Peanut Allergy Treatment Improves Quality of Life vs Peanut Avoidance

Children with peanut allergies have a lower risk of suffering life-threatening anaphylaxis if they use oral immunotherapy, according to a new study.1

A group of investigators found that children who were given the immunotherapy had higher rates of peanut challenge tolerance after 12 months compared with children who simply avoided peanuts for 12 months. The study was published in Clinical & Experimental Allergy.1

Corresponding author Michael O’Sullivan, PhD, of the University of Western Australia, and colleagues, noted that up to 3% of 1-year-old children have a peanut allergy.2 Such allergies not only involve the risk of anaphylaxis, but also other dietary, social, and emotional consequences.

A pragmatic, food-based, low-dose OIT protocol was effective at inducing peanut desensitization after 12 months and was associated with meaningful quality of life improvement. | Image Credit: Angela Schmidt - stock.adobe.com

The new study evaluated the use of peanut oral immunotherapy (pOIT), a treatment that involves daily intake of increasing amounts of peanut protein until a target maintenance is reached, the authors explained. The pharmaceutical product peanut (Arachis hypogaea) allergen powder-dnfp, which is sold under the brand name Palforzia, has been shown in randomized clinical trials to desensitize children to peanuts, leading to its FDA approval for children ages 1 and older.3

The alternative to pOIT in real-world clinical practice is peanut avoidance. The strategy of avoidance has not been thoroughly studied in direct comparison to pOIT, and the new study was an attempt to better understand the safety and efficacy of the pOIT protocol compared to avoidance.

The investigators recruited 54 participants between the ages of 1 and 4 years and randomly assigned them to either the pOIT or avoidance group. The primary outcome of the unblinded trial was desensitization, which the investigators defined as the ability to tolerate at least 600 mg of peanut protein at the end of the 12-month treatment period.

Twenty-three of the 27 children in the pOIT group and 25 of the 27 children in the avoidance group eventually underwent the peanut challenge at 12 months. Three-quarters (74%) of those in the pOIT group were able to tolerate the challenge dose. However, just 11% (3/27) of participants in the avoidance group tolerated the challenge.

O’Sullivan and colleagues noted that in the study, parents measured and administered the doses—a protocol that more closely aligns with real-world usage but which could also introduce the opportunity for human error. Nonetheless, the benefits in this new trial were similar to those of previous randomized controlled trials.

“Taken together, these findings suggest the variable composition of food products and parent-measured doses did not have a meaningful impact on the efficacy or safety of pOIT in this cohort,” they wrote.

The investigators also found that participants receiving pOIT reported significantly better quality of life compared with the avoidance group after 12 months. They added that it was also notable that they had a high retention rate, at 87%.

In terms of safety, the authors noted that 21 participants in the pOIT group reported a total of 79 treatment-related adverse events. All but 12 of the adverse events were grade 1 or 2, they said.

The study shows that pOIT is effective in a real-world setting. However, the authors added that their findings are not generalizable to all children under 5 with peanut allergies since their trial was necessarily skewed toward families who sought out interventional treatment and had the ability to adhere to the trial’s requirement. They also noted that their trial design deliberately did not subject children to food challenges at baseline, but only at the end of treatment. The authors said the decision not to include baseline challenges was based on consultations with clinicians and patients and informed by the fact that the participants either had a confirmed peanut allergy or were deemed to have a highly probable peanut allergy due to their health history or laboratory tests.

"We have shown that our pragmatic food-based low-dose OIT protocol is effective at inducing desensitization after 12 months and is associated with meaningful improvement in [quality of life] compared to avoidance," the authors concluded. "To our knowledge, this is the first randomized controlled trial to demonstrate that exclusively parent-measured dosing of a routinely available food product can be considered an effective method for OIT based on objective and patient-reported outcomes, with acceptable safety."

References

1. O'Sullivan M, Wallace R, Thomas S, et al. Pragmatic low-dose oral immunotherapy for preschool children with peanut allergy: a randomised controlled trial. Clin Exp Allergy. Published online August 4, 2025. doi:10.1111/cea.70126

2. Osborne NJ, Koplin JJ, Martin PE, et al. Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol. 2011;127(3):668-76.e762. doi:10.1016/j.jaci.2011.01.039

3. FDA approves U.S. pediatric indication extension for Palforzia oral immunotherapy for the treatment of peanut allergy. News release. Stallergenes Greer. Published July 30, 2024. Accessed August 26, 2025. https://www.stallergenesgreer.com/press-releases/fda-approves-us-pediatric-indication-extension-palforziar-oral-immunotherapy?language_content_entity=en