Low-Dose Peanut Therapy May Offer Safer Allergy Protection for Kids

Credit: Africa Studio

A new study published in The Journal of Allergy and Clinical Immunology: In Practice shows that very low-dose peanut oral immunotherapy can significantly increase tolerance in kids with peanut allergies. Children taking just 30 milligrams of peanut protein daily showed similar benefits to those on higher doses.

“This is a small enough dose that even children who do not like the taste can continue treatment,” said co-senior investigator Thomas Eiwegger, M.D., adjunct scientist in the Translational Medicine program.

Peanut allergy can be life-threatening, and for many families, strict avoidance is the only option offered. Oral immunotherapy (OIT), a treatment that involves gradually giving small amounts of peanut protein to build tolerance, has shown promise, but higher doses can increase side effects and make treatment harder to stick with. Until now, it has not been clear how low the maintenance dose of peanut OIT can safely and effectively be.

This new study looked at whether very low-dose peanut oral immunotherapy (just 30 milligrams of peanut protein) could still meaningfully increase how much peanut allergic children can tolerate, while reducing side effects. Researchers enrolled 51 peanut-allergic children, most around 10 years old, all of whom reacted to small amounts of peanut during initial food challenges.

Participants were randomly placed into one of three groups:

• A low-dose OIT group, receiving 30 milligrams of peanut protein daily
• A standard-dose OIT group, receiving 300 milligrams daily
• A strict avoidance group, which continued avoiding peanuts entirely

After one year, children in all groups underwent carefully supervised food challenges to see how much peanut protein they could safely tolerate.

The results were striking. Children in both OIT groups were far more likely to tolerate much larger amounts of peanut than those who continued strict avoidance. Nearly three-quarters of children in the 30-milligram group were able to tolerate at least 443 milligrams of peanut protein, and about 40% tolerated more than 1,000 milligrams, which is far more than what they could handle at the start of the study. These results were similar to those seen in the 300-milligram group, despite the much lower daily dose.

In contrast, none of the children in the avoidance group were able to tolerate higher doses of peanut at follow-up, showing no improvement over time.

“This is the first time we’ve compared standard doses to such a low dose, but the minimum maintenance dose to provide benefit may be even lower than 30 milligrams,” noted Eiwegger.

Blood tests also showed important immune changes. Children receiving peanut OIT at either dose developed signs of improved immune tolerance, including favorable changes in peanut-specific antibodies. These immune improvements were not seen in children who avoided peanuts.

Safety was another key finding. Children receiving the 30-milligram dose experienced fewer systemic allergic reactions than those on the higher 300-milligram dose, and fewer children dropped out of the low-dose group.

While this treatment does not cure peanut allergy, as only 10% to 20% of kids will outgrow a nut allergy, it may significantly reduce the risk of severe reactions from accidental exposure and improve quality of life for children and caregivers.

“We were excited to find that peanut OIT maintenance doses can be much lower than previously thought and still contribute to positive outcomes,” said co-lead investigator Julia Upton, M.D., M.P.H., head of the Division of Immunology & Allergy, project investigator in the SickKids Research Institute, and co-director of the SickKids Food Allergy and Anaphylaxis Program. “The more options we have, the more we can support patients’ experience and provide meaningful, tailored care.”