Jennifer A. Dantzer, MD, MHS, assistant professor of pediatrics, Johns Hopkins University School of Medicine.

Jennifer A. Dantzer, MD, MHS

A long-term follow-up of the IMPACT trial found 80% (32/40) of children treated with 

 starting at 1 to 3 years of age were still eating peanut 8 to 11 years later. Despite this finding, lead author Jennifer A. Dantzer, MD, MHS, assistant professor of pediatrics at Johns Hopkins University School of Medicine, said the field still lacks a fully powered study to answer whether these patients are in durable remission.¹

The IMPACT-PLuS study enrolled 78 of the original 146 IMPACT participants and paired questionnaire data on ongoing consumption and reactions with serologic follow-up in 58 patients.¹ Dantzer said no coordinated effort currently exists to build the kind of long-term dataset the field needs.

"I think what would be very helpful would be just more years of data for who's still eating it, how's it going, who's having reactions," Dantzer said.

Peanut OIT Follow-Up Study Highlights Gaps in Allergy Remission Research

She added that confirming true remission would require pausing consumption entirely and rechallenging patients months later. However, this approach can be difficult to counsel families through given the risk of reaction on reintroduction.

IMPACT-PLuS Long-Term Consumption and Immunologic Findings

Among the 40 patients who received pnOIT in IMPACT with no subsequent intervention, 35% (14/40) reported peanut reactions since the original trial, and 5 required epinephrine.¹ All 15 patients who had achieved remission in IMPACT were still eating peanut at follow-up, with 60% (9/15) consuming at least 1000 mg per serving.¹ Compared with the placebo arm, pnOIT-treated patients maintained significantly lower peanut and Ara h 2 IgE and higher IgG4 levels years after the original trial ended (

 <.001 for peanut IgE), suggesting sustained immune modulation rather than a transient treatment effect.¹

Predictive Biomarkers and Remission Testing Remain Unanswered

What did the IMPACT-PLuS follow-up study show?


Among children treated with peanut OIT starting at 1 to 3 years of age, 80% were still eating peanut 8 to 11 years later, with sustained changes in peanut-specific IgE and IgG4 levels.

What research gap remains in early-life peanut OIT?


There is no coordinated long-term follow-up effort, and confirming true immunologic remission would require pausing peanut consumption and performing a formal rechallenge, which researchers have not yet organized at scale.

Dantzer said the most pressing unresolved questions are identifying which patients respond best to pnOIT and whether a laboratory marker could predict success before treatment begins. She also raised a distinct long-term question: whether a marker could eventually distinguish patients who could safely space out dosing from those who have naturally outgrown their allergy altogether and no longer need to track intake at all.

Dantzer emphasized that clinicians should continue referring food-allergic children to allergists or seeing them regularly if already practicing allergy, given the expanding menu of approved and investigational treatment options. She said families and clinicians should decide together which option, if any, fits a given child.

Early-Life Peanut OIT's Decade-Long Benefit, With Jennifer Dantzer, MD

Peanut OIT Long-Term Reaction Risk, Remission, and Biomarkers

Dantzer JA, Virkud YV, Cox AL, et al. Early life peanut oral immunotherapy associated with long-term ingestion and immunologic changes. 

Dantzer J. Early-Life Peanut OIT’s Decade-Long Benefit, With Jennifer Dantzer, MD. HCPLive. Published August 24, 2026. Accessed August. 25, 2026. 

https://www.hcplive.com/view/early-life-peanut-oit-decade-benefit-jennifer-dantzer-md

Dantzer J. IMPACT-PLuS Data Show Low but Real Reaction Risk with Peanut OIT. HCPLive. August 25, 2026. 

https://www.hcplive.com/view/peanut-oit-long-term-reaction-risk-remission-biomarkers

Articles

IMPACT-PLuS investigator Jennifer A. Dantzer says predictive biomarkers and formal remission testing remain unanswered questions in peanut OIT.

A long-term follow up of IMPACT-PLuS found 35% (14/40) of children treated with 

early-life peanut oral immunotherapy (pnOIT) 

reported an allergic reaction in the 8 to 11 years since completing the trial, with 

. These children did not have an additional peanut allergy treatment following pnOIT.

The reaction data follow earlier IMPACT-PLuS findings showing 80% of this cohort remained peanut tolerant at follow-up, raising practical questions about how clinicians should weigh ongoing reaction risk against sustained tolerance. Investigators also examined whether biomarkers measured a decade after early-life pnOIT could help identify children on a path toward durable remission rather than desensitization alone.

"Even though it was great with the ongoing success, and they were eating it, it's important to note it's not without risk," said Jennifer A. Dantzer, MD, MHS, from the department of pediatrics at Johns Hopkins University School of Medicine. "Most of the symptoms and reactions were mild, but there were still 5 people who needed epinephrine. The main thing [is] being prepared, knowing the risk exists, and talking with families about it when deciding if this is the right treatment."

IMPACT-PLuS Data Show Low but Real Reaction Risk with Peanut OIT

Peanut OIT Reaction Risk and Epinephrine Use Long Term

Most reactions among the 14 affected participants were reported as rare, occurring in < 10% of peanut exposures, with oral pruritus, hives, and wheezing the most common symptoms.¹ Eleven of the 14 participants who reacted used medication to treat the reaction, including 8 who took oral antihistamines and 5 who required epinephrine, some more than once.

Three participants were diagnosed with eosinophilic esophagitis (EoE) after IMPACT, though the dataset does not establish peanut ingestion as a driver, Dantzer said. One case emerged during the trial and appeared short-term; of the other 2, diagnosed roughly 5 years later, one participant was not eating peanut at diagnosis, and the other continued eating peanut with disease controlled on treatment. Dantzer said long-term OIT studies should continue tracking EoE risk given the small sample.

Predicting Remission After Early-Life Peanut 

35% of children treated with early-life peanut OIT reported a peanut reaction years after IMPACT ended, with 5 requiring epinephrine.

Peanut and Ara h 2 IgE remained significantly lower, and IgG4 significantly higher, in pnOIT-treated children compared with placebo recipients a decade later.

No validated biomarker currently distinguishes durable remission from natural outgrowth, though age at treatment initiation and baseline IgE remain useful counseling factors.

A decade after treatment ended, children originally randomized to pnOIT still had significantly lower peanut and Ara h 2-specific IgE and higher IgG4 than those randomized to placebo. Remission-group participants trended toward the lowest IgE and smallest skin prick test wheals.¹ Many participants continued eating peanut regularly, which Dantzer said complicates isolating a stand-alone treatment effect, since ongoing exposure may itself help sustain these immunologic patterns.

No validated biomarker or lab test can currently distinguish durable remission from natural outgrowth or tolerance sustained by continued ingestion, Dantzer said. Age at pnOIT initiation and baseline peanut IgE, both predictive of remission in the original IMPACT trial, remain useful factors for counseling families on a child's likelihood of short- and long-term success, alongside their chances of natural outgrowth, when considering early-life OIT.

Watch part 1 of our interview with Dantzer here: 

Early-Life Peanut OIT’s Decade-Long Benefit, With Jennifer Dantzer, MD

Dantzer JA, Virkud YV, Cox AL, et al. Early-life peanut oral immunotherapy associated with long-term ingestion and immunologic changes. 

https://www.jacionline.org/article/S0091-6749(26)00363-5/fulltext

Dantzer J. Early-Life Peanut OIT’s Decade-Long Benefit, With Jennifer Dantzer, MD. HCPLive. Published August 24, 2026. Accessed August. 25, 2026.

Videos

IMPACT-PLuS follow-up data show 35% of children treated with peanut OIT had a reaction years later, with 5 requiring epinephrine, Jennifer Dantzer, MD, says.

IMPACT-PLuS, a long-term follow-up of the Immune Tolerance Network's IMPACT trial, found 80% of children treated with 

remained peanut tolerant a median of 9 years later.

Most food OIT trials report outcomes measured in months, leaving limited data on what happens to desensitization or remission once children reach adolescence.

 IMPACT was the first randomized, placebo-controlled trial to test pnOIT in children aged 1 to 3 years, showing greater desensitization and remission rates than typically reported in older cohorts.¹ IMPACT-PLuS was designed specifically to answer whether these early gains persist, following participants 8 to 11 years after their original enrollment.

"OIT is not the best treatment choice for everyone," said Jennifer A. Dantzer, MD, MHS, assistant professor of pediatrics, Johns Hopkins University School of Medicine, "but it's something a family with a food allergy could discuss with their allergist, weighing the risks and benefits to see if it makes sense for their family."

IMPACT-PLuS Trial Design and Long-Term Peanut Consumption Findings

IMPACT enrolled 146 children aged 12 to 47 months at 5 US sites, randomizing them 2:1 to pnOIT (2000 mg peanut protein daily) or placebo for 134 weeks, then 26 weeks of avoidance.¹ At the end of the trial, 71% of pnOIT-treated participants met desensitization criteria on an oral food challenge, compared with 2% of the placebo group.¹ Separately, 21% achieved remission after passing a 5000 mg peanut challenge following 26 weeks off therapy.¹

IMPACT-PLuS re-enrolled 78 of the original 146 participants (53%) between April 2023 and February 2024, then aged 9 to 14 years, a median of 9 years after their original enrollment.

 The primary analysis centered on group A, the 40 pnOIT-treated participants who pursued no additional peanut-directed intervention after IMPACT ended. In this group, 80% were still eating peanut at follow-up, and 35% were consuming ≥ 1000 mg of peanut protein in a single serving.

Across the full pnOIT follow-up cohort of 58 participants, including those who pursued additional therapy after IMPACT, 83% remained peanut tolerant.

 This continuation rate exceeds the roughly 50% long-term rate reported in earlier OIT cohorts.

Remission, Reactions, and Immunologic Changes After Early-Life pnOIT

In IMPACT-PLuS, 80% of children treated with early-life pnOIT and no subsequent intervention were still eating peanut a median of 9 years after enrollment.

All 15 participants who achieved remission in the original IMPACT trial remained peanut tolerant at follow-up, and 60% were eating at least 1000 mg of peanut protein per serving.

Reactions were reported by 35% of the pnOIT-only group since IMPACT ended.

All 15 participants from IMPACT's original remission group, those who passed a 5000 mg peanut challenge after 26 weeks of avoidance, were still eating peanut at follow-up, and none had reverted to full avoidance.

 In total, 60% were consuming ≥ 1000 mg of peanut protein per serving.

 Reactions were less frequent in this group than in participants who were desensitized without achieving remission or who were never desensitized, occurring in 14% versus 50% of those other subgroups (

Overall, 35% of group A reported an allergic reaction to peanuts since IMPACT ended, involving oral pruritus, hives, or wheezing.

 Eleven participants used medication to treat a reaction, and 5 received epinephrine.

 Eight participants (20%) had returned to peanut avoidance by follow-up, citing reactions, taste aversion, or difficulty maintaining the regimen.

"There's no test to say a patient would be fine spacing doses to an exact interval," Dantzer said. "I'd caution against spacing intervals without an allergist's guidance, since doing so could raise the risk of reactions for some patients."

Dantzer JA, Virkud YV, Cox AL, et al. Early-life peanut oral immunotherapy associated with long-term ingestion and immunologic changes. 

Upton J. VLOIT Boosts Multi-Nut Tolerance in Children, With Julia E. M. Upton, MD, MPH. HCPLive. Published January 17, 2026. Accessed August 24, 2026. 

https://www.hcplive.com/view/vloit-boosts-multi-nut-tolerance-in-children-julia-upton-md-mph

Wood R. OUtMATCH: Omalizumab and OIT Similarly Enable Allergenic Food Consumption, With Robert Wood, MD. HCPLive. Published March 9, 2026. Accessed August 24, 2026. 

https://www.hcplive.com/view/outmatch-omalizumab-oit-similarly-enable-allergenic-food-consumption-wood

IMPACT-PLuS follow-up found 80% of children treated with early-life peanut oral immunotherapy remained peanut tolerant 8 to 11 years later.