A reduced peanut OIT dose provides a safer and more accessible treatment for children

A reduced peanut OIT dose provides a safer and more accessible treatment for children

Children with peanut allergies may not need large doses of oral peanut immunotherapy (OIT) to build protection against peanuts, says a new study led by the Hospital for Sick Children (SickKids) and the Montreal Children's Hospital. Researchers found that a small dose can help children with their peanut allergy and reduce the risk of severe reactions from accidental exposure, with fewer side effects than current standard treatment.

In Canada, peanut allergies affect nearly two percent of children and adults, and are increasingly leading to hospitalizations. Peanut OIT is a method of increasing the amount of peanuts a child can eat before a reaction occurs, helping to protect children from accidental infection. Children receiving peanut OIT eat a gradually increasing amount of peanuts over time until they reach a “maintenance dose,” which they continue to eat regularly after treatment to maintain the effect.

While peanut OIT can help children with peanut allergies build protection, current approaches use large doses, require lengthy treatment and close medical monitoring, and can often lead to discontinuation due to taste dislike and side effects of allergic reactions such as anaphylaxis.

The study is the first of its kind to compare a commonly used peanut OIT treatment with reduced doses in children, providing evidence for a significantly lower dose that could improve treatment accessibility and help protect more children with peanut allergy.

You can go far with very little

To investigate the safety and effectiveness of a very low maintenance dose of peanut OIT, the study was published inJournal of Allergy and Clinical Immunology – In Practicerandomly assigned 51 children with peanut allergy to three groups: low-dose treatment (30 mg maintenance), standard-dose treatment (300 mg maintenance), or avoidance (no peanut OIT).

Both peanut OIT treatment groups experienced a significant and similar increase in their allergic response threshold to peanuts, showing that consuming even small amounts is better than avoiding them when it comes to training the immune system to handle more peanuts.

“We were excited to find that peanut OIT maintenance doses can be much lower than previously thought and still contribute to positive outcomes,” says Dr. Julia Upton, head of the Department of Immunology and Allergy, project researcher at the SickKids Research Institute, co-director of the SickKids Food Allergy and Anaphylaxis Program and co-first author.

The more options we have, the better we can support patients’ experiences and provide meaningful, tailored care.”

Dr. Julia Upton, Head of Immunology and Allergy, Project Researcher, SickKids Research Institute

Children in the 30 mg maintenance group had fewer side effects than the 300 mg maintenance group and none discontinued treatment.

“This is a small enough dose so that even children who don’t like the taste can continue treatment,” says co-senior study author Dr. Thomas Eiwegger, associate scientist in the “Translational Medicine” program. “This is the first time we have compared standard doses to such a low dose, but the minimum maintenance dose to achieve benefit may be even lower than 30 mg.”

The research team notes that some children and families may choose to stay at very low doses, while others may prefer to increase them over time depending on their goals. This study represents an important step toward further developing safe and effective protocols for peanut OIT. Ultimately, the goal is to make peanut OIT accessible to more children with peanut allergy.

"The study found that very small amounts of peanuts, associated with fewer reactions, could be used as effectively as large amounts for oral immunotherapy, making it safer and accessible to more Canadians, even those who are highly sensitive to the allergen," says Dr. Moshe Ben-Shoshan, co-senior author of the study, a specialist in pediatric allergy and immunology at the Montreal Children's Hospital and a scientist in the Infectious Diseases and Immunity in Global Health program at the McGill University Health Center Research Institute.

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