A Breakthrough for Kids With Peanut Allergies

June 06, 2025

University Hospitals Rainbow Babies & Children'sExperts in Children's Health

A young girl biting into a peanut butter sandwich

Peanuts are one of the most common food allergies in children. Approximately 2-5 percent of kids in the U.S. are allergic to peanuts. For many, a peanut allergy can be lifelong, but a recent study offers new hope for kids and their parents.

“This study is unique because it created tolerance in older children who were less severely allergic to peanuts, but had removed peanuts from their diet,” says Kathryn Ruda Wessell, DO, a pediatric allergy and immunology physician at University Hospitals Rainbow Babies & Children’s. “Previous studies have found tolerance is much more common in younger patients, typically around 2 years old or younger.”

Increasing Peanut Tolerance

The Mount Sinai study helped children ages 4-14 gradually eat a larger amount of peanut butter than is typically used in oral immunotherapy (OIT) food challenge studies. OIT food challenges gradually increase the amount of peanut protein a person can eat, starting with very low amounts. “Food challenges typically measure up to 2 tablespoons of peanut butter,” says Dr. Ruda Wessell. “This one measured up to 3 tablespoons.”

The study found that children with high-threshold peanut allergies who could eat half a peanut or more were gradually able to build up to 9 grams of peanut butter over the course of 18 months. This is in stark contrast to the peanut avoidance strategies of the past.

How OIT Works

With OIT, a child consumes small amounts of a food allergen each day to help the immune system gradually build up a tolerance and reduce the chance that an accidental exposure to the allergen will cause a serious, possibly life-threatening allergic reaction.

“OIT can work at any age, but it comes with risks because exposure to a food allergen, even in small, controlled doses, can trigger allergic symptoms such as oral itching, rashes and, in some cases, anaphylaxis,” Dr. Ruda Wessell says.

What Makes OIT Safe

The first OIT dose is given in a doctor’s office, where the child is monitored. Rescue medications, such as antihistamines and epinephrine, are administered if any reaction requires immediate treatment.

Throughout the therapy, whenever a dosage is increased, the first dose is given at the doctor’s office. Continued daily dosing is then completed at home. Families are given strict rules to help minimize reactions and side effects, including:

What time of day to give the dose.
How to plan exercise or physical activity around doses.
When it may be safer to skip the daily dose, such as if the child is coming down with an illness.

What Else Parents Need to Know

“OIT is a marathon, not a sprint,” says Dr. Ruda Wessell. “This is a long process that takes family commitment.” There are many dosing protocols that exist for different foods, and your child’s OIT regimen will be adjusted based on their health history.

An OIT treatment plan will consider factors like:

Your child’s age.
The form of the food that’ll be used for dosing, i.e., peanut butter vs. peanut flour.
The known trigger dose of the allergen.

Parents should also be aware that side effects of this treatment are common. They may include gastrointestinal reactions, like abdominal pain, vomiting, cramping or others, like itching in the mouth, a rash, hives, swelling, or in more serious cases, anaphylaxis. And while there is no “one size fits all” treatment, OIT is considered a leading treatment for peanut allergies.

Looking to the Future

“The good news is that research is rapidly evolving and new treatment options are continually becoming available to manage food allergies,” says Dr. Ruda Wessell.

In addition to OIT, treatments may include:

Sublingual immunotherapy: Placing allergen extracts under the tongue.
Epicutaneous immunotherapy: Exposing the skin to an allergen.
Biologic therapy: Injecting an Anti-IgE medication.

“The treatment strategy for a peanut allergy used to be a pretty clear-cut: Read labels, avoid peanuts and have access to epinephrine,” she says. “But with the evolution of OIT and other therapies, there are now many possible treatment options to consider.”