The findings point to a convenient, low-cost alternative to total peanut avoidance
A recent study published in the prestigious journal NEJM Evidence found that children with high-threshold peanut allergies who consumed gradually increasing doses of peanut butter over 18 months were able to tolerate significantly larger amounts of peanut protein without allergic reactions.
Researchers conducted a randomized controlled trial to assess the effectiveness of peanut oral immunotherapy in children aged 4 to 14 years who could initially tolerate at least half of a peanut before having an allergic reaction. A total of 73 participants were randomly assigned to either an oral immunotherapy group, which consumed store-bought, home-measured peanut butter, or a control group, which followed peanut avoidance.
The goal was to determine the difference between the groups in the proportion of participants who could tolerate a two-dose-level increase or 9,043 mg of peanut protein. To assess sustained peanut tolerance off treatment, those who reached the 9,043 mg threshold were tested again after 16 weeks of regular ingestion followed by 8 weeks of abstinence.
All of the children in the oral immunotherapy group successfully tolerated 9,043 mg of peanut protein, compared to 21% of the avoidance group. Furthermore, 68.4% of the children who received oral immunotherapy maintained their tolerance after the abstinence period, compared to only 8.6% in the avoidance group. No serious adverse events were reported, and all dosing reactions were mild. The findings suggest that a low-cost, at-home peanut immunotherapy approach could be a safe and effective strategy for children with high-threshold peanut allergy.
Sicherer, S. H., Bunyavanich, S., Berin, M. C., Lo, T., Groetch, M., Schaible, A., Perry, S. A., Wheatley, L. M., Fulkerson, P. C., Chang, H. L., Suárez-Fariñas, M., Sampson, H. A., & Wang, J. (2025). Peanut Oral Immunotherapy in Children with High-Threshold Peanut Allergy. NEJM Evidence, EVIDoa2400306. Advance online publication.