For millions of children worldwide, a peanut allergy diagnosis means a lifetime of constant vigilance. But what if there was a simple, cost-effective way to help children safely tolerate peanuts? A new study, published in NEJM Evidence, suggests there might be: peanut oral immunotherapy (P-OIT) using store-bought peanut butter. In other words, gradual, medically supervised peanut butter consumption.
Food allergies, especially peanut allergies, are among the most common childhood conditions. Until now, they had few choices beyond avoidance.
According to a groundbreaking study, however, these children can safely increase their peanut tolerance by eating small, gradually increasing amounts of peanut butter over time. The study results challenge conventional wisdom on peanut allergy treatment and could pave the way for more accessible therapies.
“Our study results suggest a safe, inexpensive and effective pathway for allergists to treat children with peanut allergy who can already tolerate the equivalent of at least half a peanut, considered a high-threshold peanut allergy,” said Scott Sicherer, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute at Mount Sinai Kravis Children’s Hospital, Chief of the Division of Allergy and Immunology in Mount Sinai’s Department of Pediatrics, and lead author of the paper.
“Our findings open the gateway to personalized threshold-based treatments of food allergy and will encourage additional studies that delve deeper into peanut and other foods for this approach that might be a game-changer for the majority of people with food allergies.”
The peanut butter treatment plan
The study enrolled 73 children, aged 4 to 14, who could already tolerate between 443 mg and 5,043 mg of peanut protein — the equivalent of at least half a peanut. The children were randomly assigned to two groups:
- One group followed a peanut oral immunotherapy (P-OIT) regimen, starting with 1/8 teaspoon of peanut butter daily, gradually increasing every eight weeks over an 18-month period until they were consuming one full tablespoon.
- The second group continued avoiding peanuts entirely.
The most important part was that the dose increase took place under medical supervision. However, after the new dose was found to be safe, the daily intake was administered at home, by parents. Throughout the study, no severe reactions occurred, though one child did require epinephrine during a supervised dose escalation.
After completing the treatment, children underwent a food challenge to determine their peanut tolerance.
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The findings were striking. Of the 38 children in the P-OIT group who completed the study, 100% could safely consume 9,043 mg (three tablespoons) of peanut butter. In contrast, only 10% of the children in the avoidance group could tolerate the same amount.
The most impressive discovery was that 68.4% of children in the P-OIT group maintained their tolerance even after an eight-week peanut-free period, demonstrating a durable, long-term effect. By comparison, only 8.6% of the avoidance group developed a natural tolerance over the same period.
A way forward
Current treatments approved by the FDA were tested in children with low-threshold peanut allergy, who cannot tolerate the equivalent of even half a peanut. This study offers new hope for children with milder allergies.
It may not work for everyone, and more research is needed to show how long-lasting the effects are. But for families desperate for a solution, this simple yet effective treatment could be the first step toward a life free from the fear of peanuts.
Other exciting finds in the field of peanut allergies are a toothpaste that can prevent serious reactions and an mRNA treatment that could eliminate the allergy altogether.
Journal Reference: SH Sicherer, et al. Randomized trial of high dose, home measured peanut oral immunotherapy in children with high threshold peanut allergy.NEJM Evidence (2025). DOI: 10.1056/EVIDoa2400306