Baked Milk, Peanut OIT Reduced Systemic Reactions by 35%, With Adnan Al Ali, MD, PhD

At the 2025 American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting in Orlando, Florida, Adnan Al Ali, MD, PhD, from McGill University Health Center, presented findings from the SoRT (Safety of Oral Immunotherapy) trial, a randomized study evaluating the safety and efficacy of oral immunotherapy (OIT) for milk and peanut allergies.

“We focused on milk and peanut because they're one of the most common allergens to cause anaphylaxis in pediatric [patients],” Al Ali told HCPLive during an on-site interview. “Having them all together in one study would expedite the science and will help us to find a real answer and a real-world data [on] which protocol is safer.”

Previous studies have examined oral immunotherapy for individual allergens with single protocols. This study represents one of the first direct head-to-head comparisons assessing multiple allergens and dosing strategies in a single trial framework.

“The main message of this study [is] that it can be done safely, and there is more than one protocol,” Al Ali said. “This study really feeds on the concept of personalizing oral immune therapy toward [the] patient's best interest, considering the patient's age. We know by now that starting with baked [milk or peanut] would have [a] lower side effect profile. Starting with [a] lower dose and slowly incrementing would also have a safer effect profile without compromising the end goal of desensitization.”

The SoRT trial compared 3 protocols—high-dose, low-dose, and baked (processed) allergen forms—for both peanut and milk OIT. The study aimed to identify safer and more effective approaches to desensitization while minimizing the risk of systemic allergic reactions, including anaphylaxis.

Key safety findings revealed that using a baked allergen form reduced systemic reactions by approximately 35%. However, higher cumulative doses of allergen were associated with an increased risk of reactions. Peanut OIT was linked to fewer local oral reactions, such as tingling or itching, but more systemic reactions compared to milk OIT.

Al Ali emphasized that OIT can be performed safely when protocols are tailored to the patient’s clinical phenotype, age, and immune status. The findings underscore the potential of personalized OIT strategies, such as initiating treatment with baked or lower-dose allergen forms, to balance safety and efficacy.

“One of the interesting findings that we did find [was that] going with the low dose protocol and with the processed protocol [achieved] the same desensitization rate as the high dose with less side effect profile, and that really challenges the previous belief that you need to go really high to de-synthesize the immune system,” Al Ali said. “It really does open the idea that there is more than one way you could desensitize the immune system with autoimmune therapy.”

Al Ali has no reported relevant disclosures.

References

Al Ali A. SoRT: safety of OIT in a randomized trial for peanut and milk. Poster presented at ACAAI 2025 in Orlando, Florida, from November 6 – November 10, 2025.