Peanuts are known to cause one of the most severe reactions in children with food allergies. Current estimates show between 2 percent and 5 percent of school-age children in the U.S. have a peanut allergy, while food allergies among children have been shown to increase for decades.
Now, a promising new treatment that gradually introduces some children to store-bought peanut butter in a controlled medical setting could help treat peanut allergies, according to a recent study published in the New England Journal of Medicine Evidence.
“Children with high-threshold peanut allergy couldn’t participate in previous food allergy treatment trials, leaving them without opportunities to explore treatment options,” said Jeanne Marrazzo, National Institute of Allergy and Infectious Diseases director in a press release. “[The] report focuses on this population and shows that a very safe and accessible form of therapy could be liberating for many of these children and their families.”
Childhood Peanut Allergies
A food allergy is caused by a person’s immune system thinking that an allergen, typically a food protein, is a threat and attacks it, resulting in an allergic reaction. Among the most severe of food allergies are those involving peanuts, many of which can cause anaphylactic shock, possibly leading to hospitalization or even death.
“Food allergy prevalence among children has been increasing for decades, up by 50 percent between 1997 and 2011, and again up by 50 percent between 2007 and 2021,” wrote the nonprofit research and advocacy group Food Allergy Research & Education (FARE). “In the United States, the prevalence of self-reported peanut or tree nut allergy in children more than tripled between 1997 and 2008.”
Peanuts are one of eight allergens the government requires to have specific labeling requirements under the Food Allergen Labeling and Consumer Protection Act of 2004. Under the law, packaged food manufacturers are required to label products that contain peanut as an ingredient.
Peanut and other food allergies are described as a “considerable burden to children and families worldwide,” not only for their potential health risks, but for the mental and emotional stress allergies create. A meta-analysis of existing scientific literature presented in February 2025 found that oral immunotherapy can improve the quality of life of children and families experiencing food allergies.
“Because of the prevalence of peanut allergies in the U.S. and the strong reactions that some people have to peanuts – including anaphylaxis – oral immunotherapy is a major area of focus,” says Justin Cole, director of Ohio’s Cedarville University Center for Pharmacy Innovation, who was not involved in the study.
Read More: Everything to Know About Allergies
Oral Immunotherapy for Peanut Allergies
Oral immunotherapy is a treatment for food allergies that the American Academy of Allergy, Asthma and Immunology described as feeding the allergic person “an increasing amount of an allergen with the goal of increasing the threshold that triggers a reaction.”
To test this therapy in children with peanut allergies, medical researchers at Mount Sinai Kravis Children’s Hospital in New York gradually exposed children with high-threshold or a less severe peanut allergy, meaning they could tolerate at least a half-peanut.
After 18 months of gradual exposure, every child in the study could eat up to three tablespoons of peanut butter without having an allergic reaction. The researchers highlight that this treatment is not suitable for the 800,000 U.S. children who have a high-threshold or severe allergy to peanuts – they should continue to avoid peanuts entirely.
Researchers split 73 participating children between four and 14 years old into two groups, one that would receive gradually increased doses of peanut butter and another that would avoid peanuts entirely.
Children in the exposure group began with an eighth teaspoon of peanut butter daily, increasing the serving size every eight weeks. Dose increases were done under medical supervision and should not be replicated in at-home treatments without a professional.
Every child exposed to peanut butter could tolerate about three tablespoons after 18 months of controlled exposure, according to the recent study.
Accessible Treatment Option
The study offers the potential for a relatively inexpensive and accessible treatment for children with high-threshold allergies, but the therapy should not be recreated at home, experts warn.
Not every peanut butter is created alike, and there may be different amounts of peanut protein in a tablespoon of peanut butter. “We can’t assume that someone can go buy any peanut butter off the shelf and give it to their child,” says Cole, highlighting that “every single dose increase was done in an office with the research team so that the child could be evaluated for potential reactions.”
The study was small with just 73 participants, and the follow-up period to determine long-term tolerance was not long.
“It wasn’t a huge number of patients, but the difference in the outcomes between the two groups was really quite striking, showing that it seemed like the majority of the patients who did get exposed, were able to get to a point where they were able to tolerate it, whereas the patients who avoided it for several weeks, when they reintroduced it, they immediately again had another reaction,” says John Ligon, a pediatrician at the University of Florida’s Division of Hematology and Oncology who was not involved in the study.
Read More: Allergies are Common Today, but Did They Also Impact Our Ancient Ancestors?
Not a Standard for Care
Around 60 percent of children had a durable response, meaning that they did not have an allergic reaction when exposed to peanuts later. However, that still means that about 40 percent did have some reaction. It’s also unclear to what extent children had maintenance dosing, which would continue exposure to peanut allergens.
“What we know about peanut oral immunotherapy, which again is fairly new, is that it typically requires ongoing maintenance dosing to sustain its benefits. If the therapy is stopped, it’s possible that the desensitization effects that they’ve gained can gradually wear off, and the individual may become sensitive to peanuts again,” says Cole.
Beyond increasing tolerance to certain allergens, oral immunotherapy presents an opportunity to reduce anxiety for families because they don’t have to worry about accidental exposure possibly causing a severe reaction, adds Cole.
“It’s a huge mental burden for the parents with kids with serious food allergies, where they really can’t just go shopping for the things that they want to cook; they really have to spend time reading those food labels, and it just adds a huge mental toll,” says Ligon.
But even though oral immunotherapy is gaining traction as a potential treatment for food allergies, Cole says it is not yet considered a standard of care.
For families curious about oral immunotherapies, Ligon recommends reaching out to an allergist who can facilitate allergen introduction in a controlled environment.
This article is not offering medical advice and should be used for informational purposes only.
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Madison’s reporting focuses on marine and environmental issues, climate change, and novel scientific discoveries related to health and technology. Raised on an island in southeast Alaska, Madison is now based in western Montana. Her writing has been featured in Time, Snopes, Business Insider, Mountain Journal, EcoWatch, and Alaska Magazine, among others. When not writing, Madison teaches yoga, raises chickens, and fosters adoptable dogs and cats.
