TOPLINE:

Among children with peanut allergy receiving oral immunotherapy (OIT), a low maintenance dose of 30 mg of peanut protein — about one eighth of a peanut — may be as effective as the standard 300-mg dose in raising tolerance thresholds, while offering an improved safety profile, a study showed.

METHODOLOGY:

• Researchers conducted a randomized controlled trial at two academic centers in Canada between 2018 and 2024, enrolling 51 children with peanut allergy (median age, 10 years).
• Participants were randomly assigned to peanut OIT with a 30-mg maintenance dose, peanut OIT with the standard 300-mg maintenance dose, or avoidance of the allergen.
• Primary outcomes were the percentages of participants tolerating ≥ 443 mg or ≥ 1043 mg of peanut protein after 1 year.

TAKEAWAY:

• Among participants assigned to the 30-mg dose, 76.5% tolerated ≥ 443 mg of peanut protein (P < .00001) and 41.2% tolerated ≥ 1043 mg (P = .007) compared with no participants in the avoidance group.
• In the 300-mg group, 58.9% and 47.1% of participants reached those thresholds (P < .001 and P = .003, respectively).
• Participants in the 300-mg maintenance group had a fivefold higher incidence of moderate or severe nonanaphylactic reactions than those in the 30-mg group (adjusted incidence rate ratio, 5.06; 95% CI, 1.16-22.70; P = .02).

IN PRACTICE:

“We expect this work will contribute to the development of future safe and effective protocols and to support patients and clinicians to have confidence in P-OIT [peanut OIT] even with lower doses,” the authors of the study wrote.

SOURCE:

Julia E.M. Upton, MD, with University of Toronto, Toronto, Ontario, Canada, was the corresponding author of the study, which was published online on October 16, 2025, in The Journal of Allergy and Clinical Immunology: In Practice.

LIMITATIONS:

This study had a relatively small sample size and a 23.5% dropout rate.

DISCLOSURES:

The research was funded by the SickKids Food Allergy and Anaphylaxis Program, Canadian Institutes of Health Research, and Montreal Children’s Hospital Foundation. Several authors disclosed having ties with pharmaceutical companies.

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