Children with peanut allergies may build tolerance by gradually eating small, controlled peanut butter doses over time.
A new study suggests that children with peanut allergies may have a way to build tolerance simply by eating small, controlled amounts of peanut butter over time. Researchers found that after an 18-month period of gradually increasing doses, all participants who started with the ability to tolerate at least half a peanut could safely consume three tablespoons of peanut butter without a reaction. This approach could be life-changing for families managing peanut allergies.
For years, treatment options for peanut allergies have focused on those with severe reactions to even the smallest trace of peanuts. The therapies available aim to reduce the risk of serious allergic responses in case of accidental exposure. But for kids who already have a higher threshold for peanuts, there has been little in the way of treatment—until now.
A team of scientists wanted to see if a simple, home-based approach could help these children tolerate more peanut protein than they already could. The study included 73 kids between the ages of 4 and 14. About 60% were white, 19% were Asian, 1.4% were Black, and 22% identified as more than one race. The children were randomly placed into two groups: one that continued to avoid peanuts and another that started ingesting small amounts.
Those in the peanut-eating group began with just 1/8 teaspoon of peanut butter per day. Every eight weeks, their dose increased under medical supervision at the study site until they reached one tablespoon. Some children used alternatives like peanut flour or peanut-containing candies instead of peanut butter. The results were promising—none of the kids in the peanut-consuming group needed emergency epinephrine for a severe reaction at home, and only one required it during a monitored visit.
At the end of the trial, children in both groups underwent a closely supervised food challenge to see how much peanut butter they could eat without an allergic reaction. Every child in the peanut-consuming group could handle the full challenge dose of 9 grams of peanut protein, which equals three tablespoons of peanut butter. In contrast, only three children in the avoidance group reached that same level of tolerance.
Since the study took place during the COVID-19 pandemic, not all families returned for the final food challenge. However, statistical analysis accounting for those missing results suggests that all the children in the peanut-consuming group increased their peanut tolerance by at least two dose levels, compared to just 21% in the avoidance group.
After completing the initial 18-month period, kids who had built up their tolerance continued to eat at least two tablespoons of peanut butter each week for four months. Then, they completely avoided peanuts for another two months before returning for a final food challenge. Even after this break, most of the children—nearly 87%—still tolerated the full 9 grams of peanut protein. By comparison, the few children in the avoidance group who had initially passed the challenge seemed to develop a natural tolerance on their own.
These findings suggest that for children with a higher threshold for peanut allergies, eating controlled amounts of peanut butter at home could be an effective way to improve tolerance. The researchers are now interested in seeing if this approach could work for other common food allergies.
The study was led by Dr. Scott Sicherer and Dr. Julie Wang at the Elliot and Roslyn Jaffe Food Allergy Institute at Mount Sinai Kravis Children’s Hospital in New York. Dr. Sicherer, a leading expert in pediatric allergy and immunology, emphasized that this simple strategy could offer new hope for families navigating food allergies. Further research will help determine whether the tolerance built during the trial will last long-term, but these early results are promising.
Sources:
Children with peanut allergy achieve tolerance with gradual peanut butter ingestion
Peanut Oral Immunotherapy in Children with High-Threshold Peanut Allergy
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