PEANUT allergy remains a significant challenge for many patients, particularly those with allergic reactions to multiple peanut proteins. Current approved therapies do not address this complexity, highlighting the need for alternative treatment approaches. A recent study investigated the efficacy of peanut oral immunotherapy (P-OIT) using home-measured peanut butter compared to strict peanut avoidance in children aged 4 to 14 years who reacted to a peanut protein challenge between 443 mg and 5043 mg.
Seventy-three participants were randomly assigned to either P-OIT (38 participants) or peanut avoidance (35 participants). The primary goal was to determine the proportion of participants in each group who could tolerate a two-dose-level increase or 9043 mg of peanut protein. Additionally, for those in the ingestion group who tolerated 9043 mg, sustained unresponsiveness was assessed following 16 weeks of regular ingestion and an 8-week abstinence period.
Results demonstrated a significant benefit of P-OIT. Among those who completed the primary food challenge, 100% of participants in the ingestion group successfully tolerated 9043 mg, compared to only 21.0% in the avoidance group, reflecting a between-group difference of 79.0 percentage points. Similarly, in the intention-to-treat analysis, 68.4% of P-OIT participants achieved sustained unresponsiveness compared to just 8.6% in the avoidance group. The between-group difference of 59.9 percentage points underscores the durability of desensitisation induced by P-OIT.
Importantly, no serious adverse events occurred, and no dosing reactions exceeded grade 1 severity, suggesting that P-OIT with home-measured peanut butter is both effective and well tolerated. The study’s findings offer a compelling case for reconsidering peanut allergy management strategies. While peanut avoidance remains the standard approach, this study highlights the potential for P-OIT to induce significant and sustained desensitisation in children with high-threshold peanut allergies. Future research should explore long-term outcomes and the applicability of P-OIT across broader patient populations. By integrating immunotherapy into standard care, more patients may achieve meaningful tolerance, reducing the risk of severe allergic reactions and improving overall quality of life.
Katie Wright, EMJ
Reference
Sicherer SH et al. Peanut Oral Immunotherapy in Children with High-Threshold Peanut Allergy. NEJM Evid. 2025;DOI:10.1056/EVIDoa2400306.
