Oral immunotherapy for relieving high-threshold peanut allergy in children

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Created On: 06/09/2025

Current treatments for peanut allergy are not tailored to individuals who experience allergic reactions to multiple peanut components.

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Key take away

In children suffering from high-threshold peanut allergy, peanut oral immunotherapy using home-measured peanut butter markedly increases desensitization and sustained tolerance.

Background

Current treatments for peanut allergy are not tailored to individuals who experience allergic reactions to multiple peanut components. This study sought to investigate peanut oral immunotherapy in pediatric-related high-threshold peanut allergy.

Method

Kids (aged 4 to 14 years) who reacted to peanut protein doses ranging from 443 mg to 5043 mg during an initial food challenge were randomly allocated in a 1:1 ratio to get peanut oral immunotherapy (P-OIT) using store-bought, home-measured peanut butter, or to follow a peanut avoidance regimen. The key outcome ascertained was the proportion of volunteers in each group able to tolerate either a two-dose-level increase or a total of 9043 mg of peanut protein. For those who tolerated 9043 mg, sustained unresponsiveness was investigated after 16 weeks of voluntary consumption followed by an 8-week avoidance period.

Result

Out of 73 total participants, 38 were assigned to the P-OIT group and 35 to the avoidance group. Of these, 32 (84.2%) in the treatment group and 30 (85.7%) in the avoidance group completed the primary outcome challenge. Based on the primary analysis utilizing prespecified multiple imputation for missing data, 100% of the P-OIT group attained the desensitization threshold, compared to only 21% in the avoidance group (difference of 79.0 percentage points).

All 32 subjects receiving P-OIT and only 3 of 30 in the avoidance group tolerated 9043 mg. In the intention-to-treat assessment, persistent unresponsiveness was noted in 68.4% (26 of 38) of those treated with P-OIT, as opposed to 8.6% (3 of 35) in the avoidance group (difference of 59.9 percentage points). No treatment-related adverse reactions exceeded grade 1 in severity, and no serious adverse events were noted.

Conclusion

P-OIT utilizing home-measured peanut butter markedly improved desensitization outcomes and resulted in a sustained response after treatment discontinuation in kids with high-threshold peanut allergy, when compared to avoidance strategies.