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Low-Dose Peanut OIT (30 mg) Matches Benefits of 300 mg Dose With Fewer Reactions

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In a recent study, a 30 mg maintenance dose significantly increased reaction thresholds and improved immune markers in children with peanut allergy.

A recent study found that a 30 mg maintenance dose for peanut oral immunotherapy signficantly increased the reaction threshold compared to strict avoidance, showing clinical results similar to a 300 mg dose.1

“Maintenance doses of only 1/8 peanut (30 mg peanut protein) provide large increases in desensitization and favorable immunological changes versus avoidance with improved safety versus 300 mg doses,” wrote study investigator Julia E.M. Upton, MD, MPH, from the Hospital for Sick Children in Toronto, and colleagues.1

The US Food & Drug Administration (FDA)-approved peanut oral immunotherapy (Palforzia) consists of daily exposure to peanut protein powder in gradually increasing doses over 6 months to help children build tolerance. The process consists of 3 phases: initial dosing (0.5 mg, 1.5 mg, 3 mg, and 6 mg during a 4-hour visit with 20 – 30 minutes between doses), up-dosing (dose increases over 11 visits: 3 mg, 6 mg, 12 mg, 20 mg, 40 mg, 80 mg, 120 mg, 160 mg, 200 mg, 240 mg, 300 mg; again, each visit has a 20 – 30 minute wait time), and maintenance dosing (300 mg daily at home).2

Oral immunotherapy can help desensitize patients to food allergens, but it demands substantial medical resources and is often discontinued because of allergic reactions, limited progress, or poor tolerability. However, this new research suggests that children may not need to up-dose as high as 300 mg to build tolerance and experience meaningful benefit. Stopping at 30 mg may be enough help manage peanut allergy.1

Investigators sought to assess whether low dose peanut oral immunotherapy (30 mg) could safely and effectively increase tolerated doses and induce immunological changes in children reactive to ≤ 444 mg peanut protein.1 To evaluate this, the team conducted double-blind, placebo-controlled food challenges and randomized 51 children (1:1:1) into 3 arms: oral immunotherapy up to 30 mg (n = 17), oral immunotherapy up to 300 mg (n = 17), and and open-label avoidance (n = 17). The study compared cumulative tolerated peanut protein doses of ≥ 443 and ≥ 1045 mg versus avoidance at 1 year.

The sample had a median age of 10 years (IQR, 7 – 13), 51% males, and an initial cumulative-tolerated dose of 44 mg (IQR 14 – 144). In total, 15 children in the 30 mg group, 12 in the 300 mg group, and 12 in the avoidance group completed the food challenges.

In the intention-to-treat analysis, 13 children in the 30 mg arm tolerated ≥ 443 mg of peanut protein and 7 tolerated ≥ 1043 mg compared with the avoidance arm (P <.001 and P <.007, respectively)). Among the 300 mg group, 10 tolerated ≥ 443 mg of peanut protein and 8 tolerated ≥ 1043 mg compared to the avoidance group (P <.001 and P =.003, respectively). No children in the avoidance group tolerated ≥ 443 mg or ≥ 1043 mg of peanut protein.1

Investigators observed similar sIgE and SIgG4 changes between the 30 mg and 300 mg groups, both signficantly improved over the avoidance group. Moreover, the team observed fewer systemic adverse events in the 30 mg arm vs the 300 mg arm.

“A 30 mg maintenance dose for [peanut oral immunotherapy] significantly increases threshold over strict avoidance, clinically similarly to 300 mg, and may allow for a simplified and safer [oral immunotherapy] regimen and less treatment dropouts,” investigators concluded.1

References

  1. Upton JEM, Rivero DT, Ke D, et al. Peanut oral immunotherapy using 30 mg and 300 mg maintenance doses. J Allergy Clin Immunol Pract. Published online October 16, 2025. doi:10.1016/j.jaip.2025.10.007
  2. Peanut Oral Immunotherapy (OIT). ACAAI Public Website. https://acaai.org/health-care-providers/peanut-oral-immunotherapy-oit/



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