For Less Severe Child Peanut Allergies, Small Doses of Peanut Butter May Help

TUESDAY, Feb. 11, 2025 (HealthDay News) -- More than 800,000 U.S. children have what's called "high threshold" peanut allergy, meaning they can tolerate about half a peanut daily before symptoms arise.

New research suggests that exposing these kids to tiny but gradually increasing levels of store-bought peanut butter might help ease the allergy for good. 

“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 study lead author Dr. Scott Sicherer, chief of allergy and immunology at Mount Sinai in New York City.

He believes the findings could have implications for food allergies in general.

“Our findings open the gateway to personalized threshold-based treatments of food allergy," Sicherer said in a Mount Sinai news release, adding that the approach could "be a game-changer for the majority of people with food allergies.”

The new trial was funded by the U.S. National Institute of Allergy and Infectious Diseases and published Feb. 10 in NEJM Evidence.

For some children and adults, even minuscule amounts of peanut can trigger severe reactions, including life-threatening anaphylaxis. These cases -- in which the amount of exposure needed is under half a peanut -- are deemed to be "low-threshold" allergies.  

The U.S. Food and Drug Administration (FDA) recently approved treatments, such as an injected biologic, as well as very carefully dosed oral peanut immunotherapy (peanut exposure), to help ease these cases. 

However, there are many cases of high-threshold peanut allergy, Sicherer's team noted.

Co-senior author Dr. Julie Wang noted that prior research "found that more than half of people with peanut allergy can tolerate half a peanut or more, and [researchers] thought that this group of people might be treatable if we took a different approach to peanut oral immunotherapy."

The new trial involved 73 children ages 4 to 14, all of whom had high-threshold peanut allergy. 

Half of the kids were instructed to follow their usual pattern and simply avoid peanuts, while the other half were given gradually larger doses of store-bought peanut butter. 

The treatment group began with a minimum dose of 1/8 teaspoon of peanut butter per day, and gradually increased their dose every eight weeks over the course of 18 months. 

By the end of the trial, these children were consuming at one tablespoon of peanut butter daily, or an equivalent amount of a different peanut product. 

All dosing was conducted under medical supervision. Only one child required an epinephrine  ("EpiPen") shot during the trial, and no severe reactions or epinephrine shots were needed for any child enrolled in the peanut-ingestion group. 

At the end of the trial, the 32 kids in the peanut-ingestion groups underwent a medically supervised test to see if they could tolerate up to three tablespoons of peanut butter. All 32 could do so, the research team reported.

"We were thrilled to find that this treatment strategy was even more successful than we had anticipated," said Wang, who is a clinical researcher at Mount Sinai's Jaffe Food Allergy Institute.

In contrast, only three of the 30 children who had been in the peanut-avoidance group could ingest the same amount of peanut butter without allergy symptoms, the team noted. 

Would the benefits of peanut exposure therapy last? 

To help find out, children in the peanut-ingestion group were placed on a regimen where they consumed at least two tablespoons of peanut butter weekly for four months, and then avoided peanuts entirely for two months. 

Nearly all -- 26 of the 30 children -- continued to tolerate peanut butter once they resumed consuming it after the two-month avoidance period, the researchers said.

Overall, 68.4% of kids in the peanut-ingestion group developed a durable, natural tolerance to peanuts.

“These study results are very exciting and a huge step forward in personalizing food allergy treatment,” concluded Sicherer, who is also professor of pediatric allergy and immunology at Mount Sinai. “My hope is that this study will eventually change practice to help these children and encourage additional research that includes this approach for more foods.”

More information

Find out more about peanut allergies at the American Academy of Allergy, Asthma and Immunology.

SOURCE: Mount Sinai, news release, Feb. 10, 2025