New Horizons in Pediatric Allergy and Immunotherapy: Key Takeaways from ACAAI 2025

ACAAI 2025 presentations reported that oral immunotherapy (OIT) protocols enabled 64% of treated children to consume the target allergen freely—a result likely to shape counseling and shared decision-making in pediatric allergy clinics.

Early childhood food-allergy management long prioritized strict avoidance and emergency preparedness rather than active desensitization. The ACAAI presentations were framed as preliminary but practice-informing: clinicians should weigh these conference results alongside published trial data, program experience, and local resource and risk profiles before changing practice.

Where programmatic safety, follow-up capacity, and family readiness align with treatment goals, the data modestly expand the rationale for supervised oral desensitization in younger children.

Presenters described the safety profile as largely mild-to-moderate adverse events that were manageable in clinic settings; severe reactions and long-term discontinuations were uncommon in the cohorts shown.

Conference teams emphasized oral food challenges (OFCs) as diagnostic clarifiers and therapeutic decision tools—useful to resolve uncertainty about baseline reactivity and to define safe intake thresholds. Presenters also reported a preliminary 'raw-then-roasted' infant peanut protocol as an early signal of reversal of peanut allergy in infancy, pending peer-reviewed confirmation.

Key Takeaways:

• OIT and OFC outcomes now provide tangible probabilities to discuss with families—integrate these data into counseling to set realistic expectations and clear next steps.
• The raw-then-roasted infant peanut protocol offers a potential early-intervention option for select high-risk infants and should lower the threshold for referral to specialized centers that can provide supervised protocols and OFC confirmation.
• Scaling OIT/OFC programs safely requires operational changes—expanded staffing for supervised dosing, standardized monitoring protocols, and targeted family education should be programmatic priorities.