Therapy boosts peanut tolerance in allergic kids

Researchers tested whether a simple strategy could help kids with high-threshold peanut allergy tolerate more peanut protein. Zoeytoja / Shutterstock

Peanut is one of the most common food allergies. It often begins in childhood and usually lasts for life. NIH-supported studies over the past few decades have led to important advances and improved treatment options for many people with peanut allergies. Most such treatments were tested in kids who are highly sensitive to peanuts, unable to tolerate even the equivalent of a half peanut. These treatments can raise the safe threshold before a reaction, but peanut avoidance is still advised.

Less has been known about effective treatments for the estimated 800,000 children in the U.S. who have “high-threshold” peanut allergy. These children can tolerate eating half a peanut or more.

A research team led by Drs. Scott H. Sicherer and Julie Wang of the Icahn School of Medicine at Mount Sinai designed a clinical trial, funded by NIH, to assess whether a simple, low-cost, at-home treatment strategy could help kids with high-threshold peanut allergy tolerate more peanut protein. The study included 73 children, ages 4 to 14 years. They were randomly assigned to either test the new treatment strategy or continue avoiding peanut.

At the start, children in the treatment group received a minimum daily dose of 1/8 teaspoon of store-bought peanut butter. Doses were gradually increased and tested under medical supervision every eight weeks, followed by at-home dosing. By 8 to 17 months, daily doses had reached about the equivalent of 1 tablespoon of peanut butter.

Finally, participants in both the treatment and avoidance groups underwent a medically supervised feeding test to assess how much peanut they could eat without an allergic reaction. Results appeared on February 10, 2025, in NEJM Evidence.

The researchers found that all 32 treated children who participated in the oral food challenge could tolerate 9 grams of peanut protein. That’s equivalent to about two and a half tablespoons of peanut butter. By contrast, only three of the 30 kids who underwent the oral food challenge in the avoidance group (10%) could tolerate that much peanut protein.

The treatment group’s daily at-home doses of peanut butter were well tolerated. None of the treated children needed epinephrine to ease severe allergic reactions at home, although one needed it for a reaction during a medically supervised dose increase.

To assess the potentially lasting effects of treatment, kids in the treatment group continued to eat at least 2 tablespoons of peanut butter weekly for 16 weeks. They then avoided peanut for eight weeks and returned for a final food challenge. The researchers found that 26 of the 30 treated children (86.7%) were still able to tolerate 9 grams of peanut protein.

“Our study results suggest a safe, inexpensive, and effective pathway for allergists to treat children with peanut allergy who can already tolerate the equivalent of at least half a peanut, considered a high-threshold peanut allergy,” Sicherer says. “My hope is that this study will eventually change practice to help these children and encourage additional research that includes this approach for more foods.”