What CAFETERIA Means for Long-Term OIT Goals, with Scott Sicherer, MD

Months after topline results from the CAFETERIA study demonstrated the ability to instill high levels of tolerance in children with high-threshold peanut allergy, questions remain about how its findings fit within traditional oral immunotherapy (OIT) goals and how it highlights the distinction between desensitization and sustained unresponsiveness.1

The CAFETERIA study was highlighted in a session given by Scott H. Sicherer, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute and the Elliot and Roslyn Jaffe Professor of Pediatric Allergy and Immunology at the Icahn School of Medicine at Mount Sinai, at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2026 Annual Meeting held in Philadelphia, Pennsylvania.2

HCPLive sat down with Sicherer to discuss how clinicians should interpret the study’s results in real-world practice. He noted that terms like “remission” and “sustained unresponsiveness” are often used loosely, but in research they are highly protocol-specific. In many OIT trials, sustained unresponsiveness is defined by a relatively short avoidance period of often 6 weeks before re-challenge. In CAFETERIA, the team sought to mirror a more realistic scenario. After children demonstrated the ability to tolerate the equivalent of a peanut butter sandwich, they were asked to incorporate peanut more naturally into their diets for 16 weeks, consuming modest amounts weekly rather than adhering to a strict daily regimen. Only after that period were they instructed to completely avoid peanut for eight weeks before undergoing a final oral food challenge.

Most participants maintained tolerance after that extended, real-world–informed approach. Still, Sicherer is cautious about framing the results as a “cure.” In practice, he continues to counsel families that ongoing ingestion is important. Even if 1 to 2 tablespoons per week appears sufficient to maintain benefit, prolonged avoidance could allow clinical reactivity to return. For that reason, he advises continued dietary inclusion and routine follow-up rather than declaring the allergy resolved.

While CAFETERIA was a single-site study can not be generalized across food allergies, Sicherer believes the core principle of the study, that individuals with lower baseline IgE levels and higher initial tolerance thresholds may respond more readily to low-intensity OIT, likely extends beyond peanut. The concept may be applicable to other common allergens such as milk, egg, or tree nuts and would benefit from broader replication. Whether larger, multi-center trials will test that hypothesis remains to be seen, but the phenotype-driven approach introduced by CAFETERIA may signal a broader evolution in food allergy management.

“There's nothing so special about peanut. In fact, it might be that peanut would have been a harder case to approach. So would this apply to egg or milk or or other nuts and just other foods in general? I think the answer is yes. But are the studies going to be done? We'll wait and see,” Sicherer said.

References

1. Sicherer SH, Bunyavanich S, Berin MC, et al. Peanut Oral Immunotherapy in Children with High-Threshold Peanut Allergy. NEJM Evidence. Published online February 10, 2025. doi: 10.1056/evidoa2400306

2. Sicherer S. FAED Presents: The Potential for Tolerance After Oral Immunotherapy in High-Threshold Patients: The CAFETERIA Study. Presented at: AAAAI 2026 Annual Meeting, February 27-March 2, Philadelphia, Pennsylvania. Session 1705.