Starting peanut oral immunotherapy during infancy can improve a child’s immune response over time

In a new study published in the Journal of Allergy & Clinical Immunology: In Practice, children aged 7 to 11 months developed tolerance by eating tiny amounts of peanuts in a step-by-step, controlled process.

For this retrospective study, researchers at the Cleveland Clinic reviewed data from 22 infants who received peanut oral immunotherapy at the clinic’s Food Allergy Center of Excellence. The babies were started on a daily dose of 18 mg of peanut protein in the form of peanut butter or peanut powder. Over six months, participants were progressively given larger servings each day until they reached a maintenance dose of 500 mg (equivalent to two peanut kernels). All 22 babies achieved this milestone. During treatment, more than half of the infants experienced mild allergic reactions that self-resolved, and one required epinephrine. Around 27% experienced no allergic reactions whatsoever.

On completion of the treatment, 14 of the 22 babies received an allergy test to check their levels of peanut-specific antibodies. The results showed that all 14 babies had a reduced sensitivity to peanuts. Eleven of those babies participated in an oral food challenge in which they were fed increasing doses of peanut protein, up to 2,000 mg (approximately nine peanuts). Results showed that 91% of the babies could tolerate peanuts without any allergic reaction.

The findings show that peanut oral immunotherapy with a higher maintenance dose is safe and efficacious in children under one year of age, further confirming that age is a crucial factor in the success of this treatment.

Johnson, S. R., McNamara, K., Bjelac, J., Kerns, L. A., Subramanian, A., Hoyt, A. E. W., Whitsel, R., & Hong, S. J. (2023). Safety and effectiveness of peanut oral immunotherapy in children under 12 months. The Journal of Allergy and Clinical Immunology: In Practice, S2213-2198(23)00780-8. Advance online publication.

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