Emerging Trends in Food Allergy Management: Low-Dose Immunotherapies

SickKids and Montreal Children’s Hospital report a randomized pediatric trial showing that a low-dose peanut oral immunotherapy (OIT) regimen—30 mg maintenance—protects children from severe reactions while lowering treatment-related adverse events. The finding suggests a lower maintenance target could expand safe outpatient access to pediatric OIT.

The investigators compared a 30 mg maintenance dose with a higher standard maintenance dose, using prevention of severe allergic reactions and treatment-limiting adverse events as primary endpoints. Reportedly, the low-dose arm had fewer severe events and adverse outcomes.

The report also notes that children in the 30 mg maintenance dose group experienced fewer adverse reactions and no withdrawals from treatment, suggesting improved tolerability.

Key Takeaways:

• A pediatric comparison finds a 30 mg maintenance dose of peanut OIT confers protection against severe reactions while lowering adverse-event rates versus higher maintenance dosing.
• Children eligible for peanut OIT may be more likely to tolerate and remain on therapy at lower maintenance doses, potentially expanding candidacy for outpatient programs.
• Programs may evaluate lower maintenance targets and update counseling and monitoring plans while awaiting larger trials and longer-term follow-up to confirm durability and generalizability.