Peanut Allergy Treatment
At a Glance: Peanut Allergy Treatment
- Treatment goals: Peanut allergy treatments help desensitize the immune system and reduce the risk of a severe allergic reaction after accidental peanut exposure. They are designed to increase tolerance to peanut but are not a cure.
- Types of peanut allergy immunotherapy. Treatment options include oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT, or the peanut patch). OIT is available through some allergists, while SLIT and EPIT remain investigational and are not FDA-approved.
- Biologic therapy. Xolair® (omalizumab) is FDA-approved for adults and children ages 1 year and older with one or more IgE-mediated food allergies. It helps reduce the risk of allergic reactions after accidental exposure but does not cure peanut allergy.
- Who may benefit. Peanut allergy treatment is not right for everyone. Your allergist can help determine whether immunotherapy is appropriate based on your age, allergy history, risk of accidental exposure, treatment goals, and lifestyle.
- Safety is essential. People receiving peanut allergy treatment must continue to avoid peanuts, carry epinephrine, and follow their allergist’s treatment plan. Never attempt peanut allergy immunotherapy on your own.
- Early introduction helps prevent peanut allergy. Research shows that introducing peanut-containing foods during infancy, when appropriate and guided by current recommendations, has helped reduce the number of children who develop peanut allergy.
Peanut allergy is one of the most common food allergies in the United States. It is estimated that 6.2 million people, including 1.5 million children, have peanut allergy in the United States.
Peanut allergy treatments and therapies are available to help people with peanut allergy. It is available for adults and most children. Peanut allergy immunotherapy is not for everyone with peanut allergies. Work together with an allergist or food allergy specialist to determine if it is right for you.
The good news is that with adoption of early allergen introduction, peanut allergies may be declining. Recent research has shown decreased rates of peanut allergy (and other food allergies) since early introduction became part of national guidelines.
What is Peanut Allergy Immunotherapy?
Peanut allergy immunotherapy is a treatment that focuses on building tolerance to peanut. It desensitizes the body to the allergen.
Peanut allergy immunotherapy is available in two ways:
- oral immunotherapy (OIT)
- sublingual immunotherapy (SLIT)
A third type of immunotherapy is epicutaneous immunotherapy (EPIT). This is still in development and not yet available.
Peanut allergy immunotherapy is a treatment, not a cure. It is designed to reduce the frequency and severity of allergic reactions. This includes life-threatening anaphylaxis.
OIT should only be done in a medical setting. Emergency treatment should be available in case of an allergic reaction to immunotherapy. Do NOT attempt peanut allergy immunotherapy on your own.
Considering Peanut Allergy Treatment? What Parents and Patients Need to Know
Stephanie Polk’s daughter Olivia has lived with peanut allergy since she was 2 years old. Olivia has successfully avoided peanut, but that could change as she begins middle school. Stephanie worries the potential for exposure could increase in a new environment.
Has Stephanie considered peanut allergy immunotherapy as a treatment option?
“It’s on my mind,” she says. “I have anxiety about exposing Olivia to her food allergen. We’ll wait to see how the school handles it and talk with teachers and the school nurse about the level of risk. The only way she would have peanut is if she were to eat someone else’s snack or there’s a school party with food. Olivia is pretty smart and careful about what she eats.”
Peanut allergy immunotherapy should be done by allergists with expertise in food allergy. Be sure to ask your allergist about their experience and training with OIT. Find out what steps are taken to maximize safety.
The decision to consider peanut allergy treatment is often a very personal one for families.
What Types of Peanut Allergy Immunotherapy are Available?
Peanut allergy OIT is the most common peanut allergy treatment. Other products and methods of peanut allergy immunotherapy are being studied. These are not approved by the U.S. Food and Drug Administration (FDA).
Oral immunotherapy (OIT)
OIT starts with giving a tiny amount of peanut protein, then gradually larger amounts until a target dose is reached. The patient then stays on that dose indefinitely. Building up peanut exposure desensitizes the patient to higher doses of peanut protein. Maintaining the dosing allows for continued tolerance.
Peanut allergy OIT is currently only available as an office-based treatment from allergists who specialize in this therapy. The allergist prepares a non-pharmaceutical grade peanut OIT product using specific evidence-based protocols for use in the therapy. While not FDA-approved, office-based products have shown proven benefits for many patients.
The U.S. Food and Drug Administration (FDA) approved a peanut allergy OIT product called Palforzia® for children ages 1-17, but it has been discontinued. The manufacturer, Stallergenes Greer, said the discontinuation was a business decision. It was not related to the product’s safety, quality, or effectiveness. People who used Palforzia should talk with their allergists about other options.
Sublingual immunotherapy (SLIT)
SLIT is another form of peanut allergy therapy. It is currently an investigational treatment and is not FDA approved.
SLIT involves placing drops of peanut protein extract under the tongue for 2 minutes before swallowing. It is taken every day. This helps train the immune system to become less sensitive to peanut over time. SLIT is not a peanut allergy cure. Studies suggest it may reduce the risk of a severe reaction from accidental peanut exposure. More research is needed to prove it is safe and effective.
SLIT is only available for patients as an office-based treatment by allergists who know how to make the liquid drops. It may also be available in food allergy research centers.
Epicutaneous immunotherapy (EPIT)
Researchers are evaluating Viaskin™ Peanut (DBV Technologies) as another type of peanut allergy treatment. It is commonly referred to as the “peanut patch.” The product is not FDA-approved. Researchers are compiling data to support the patch’s effectiveness.
Viaskin Peanut involves attaching an adhesive patch to the skin. The patch contains a tiny dose of peanut allergen – approximately 1/1000 of a peanut on it. Because the dose of allergen on each patch is so small, this approach is often well tolerated by patients. Many can increase their threshold of peanut exposure and avoid an allergic reaction.
Viaskin Peanut works by desensitizing patients to peanut and increasing tolerance. It offers increased protection from an accidental exposure. The patch is a treatment that requires close supervision by a healthcare provider.
Can Biologic Medications Treat Peanut Allergy?
Omalizumab (Xolair®) is the first biologic medication approved by FDA as a food allergy therapy. It was approved in February 2024. Xolair is indicated for adults and children ages 1 year and older with food allergy. It’s given as an injection every 2-4 weeks.
Xolair is an anti-IgE medication. This means it blocks the Immunoglobulin E (IgE) antibody which is a driver of food allergy reactions. Reducing IgE levels can help keep the body from reacting to an allergen. The biologic allows people with peanut allergy to better tolerate an accidental exposure to peanut. It can also reduce the risk of an allergic reaction.
Xolair is not a cure for food allergy. People taking the medication as a food allergy therapy must still avoid their food allergen(s). They should continue to carry and use epinephrine in case of a severe allergic reaction.
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How do I Determine If Peanut Allergy Immunotherapy Is Right for Me or My Child?
Allergists can work together with you to make sure peanut allergy OIT is a shared decision. Your decision should be evidence-based, not fear-based.
Several factors can play a role in the decision:
- How have you or your child fared with strict avoidance of peanut?
- What is the risk of exposure?
- How severe are the allergic reactions to peanut?
What Age Can Children Undergo Peanut Allergy Immunotherapy?
In some cases, children as young as 1 year old may be eligible for immunotherapy. Talk with an allergist who specializes in peanut allergy immunotherapy to learn about the treatment options for your child.
How Do I Find Accurate Information About Peanut Allergy Immunotherapy?
When considering food allergy immunotherapy, it’s important to make sure you find trustworthy, credible information.
With food allergy, there is so much information available, and just as much misinformation. When you add food allergy treatment options such as immunotherapy, you may wonder: How do I make a decision about this?
Your first source for accurate information is your allergist or a healthcare professional knowledgeable in immunotherapy. Ask questions. Talk about your concerns or uncertainties.
If you’re like most people, you search for health news and information online. As you do this, ask yourself: what online resources am I using and what websites am I going to? Are my sources of information trustworthy and credible? What social media platforms do I visit and are they trustworthy?
Getting good solid information is the first step to making a decision that is best for you and your family.
How Do I Evaluate the Pros and Cons of Peanut Allergy Immunotherapy?
Most people living with a food allergy simply want protection against accidental exposure. If this is you, talk with your allergist about the pros and cons of peanut allergy immunotherapy. Determine whether benefits outweigh the risks. Find out about any potential side effects.
For some, peanut avoidance is most appropriate and preferred. These patients must have an anaphylaxis emergency plan in place. They should also carry epinephrine with them in case of an accidental exposure.
Ask yourself, ‘What are my goals with food allergy immunotherapy? Why do I want to pursue this?’ When you focus on the why, all the processes and procedures may become clear to you. And your decisions may start to fall into place.
Unsure about peanut allergy OIT even after consulting with an allergist? Talk with a patient who recently underwent peanut allergy OIT. Another perspective may help with your decision-making.
Reviewed by:
Ashwin K. Shankar, MD, is a double board-certified pediatric and adult allergist/immunologist practicing in Dallas. A state and national speaker, mentor, consultant, advisor, and published author, he is dedicated to advancing evidence-based allergy and immunology care through patient education, advocacy, health equity, and innovation. Dr. Shankar is passionate about expanding access to high-quality care while mentoring the next generation of allergy and immunology professionals.
