Abstract Mindset – the attitudes, beliefs, and expectations an individual holds – plays a critical yet often underappreciated role in managing food allergies, especially during oral immunotherapy (OIT). Emotional states such as stress and anxiety can amplify allergic responses and shape how patients experience OIT, influencing adherence and perceived risk. Experimental evidence from behavioural conditioning, neuroimmunology, and placebo research demonstrates that psychological factors can modulate immune function, even in the absence of allergens, through learned associations and expectation-driven physiological responses. Symptom framing also matters. Describing mild OIT symptoms as “positive signals” of progress, rather than “side effects,” may improve emotional responses and support treatment retention. Patient education requires recognition of the patient and parent mindset as emphasised in the Preparing Patients for Oral Immunotherapy (PPOINT) expert consensus guidelines. This acknowledges the mental challenges that OIT can bring and helps to empower patients and their families. Additionally, stress-induced changes to gut barrier integrity and immune activation underline the biological plausibility of mindset-driven effects. Notably, emerging research also shows that immune sensing of allergens can directly shape behaviour, with allergic sensitisation prompting avoidance even in the absence of anaphylaxis. Collectively, these findings support the integration of mindset, emotional regulation, and communication strategies into OIT protocols to reduce adverse events and enhance long-term outcomes. This perspective advocates for a broader application of behavioural science in allergy management, emphasising its feasibility, safety, and clinical relevance.