TOPLINE: 

About 84% of patients receiving peanut oral immunotherapy (OIT) in a real-world study did not have immediate allergic reactions during treatment, but factors such as physical activity and sleep deprivation may increase the likelihood of having a reaction that requires treatment with epinephrine.

METHODOLOGY: 

• Researchers conducted a retrospective study of 295 patients with peanut allergy (mean age, 10.8 years; 63.1% boys) at 12 centers in France between November 2019 and July 2021.
• They examined how many patients had an immediate allergic reaction, defined as an allergic reaction occurring within 6 hours of peanut intake during the previous year of peanut OIT.
• The investigators also considered various circumstances at the time of treatment, including recent physical activity and fatigue.

TAKEAWAY: 

• Overall, 15.6% of participants had at least one immediate allergic reaction, of which 50.7% were grade 1, 20.5% were grade 2, 17.8% were grade 3, and 11% were grade 4.
• About half of the reactions occurred in the context of external cofactors, most commonly recent physical activity (65.8%), fatigue or sleep deprivation (18.4%), and stress (13.2%).
• Use of epinephrine was significantly higher when cofactors were present (18.4% vs 0.0%; P = .01).
• About 11% of the participants had nonimmediate allergic reactions, most commonly chronic abdominal pain.

IN PRACTICE:

Clinicians should “continue to educate the patient about how to recognize cofactors and manage anaphylaxis, monitor dietary intake, and adapt protocols for high-risk patients,” the authors of the study wrote.

SOURCE:

Flore Amat, MD, PhD, Hôpital Robert-Debré, Paris, France, was the corresponding author of the study, which was published online on December 17, 2025, in The Journal of Allergy and Clinical Immunology: Global. 

LIMITATIONS:

This study was limited by its retrospective design, incomplete documentation of immediate allergic reactions, variability in peanut OIT practices across centers, and lack of follow-up beyond 20 months.

DISCLOSURES:

Some researchers reported receiving consulting or lecture fees from Aimmune Therapeutics, ALK, Novartis, and Stallergenes Greer.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.