11 Feb Mount Sinai Study Emphasizes Importance of Personalizing Peanut Allergy Immunotherapy in Children
Editor’s note: Do not attempt immunotherapy for peanut or other allergens without the express direction of your health care provider. Life-threatening reactions may occur.
MedicalResearch.com Interview with:
Dr. Sicherer
Scott H. Sicherer, MD
Elliot and Roslyn Jaffe Professor of Pediatrics, Allergy and Immunology
Director, Jaffe Food Allergy Institute
Division Chief, Pediatric Allergy
Medical Director, Clinical Research Unit
Icahn School of Medicine at Mount Sinai
Jack and Lucy Clark Department of Pediatrics
Mount Sinai Kravis Children’s Hospital
New York, NY 10029
MedicalResearch.com: What is the background for this study?
Response: About 2% of people have a peanut allergy. While many of them are exquisitely allergic to tiny amounts, about half can tolerate a half a peanut kernel or more before they have symptoms, although the symptoms can be severe.
Current studies and FDA approved treatments for peanut allergy have typically focused on people reacting to about half a peanut or less. We thought that those with higher threshold may be more easily treated.
We focused on children ages 4-14 years who we identified through a medically supervised feeding test as having allergic reactions from 443 to 5043 mg of peanut protein. A peanut kernel is about 250 mg of peanut protein. The 73 children were randomized to a treatment (oral immunotherapy, OIT) using home-measured, store bought peanut butter versus continuing the standard of care, avoidance. OIT involves medically supervised dosing going from a small amount to gradually increasing larger amounts. The increases are done under direct allergist supervision, then the tolerated dose is taken at home daily. Families are given instructions about avoiding things that can cause a reaction from dosing, such as exercise after a dose, and to skip dosing for illness. Dosing can cause reactions and they were instructed on how to recognize and treat any such reactions. We did increases every 2 months.
Most of the children (62) stayed in the study to be tested after the period of treatment, that aimed for having a level tablespoon of peanut butter each day. All of the treated children who completed testing (32) were able to eat 9 grams of peanut. Only 3 of 30 who continued to avoid peanut were able to do this.
MedicalResearch.com: What are the main findings?
Response: To test the durability of this response, we had the treated children eat peanut “ad lib” encouraging 2 tablespoons per week equivalent peanut butter for 4 months then totally avoid it for 2 months and had them undergo another medically supervised feeding test. There were 28 available for this final test and 26 of them were still able to eat the full amount. There were no severe allergic reactions from treatment, one child was treated with epinephrine during a medically supervised increase in dose of peanut.
Overall, we saw that for this group with a “high threshold” peanut allergy, most were treatable with allergist-supervised high dose peanut OIT using store bought, home-measured peanut.
MedicalResearch.com: What should readers take away from your report?
Response: We think it is important to personalize food allergy treatments. This study showed that those with a higher threshold peanut allergy were substantially treatable with a durable response using a simple and inexpensive approach.
From a practical standpoint, the approach we studied should be accessible to allergists who can have shared decision-making conversations with patients who may qualify.
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: Larger studies are needed to validate these findings and learn more about risk/benefit nuances and whether this is applicable to other foods. Identifying those with this “higher” threshold can be tricky and this also needs more research.
MedicalResearch.com: Is there anything else you would like to add? Any disclosures?
Response: The research was supported by the NIH, National Institute of Allergy and Infectious Diseases. It was undertaken at the Jaffe Food Allergy Institute, Kravis Children’s Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai in New York.
Citation: Scott H Sicherer, Supinda Bunyavanich, M Cecilia Berin, Tracy Lo, Marion Groetch, Allison Schaible, Susan A Perry, Lisa M Wheatley, Patricia C Fulkerson, Helena L Chang, Mayte Suárez-Fariñas, Hugh A Sampson, Julie Wang. Peanut Oral Immunotherapy in Children with High-Threshold Peanut Allergy. NEJM Evid. 2025 Feb 10:EVIDoa2400306. doi: 10.1056/EVIDoa2400306. Online ahead of print.
PMID: 39928078 DOI: 10.1056/EVIDoa2400306
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Last Updated on February 11, 2025 by Marie Benz MD FAAD