Bowl of peanuts

The Difference in Treatment is More Than Peanuts

Could starting oral peanut immunotherapy earlier help reduce the severity of life-threatening peanut allergies... or even eliminate them?


Having a peanut allergy can be hard: there are peanuts in many foods, cooking oils, and in non-edible products such as shampoos and creams.

Further, a peanut allergy is most often lifelong and deadly, meaning even the slightest exposure to a peanut can cause someone to go into anaphylactic shock. But what if there was a way to reduce the risk of severe peanut allergies?

What is already known in peanut allergy research?

Previous research by Dr. Lianne Soller, the Allergy Research Manager at BC Children’s Hospital and Project Manager at the University of British Columbia‘s Department of Pediatrics, investigated the use of peanut oral immunotherapy in children. This is a method that involves ingesting small amounts of peanut protein daily over an extended period of time (referred to as maintenance).

Soller and colleagues found that peanut oral immunotherapy was effective in some preschoolers (9 months to 5 years old) but not all. Therefore, scientists are now considering trying peanut oral immunotherapy even earlier, such as in infancy. This is because an infant’s (<12 months) immune system is more adaptable than a preschooler’s.

As a follow-up to their previous research, Soller and colleagues from Dalhousie University and the University of Manitoba explored the safety and effectiveness of peanut oral immunotherapy in infants compared to preschoolers. Their study was published in The Journal of Allergy and Clinical Immunology.

Their current research study included infants (<12 months old) and preschoolers (12 to 70 months old) with clinical peanut allergies. Both groups were given 0.3 milligrams of peanut protein each day for one year.

Peanut oral immunotherapy in infants compared to preschoolers

After one year of maintenance, the participants were asked back to complete an oral food challenge where they were given four grams of peanut protein (equivalent to 16 peanuts or over one tablespoon of peanut butter) and their symptoms were recorded.

The results from the study showed that 81% of infants tolerated four grams of peanut protein after one year of maintenance compared to 76% of preschoolers who tolerated four grams. Zero percent of the infants experienced worse than a mild allergic reaction to four grams of peanut protein compared to 8% of the preschoolers who experienced a moderate or severe allergic reaction when ingesting four grams of peanut protein.

Furthermore, although this was not significant, none of the infants required epinephrine (e.g., an EpiPen) to help reverse the symptoms of their allergic reactions, while five of the preschoolers did.

All in all, the study suggests that oral peanut immunotherapy is not more effective in infants compared to preschoolers, but that oral peanut immunotherapy may be safer for infants compared to preschoolers. This was illustrated by the fact that less severe allergic reactions were recorded for infants during the oral food challenge compared to preschoolers.

What does this mean?

After one year of peanut protein maintenance, an infant would be able to eat one peanut butter cookie (around one tablespoon of peanut butter) without going into an anaphylactic shock. For parents with infants who have a clinical peanut allergy, this will come as a great relief because parents cannot always control what their infants are exposed to or what they put in their mouths every day.

However, future research is required to replicate these findings. If these results can be replicated in other infants with clinical peanut allergies, implementing peanut oral immunotherapy during infancy could become the gold standard in peanut allergy desensitization. This will hopefully lead to less severe peanut allergy reactions in one’s life, or perhaps eliminate the peanut allergy altogether.

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Alexandria (Alex) Samson is a PhD student in the Department of Psychology at the University of Toronto. She completed her BSc in Neuroscience from Dalhousie University. Alex is a strong believer in open science and is passionate about making scientific research accessible to all audiences.