Initiating peanut oral immunotherapy before age 2 facilitates ad-lib consumption

Published online February 5, 2025

Peanut allergy (PA) affects 1-2% of individuals in the United States, is typically lifelong, and adversely affects quality of life. Management has historically focused on strict avoidance and treatment of accidental exposures, but there are now FDA-approved treatments for peanut allergy. Although peanut oral immunotherapy (POIT) has been shown to desensitize individuals 1-17 years of age to peanut, there are limited data on the role of POIT facilitating ad-lib peanut consumption, especially in children as young as 6 months to 2 years old.

A recent article in The Journal of Allergy and Clinical Immunology: In Practice by Mustafa et. al. evaluated real world outcomes of high-dose POIT in children 6 months to 4 years of age. Children 6 months to 4 years of age with a diagnosis of PA were enrolled in a POIT protocol with goal dose of 3000 mg (~12 peanuts). The authors evaluated clinical outcomes up to 6 months after POIT, including adverse events, achievement of ad-lib consumption, and the impact of age on these outcome measures.

Sixty children started POIT, at a median age of 16 months. Fifty-one (85%) children completed POIT in a median of 7 months and were able to consume ad-lib peanut products. Sixteen (26.7%) children experienced 22 adverse reactions, with 6.7 % requiring treatment with epinephrine. Initiating POIT prior to 24 months of age increased the likelihood of ad-lib peanut consumption by 11 fold. The study therefore demonstrates that high dose POIT in infants and toddlers can safely lead to ad-lib consumption of peanut products, especially if initiated before two years of age.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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