PEANUT oral immunotherapy (P-OIT) using home-measured peanut butter significantly increased desensitisation rates and sustained tolerance in children with high-threshold peanut allergy compared to peanut avoidance. Peanut allergy is a common and potentially life-threatening condition, and while current treatments focus on minimising reactions, they are not tailored for patients who react to multiple peanut components. This study investigated whether P-OIT could effectively desensitise children with high-threshold peanut allergy, offering a practical, widely accessible treatment option.
A total of 73 children aged 4–14 years, all of whom reacted to an initial peanut challenge of 443–5,043 mg, were randomly assigned to either P-OIT (n=38) using peanut butter or strict peanut avoidance (n=35). The primary endpoint was the proportion of participants able to tolerate a dose increase or a total of 9,043 mg of peanut protein. In the ingestion group, 100% of participants met this endpoint, compared to only 21% in the avoidance group, yielding a between-group difference of 79.0 percentage points (95% CI: 64.6–93.5; P<0.001). Additionally, all 32 participants in the ingestion group who completed the challenge tolerated 9043 mg, compared to just 3 out of 30 (10%) in the avoidance group. A sustained unresponsiveness test was performed after 16 weeks of regular peanut ingestion followed by 8 weeks of abstinence, showing that 68.4% (26/38) of the P-OIT group-maintained tolerance, compared to 8.6% (3/35) in the avoidance group, a between-group difference of 59.9 percentage points (95% CI: 42.4–77.3). No severe dosing reactions (greater than Grade 1) or serious adverse events were reported.
These findings suggest that P-OIT using home-measured peanut butter is a safe and highly effective method of achieving long-term desensitisation in children with high-threshold peanut allergy. The ability to sustain tolerance even after a period of avoidance highlights its potential for long-term clinical benefit. This approach could provide a cost-effective and widely available alternative to pharmaceutical-grade immunotherapy, giving patients and caregivers more flexibility in managing peanut allergies. Future research should explore whether this method could be extended to lower-threshold allergies and whether similar approaches could be used for other food allergens.
Jenna Lorge, EMJ
Reference
Sicherer SC et al. Peanut oral immunotherapy in children with high-threshold peanut allergy. NEJM Evid. 2025;DOI:10.1056/EVIDoa2400306.
