<p>Food allergies affect 6–8% of children worldwide and can significantly impact quality of life, with potentially severe reactions including anaphylaxis. Over recent decades, oral immunotherapy (OIT) has emerged as a treatment option for food allergies, but safety concerns with conventional high-dose protocols have limited its broader adoption. Low-dose OIT protocols have been developed to address these safety issues while maintaining therapeutic efficacy. This review focuses specifically on low-dose OIT protocols, their clinical outcomes, and evidence-based patient selection strategies. Low-dose OIT has demonstrated efficacy for several food allergens via successful desensitization and sustained unresponsiveness (SU). Clinical trials have reported SU achievements of 33–50% for milk, up to 71% for eggs, 25–37.5% for wheat, and 33–74% for peanut allergies after treatment. Notably, these protocols have shown improved safety profiles compared to conventional higher dose approaches, with substantially reduced rates of severe adverse reactions. Long-term follow-up studies of up to 6&#xa0;years have shown progressively improving SU rates and a decrease in adverse events over time, supporting the durability of low-dose approaches. Critical factors for successful low-dose OIT implementation include appropriate patient selection based on age, risk stratification, and individual clinical characteristics. Integration with biological agents such as omalizumab may further enhance safety and efficacy in selected high-risk patients. While low-dose OIT offers a safer therapeutic option for persistent food allergies, careful patient selection remains essential to optimize treatment outcomes and minimize risks.</p>