Slow Peanut Up-Dosing Helped Many Toddlers With Peanut Allergy

Key Takeaways

• In toddlers with confirmed peanut allergy, higher short-term peanut tolerance was observed with active treatment than with avoidance in the randomized comparison.
• The protocol started with a very low hospital dose, followed by daily home intake and slow increases to a low maintenance dose.
• Adverse events were mostly mild, more serious reactions clustered during escalation, and a few children received adrenaline.

In Stockholm, toddlers aged 1 to 3 years with confirmed peanut allergy had higher short-term tolerance after slow peanut oral immunotherapy than with avoidance, 82% versus 12%, in a randomized comparison. The children were assigned either to gradual daily peanut exposure or to complete avoidance. Investigators used a slow build-up approach rather than rapid escalation. The lead result centered on higher post-treatment tolerance after three years of follow-up.

The study enrolled 75 children in Stockholm, with 50 assigned to active treatment and 25 to complete peanut avoidance. Confirmed peanut allergy ranged from mild symptoms to severe reactions after ingestion. Children were identified through the Karolinska University Hospital laboratory and treated at the Sachs' Children and Youth Hospital research unit. Treatment began in hospital with a very low dose of peanut puffs, which investigators described as easy for families to use. Daily intake then continued at home, with increases every four to six weeks until about one and a half peanuts per day.

After three years, children in the treatment group were reassessed after a four-week break from peanut intake. At that point, 82% could eat at least three and a half peanuts without an allergic reaction, compared with 12% of controls. The tolerance test followed a pause in dosing rather than an immediate post-dose assessment. Investigators described the trial as the first randomized toddler oral immunotherapy study using slow up-dosing and a low maintenance dose. The tolerance finding was limited to the study's observed follow-up period.

Side effects were usually mild and included mouth itching and skin rashes. More serious reactions occurred mainly during dose escalation, and a few treated children required adrenaline injections for severe allergic reactions. These events were concentrated during periods when intake levels were being raised. The authors said the treatment was intended for controlled conditions with close healthcare follow-up and was not something parents should try at home.

The authors said the next research step is to examine immune changes during treatment and continue observing the children over time. The report also noted that some authors had received pharmaceutical company fees unrelated to this work. Whether tolerance persists beyond the current follow-up period remains unresolved.