The kinetics of early peanut allergy persistence and resolution
Published online July 1, 2025
Until recently, it has been suggested that peanut allergy is outgrown in a minority of children (≤20%) but there is scant literature on the trajectory of peanut allergy from infancy to childhood. Two joint publications, Foong et al and Suarez-Farinas et al) published in The Journal of Allergy and Clinical Immunology (JACI) describe the kinetics of peanut allergy development, resolution and persistence by looking at the natural history and biomarkers of peanut allergy longitudinally in children from the Enquiring About Tolerance trial (EAT) (general population), Learning Early About Peanut allergy trial (LEAP), and Peanut Allergy Sensitization study (PAS) (high risk populations) cohorts, starting in early infancy (3-11 months) until each study end point (36-months for EAT, 60-months for LEAP and PAS).
The development of peanut allergy was examined in the EAT, LEAP and PAS cohorts. Early peanut allergy was defined by skin prick test (SPT) >4mm by 12-months or oral food challenge at study entry. Peanut allergy was confirmed by oral food challenge at study endpoint (36-months for EAT, 60-months for LEAP/PAS). Four groups were defined: early peanut allergy development with persistence (EP); early peanut allergy development with resolution (ER); late peanut allergy development (LA); never peanut allergic (NA). Foong et al compared the clinical characteristics and biomarkers between the groups and more specifically, Suarez-Farinas et al compared epitope biomarkers.
In this cohort of children, 32.1% of infants who developed peanut allergy in the first year of life outgrew it by their study endpoint which is higher than what has generally been reported in the literature. The rate of early peanut allergy resolution was 54.2% in EAT, 41.4% in LEAP and 18.6% in PAS cohorts. The absence of eczema and egg allergy, low peanut-sIgE or SPT were predictive of peanut allergy resolution. Infants with resolution of peanut allergy had lower baseline sIgE to peanut, Ara h-2 sIgE and lower SPT compared to infants with persistent peanut allergy.
Children who developed peanut allergy later (LA) showed a rise in biomarkers mainly by 36-60-months of age including component expansion (i.e. having Ara h 1-sIgE, Ara h 2-sIgE and Ara h 3-sIgE >0.1kUA/L). This differed from the children who had early peanut allergy resolution (ER) who had peanut component expansion from baseline to 12-months but component retraction by the study endpoint in keeping with peanut allergy resolution. Higher baseline epitope-sIgE antibodies were also associated with early peanut allergy and increasing levels were associated with peanut allergy development and persistence. Machine learning models that used baseline epitope-sIgE were found to be predictive of persistent peanut allergy and could be a potential future useful method of identifying peanut-reactive infants <1-year old who develop persistent peanut allergy.
Identifying distinct phenotypes of peanut allergy through early monitoring of immunological parameters will allow us to target children at greater risk of developing persistent peanut allergy. This could be a useful strategy in identifying children who may benefit from early intervention treatments such as peanut immunotherapy.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI and is the most-cited journal in the field of allergy and clinical immunology.
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