A long-term follow-up of the IMPACT trial found 80% (32/40) of children treated with peanut oral immunotherapy (pnOIT) 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.
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 (P <.001 for peanut IgE), suggesting sustained immune modulation rather than a transient treatment effect.¹
Predictive Biomarkers and Remission Testing Remain Unanswered
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.
Continued Allergist Involvement Advised
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.
Read more from this interview series:
Part 1: Early-Life Peanut OIT's Decade-Long Benefit, With Jennifer Dantzer, MD2
Part 2: Peanut OIT Long-Term Reaction Risk, Remission, and Biomarkers3
Dantzer has no reported disclosures.
References
Dantzer JA, Virkud YV, Cox AL, et al. Early life peanut oral immunotherapy associated with long-term ingestion and immunologic changes. J Allergy Clin Immunol. Published online May 20, 2026. doi:10.1016/j.jaci.2026.05.009
