PEANUT oral immunotherapy at a very low maintenance dose was shown to significantly raise reaction thresholds in children with peanut allergy, offering a potentially safer and simpler treatment approach.
New clinical trial data demonstrated that a 30 mg peanut oral immunotherapy (P-OIT) maintenance dose improved peanut tolerance to a similar extent as a higher 300 mg dose, while being associated with fewer systemic adverse events. The findings suggested that lower-dose regimens may reduce treatment burden without compromising effectiveness.
Peanut Oral Immunotherapy and Allergy Thresholds
Peanut allergy is one of the most common food allergies in children and is a leading cause of severe allergic reactions. Standard management has relied on strict avoidance, which does not modify underlying disease risk. Peanut oral immunotherapy aims to increase the amount of peanut protein that patients can tolerate, reducing the risk of reactions following accidental exposure.
In this randomised study, researchers enrolled 51 children with confirmed peanut allergy who reacted to 444 mg peanut protein or less during double-blind, placebo-controlled food challenges. Participants were assigned to a 30 mg P-OIT group, a 300 mg P-OIT group, or an avoidance-only group.
After 1 year, 13 of 17 patients in the 30 mg group tolerated at least 443 mg peanut protein, compared with none in the avoidance group. Similar improvements were observed in the 300 mg group. Importantly, systemic adverse events were fewer among children receiving the 30 mg maintenance dose, highlighting a potential safety advantage.
Immunological markers also improved. Peanut-specific immunoglobulin E decreased and immunoglobulin G4 increased in both peanut oral immunotherapy groups, with no meaningful differences between the two dosing strategies.
Clinical Implications and Future Directions
These findings were notable because they challenged the assumption that higher maintenance doses are necessary for clinical benefit. A simplified peanut oral immunotherapy regimen could improve adherence and reduce dropout rates, which remain a key challenge in real-world allergy care.
The authors acknowledged limitations, including the modest sample size and paediatric-only population. Larger and longer-term studies are needed to determine whether low-dose peanut oral immunotherapy can maintain tolerance over time and whether similar benefits are seen in adults.
For clinicians managing patients with food allergy, the results supported ongoing efforts to individualise immunotherapy approaches.
Reference
Upton JEM et al. Peanut oral immunotherapy using 30 and 300 mg maintenance doses. J Allergy Clin Immunol Pract. 2026;14(1):223-32.
