Specific immunotherapy (SIT) is one of the important lines for the treatment of food allergy. Efficacy tests for clinical response to SIT are limited and subjective. In this study, we aimed to evaluate the validity of food specific IgE levels as a biomarker of clinical improvement in children with food allergy treated with oral immunotherapy (OIT). We analysed 184 children with food allergy, 143 had undergone 2 years of food OIT and 41 were on allergen restricted diet and considered as control. All patients were subjected to Double-Blind Placebo-Controlled Food Challenge test (DBPCFC), allergic symptom score calculation, and serum food specific IgE level before and after oral immunotherapy for treated patients and after 2 year of allergen restricted diet for the control group. Receiver Operating Characteristic Curves (ROCs) analysis was done to determine the cut off areas under the curve, sensitivity, and specificity for the specific IgE test. Milk allergy was the most frequent food allergy as it was encountered in 76 out of 184 children (41.3%), followed by egg and fish allergy in 64(34.7%), and 44 (23.7%) respectively. Oral desensitization was successful in 91 %, 82%, and 67% of patients with milk, Egg, and fish allergy, respectively. The OIT group showed a statistically significant reduction in symptom scores compared to the control group (P<0.001). Also, there was a significant decrease in food specific IgE level in responders for all types of food allergy tested (P ˂0.001), and there was significant correlation between the specific IgE level and scores (r = 0.5, P = 0.03)