injection every two or four weeks. It works by binding to IgE antibodies in the bloodstream before they can trigger an allergic reaction. The result is a significantly raised threshold for reaction from accidental exposure. The FDA approved Xolair for food allergy in February 2024 — the first and only medicine indicated specifically to reduce reactions from accidental food exposure. We covered Xolair in detail in our Burbank allergist's guide to Xolair.

Palforzia (peanut allergen powder)

Palforzia is the only FDA-approved oral immunotherapy product. It's specifically and exclusively for peanut allergy and is administered as a daily powder mixed into food. Because it's an FDA-approved pharmaceutical rather than compounded food protein, it has its own insurance pathway and a standardized protocol every clinic follows the same way. Palforzia was originally approved for ages 4 to 17 and is now approved for children as young as one year old.

The Side-by-Side Comparison

Here's how the three options compare across the dimensions that matter most when families are making this decision.

1. Mechanism (What It Actually Does)

• OIT: Desensitizes the immune system through gradual exposure to the actual food. Over time, the body learns to tolerate the allergen.
• Xolair: Blocks IgE antibodies from triggering allergic reactions. The allergy is still there; the body's reaction to it is muted.
• Palforzia: Same desensitization mechanism as OIT, but standardized for peanut using FDA-approved peanut protein powder.

2. Who It's Approved For

• OIT: Generally available for ages 2 and up, depending on the clinic and the allergen. At LAFAI, evaluations start as early as age 2.
• Xolair: Approved for adults and children ages 1 and older with IgE-mediated food allergy. The widest age window of the three.
• Palforzia: Approved for ages 1 to 17. Restricted exclusively to peanut allergy — it does nothing for other allergens.

3. What Allergens It Treats

• OIT: Peanut, tree nuts, milk, egg, wheat, soy, sesame. Can be used for single allergens or multiple allergens (multi-food OIT).
• Xolair: Any IgE-mediated food allergy, single or multiple — all addressed by the same injection. This is its biggest practical advantage for families with multiple allergens.
• Palforzia: Peanut only.

4. Time Commitment

• OIT: Significant. Initial dose escalation day in clinic, then clinic visits every 1 to 2 weeks for the build-up phase (typically 4 to 12 months), then daily home dosing on an ongoing basis. Activity and shower restrictions for a few hours after each home dose.
• Xolair: Light. Injection every 2 to 4 weeks, with no daily home routine and no activity restrictions tied to dosing.
• Palforzia: Structured. About 11 clinic visits during the 6-month up-dosing phase, then daily 300 mg maintenance dosing at home. Same activity restrictions as OIT after each dose.

5. What "Success" Looks Like

This is where the three treatments diverge most. They're designed to produce different kinds of outcomes.

• OIT: The goal is desensitization — the ability for the patient to eat the allergen as part of normal life. For a peanut-allergic child on OIT, that often means peanut butter sandwiches without fear. Published research generally shows 60% to 85% of patients achieve meaningful desensitization with traditional OIT, depending on the food, the protocol, and the population.
• Xolair: The goal is protection from accidental exposure, not tolerance for daily eating. In the trial that led to FDA approval, 68% of Xolair patients could consume roughly six times more peanut without a moderate or severe reaction than they could before treatment. Most stay on Xolair as a maintenance medication; protection wears off if dosing stops.
• Palforzia: The goal is reducing the risk and severity of accidental peanut exposure. Patients continue to avoid peanuts in daily life, but the maintenance dose protects them from accidental ingestion. After completing the protocol, patients typically tolerate doses far higher than what would have caused a reaction before treatment.

6. FDA Status

• OIT: Off-label for most allergens. The procedures are FDA-recognized; the use of compounded food protein for desensitization is not separately FDA-approved.
• Xolair: FDA-approved for food allergy as of February 2024.
• Palforzia: FDA-approved for peanut allergy. The only FDA-approved oral immunotherapy product currently on the market.

7. Insurance Coverage

This is a big practical differentiator. The full breakdown is in our OIT cost guide for LA families, but the summary:

• OIT: Office visits, testing, and follow-ups are generally covered by insurance. The OIT program fee — the part that covers protocol design, dose compounding, and clinical support — is typically not covered and is paid out of pocket.
• Xolair: Generally covered by insurance for the food allergy indication, with prior authorization. Manufacturer copay assistance is available for eligible commercial insurance plans.
• Palforzia: Often covered with prior authorization, since it's an FDA-approved medication. Some plans require step therapy. Coverage varies meaningfully by plan.

8. Side Effects

• OIT: Most common are gastrointestinal symptoms (stomach pain, nausea) and mild allergic reactions during dose escalation. Anaphylaxis is possible, which is why dose escalations happen in the clinic. A small percentage of patients develop eosinophilic esophagitis (EoE) and need to stop treatment.
• Xolair: Most common are injection site reactions and fever. Xolair has a Boxed Warning for anaphylaxis, though this is rare. Side effect profile is generally milder than OIT for the populations studied.
• Palforzia: Same side effect profile as OIT — gastrointestinal symptoms, mild reactions during up-dosing, possible EoE. The structured protocol and FDA-approved dosing make management more standardized.

9. What Happens If Treatment Stops

• OIT: If daily maintenance dosing stops for an extended period, tolerance can erode. Most patients continue daily maintenance dosing long-term.
• Xolair: Protection wears off when dosing stops. Patients who discontinue typically return to their pre-treatment level of risk over weeks to months.
• Palforzia: Same as OIT — tolerance can decrease if daily dosing stops. Maintenance is ongoing.

Which One Is Right for Your Family?

Honest answer: it depends on what you want the outcome to be, which allergens are involved, what your family's tolerance for daily routine is, and what your insurance looks like. There are some patterns that help orient the conversation, though.

OIT tends to fit families who:

• Want their child to be able to eat the allergen as part of normal life — not just be protected from accidental exposure.
• Are comfortable with a 1 to 2 year active treatment commitment and daily home dosing.
• Have one allergen or a small number of allergens they want to address directly.
• Can manage the out-of-pocket program fee component.

Xolair tends to fit families who:

• Have multiple food allergies to manage at once and don't want to run separate desensitization protocols for each.
• Are primarily focused on protection from accidental exposure rather than incorporating the food into daily eating.
• Want a simpler routine — every 2 to 4 weeks rather than daily dosing.
• Have insurance that covers it well.
• Have a child as young as one year old who isn't yet a candidate for OIT.

Palforzia tends to fit families who:

• Are dealing specifically and only with a peanut allergy.
• Want the FDA-approved, standardized protocol with the most published efficacy and safety data.
• Have insurance that covers Palforzia well (often better than off-label peanut OIT).
• Prefer a powder formulation over the compounded food protein approach.

Combination approaches

For some families, the right answer isn't choosing one — it's combining them. Xolair plus OIT, for example, can make the OIT process faster and safer for patients with high-risk allergies. We covered the combination approach in detail in the Xolair guide.

What This Decision Looks Like at LAFAI

When a family comes in for an initial consultation at our Burbank clinic, we don't start by recommending a specific treatment. We start by asking what the family is trying to achieve. Maximum protection from accidental exposure? Tolerance to eat the food normally? Coverage for multiple allergens at once? A treatment that fits a busy family schedule? An option for a toddler under age 2?

From there, we look at the diagnostic picture — which allergens, how severe, what the testing shows, what the patient's age and weight and IgE levels are. We talk about insurance. And then we make a specific recommendation, sometimes for a single treatment, sometimes for a combination, sometimes for waiting and watching.

This isn't a sales pitch. It's a different model from clinics that lead with their preferred treatment and fit every patient to that mold. Being able to offer Xolair, traditional OIT, and Palforzia means we can fit the treatment to the family rather than the other way around.

Want a Side-by-Side Reference?

If you'd like a clean, single-page summary of this comparison to discuss with your pediatrician or your partner, we've prepared a downloadable PDF chart that pulls everything in this post into one reference document. Request it through our contact page and we'll send it over.

Next Step

If you're a family in Burbank, Glendale, Pasadena, Sherman Oaks, Studio City, North Hollywood, La Crescenta, or anywhere across the LA area weighing your child's food allergy treatment options, the most useful next step isn't to commit to a treatment online. It's to book a treatment-options consultation with our team. We'll go through the full diagnostic picture, the family goals, the insurance landscape, and the trade-offs of each option — and you'll leave with a clear recommendation tailored to your child, not a generic protocol.

Book a treatment options consultation with the LAFAI team →

This article reflects publicly available information about Xolair (omalizumab), Palforzia (peanut allergen powder), and oral immunotherapy as of 2026, including FDA approvals and published clinical research. It is educational and does not constitute medical advice. Each treatment has specific indications, contraindications, and possible side effects; Xolair and Palforzia carry Boxed Warnings as part of their prescribing information. A clinical evaluation with a board-certified allergist is required to determine which treatment, if any, is appropriate for an individual patient.

‍