For Canadian families navigating the anxieties of peanut allergies, a surprising new finding offers a glimmer of hope: less peanut may be enough. A study led by The Hospital for Sick Children (SickKids) and Montreal Children’s Hospital reveals that remarkably small doses of peanut oral immunotherapy (OIT) can build protection against accidental exposures, with fewer side effects than current standard treatments.
Peanut allergies affect almost two per cent of children and adults in Canada, and are increasingly linked to hospitalizations. Peanut OIT works by gradually increasing the amount of peanut a child can tolerate, shielding them from reactions caused by accidental contamination. Typically, this involves steadily increasing peanut intake to a regular “maintenance” dose.
Published in journal of Allergy and Clinical Immunology – In Practice.The study randomly assigned 51 children with peanut allergy to one of three groups: a low-dose treatment (30mg maintenance), a standard-dose treatment (300mg maintenance), or an avoidance group (no peanut OIT).
Importantly, both peanut OIT groups-nonetheless of dose-showed significant and similar increases in their threshold for allergic reaction to peanuts. This suggests that even small amounts of peanut exposure can effectively train the immune system to better manage the allergen.
“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 Division of Immunology & Allergy at SickKids, project Investigator in the SickKids Research Institute, and Co-Director of the SickKids Food Allergy and Anaphylaxis Program. “The more options we have, the more we can support patients’ experience and provide meaningful, tailored care.”
Children in the 30mg maintenance group experienced fewer adverse reactions compared to the 300mg group, and no participants withdrew from treatment.
“This is a small enough dose that even children who do not like the taste can continue treatment,” explains co-senior study author Dr. Thomas Eiwegger, Adjunct Scientist in the Translational Medicine program. “This is the first time we’ve compared standard doses to such a low dose, but the minimum maintenance dose to provide benefit might potentially be even lower than 30mg.”
The research team acknowledges that some children and families may opt for very low doses, while others may prefer to gradually increase intake based on their individual goals. This study represents a crucial step toward developing safer and more accessible protocols for peanut OIT, with the ultimate aim of expanding access to more peanut-allergic children.
“The study found that very small amounts of peanuts, that are associated with less reactions, could be used as effectively as large amounts for oral immunotherapy, making it safer and accessible to more Canadians, even those who are very sensitive to the allergen,” says Dr. Moshe Ben-Shoshan, co-senior author of the study, a paediatric allergy and immunology specialist at the Montreal children’s Hospital and Scientist in the Infectious Diseases and Immunity in Global Health Program at the Research Institute of the McGill University Health Centre.
The research was funded by the SickKids Food Allergy and anaphylaxis Program, Canadian Institutes of Health Research (CIHR), Montreal Children’s Hospital Foundation and the US peanut advisory board.
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