A new study led by Mount Sinai researchers reveals that children with high-threshold peanut allergies can safely consume peanuts by slowly increasing their intake of store-bought peanut butter, offering hope for a new, affordable allergy treatment.
In an inspiring breakthrough that could change the lives of children with peanut allergies, a recent study led by researchers at the Icahn School of Medicine at Mount Sinai has discovered that gradually increasing doses of store-bought peanut butter can safely desensitize children with high-threshold peanut allergies.
Scott Sicherer, director of the Elliot and Roslyn Jaffe Food Allergy Institute at Mount Sinai Kravis Children’s Hospital and lead author of the study published today in the journal NEJM Evidence, expressed optimism about the findings.
“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,” he said in a news release. “Our findings open the gateway to personalized threshold-based treatments of food allergy and will encourage additional studies that delve deeper into peanut and other foods for this approach that might be a game-changer for the majority of people with food allergies.”
Historically, individuals with food allergies are advised to avoid the allergens, but in recent years, a method called peanut oral immunotherapy (OIT ) — which gradually introduces small, increasing amounts of peanut protein under medical supervision — has gained traction.
However, previous studies and FDA approvals have focused on low-threshold allergies, where individuals react to minuscule amounts of peanut protein.
Approximately 800,000 children in the United States have high-threshold peanut allergies, and this study presents a promising new treatment strategy for this group.
In the study, 73 children aged 4-14 were randomly assigned to either the peanut-ingestion group or the avoidance group. The treatment regimen began with a daily dose of 1/8 teaspoon of peanut butter, gradually increasing every eight weeks over 18 months until reaching one tablespoon, all under strict medical supervision.
The results were remarkable. At the end of the treatment period, all 32 children in the peanut-consuming group who took the feeding test could tolerate nine grams of peanut protein (three tablespoons of peanut butter). In stark contrast, only three of the 30 children in the avoidance group could handle this amount.
Co-senior author Julie Wang, a professor of pediatrics at the Icahn School of Medicine and clinical researcher at the Jaffe Food Allergy Institute, reflected on the importance of this new approach.
“Years ago, when people with milk and egg allergies were advised to undertake strict avoidance, our team initiated studies that found most people with milk and egg allergies could tolerate these foods in baked goods, which changed the global approach to these allergies,” she said in the news release. “The research team recognized that more than half of people with peanut allergy can tolerate half a peanut or more, and thought that this group of people might be treatable if we took a different approach to peanut oral immunotherapy.”
To test long-term effectiveness, children who could tolerate nine grams of peanut protein were asked to consume at least two tablespoons of peanut butter weekly for 16 weeks and then avoid peanuts entirely for eight weeks.
The majority of these children maintained their tolerance even after the abstinence period, an indication of sustained unresponsiveness.
Looking forward, the Mount Sinai team aims to broaden their research to other foods and refine methods for identifying individuals with high-threshold allergies.
“These study results are very exciting and a huge step forward in personalizing food allergy treatment,” Sicherer concluded. “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.”