New research reveals that many children with low-risk peanut allergies may naturally outgrow them without treatment, prompting experts to rethink diagnostic approaches and potentially save thousands of families from unnecessary interventions.
At a Glance
- Two-thirds of children with peanut allergies remain allergic by age 10, but most who outgrow it do so by age six
- Changes in specific antibody levels (sIgG4 and sIgE) can help predict which children will naturally outgrow their peanut allergy
- Nearly 70% of children with low-risk peanut allergy can actually tolerate peanuts during oral food challenges
- New research suggests doctors should consider testing low-risk allergic children before starting intensive treatments
The Natural Resolution of Peanut Allergies
Peanut allergies affect approximately 2% of children in the United States, often causing significant anxiety for families navigating daily life with the risk of potentially life-threatening reactions. However, groundbreaking research is changing our understanding of how these allergies progress over time. A recent study following 156 infants with confirmed peanut allergies through ages four, six, and ten discovered that while two-thirds remained allergic by age ten, those who outgrew their allergy typically did so by age six. This natural resolution pattern provides valuable insight for both medical professionals and parents about when intervention might be most appropriate.
Researchers identified specific antibody patterns that can help predict which children are likely to outgrow their allergies naturally. By measuring changes in antibody levels, specifically sIgG4 and sIgE, doctors may soon be able to identify children who could resolve their peanut allergies without intensive treatments. This breakthrough could significantly reduce unnecessary medical interventions and the associated psychological burden on families.
Rethinking Diagnosis Before Treatment
Perhaps the most surprising finding comes from research at the University of Michigan, where Dr. Kelly M. O’Shea and colleagues discovered that nearly 70% of children classified as having “low-risk” peanut allergies actually tolerated peanuts during an oral food challenge. The criteria for low-risk included having a history of allergic reaction without anaphylaxis, a skin prick test wheal diameter less than 8 mm, and peanut serum immunoglobulin E levels below 5 kU/L. This revelation suggests many children may be unnecessarily diagnosed and treated for peanut allergies they don’t actually have or that would resolve naturally.
Babies with peanut allergies in Australia will now have access to a potentially life-saving treatment in a new program considered to be a world first.
As a treatment, affected infants will receive daily doses of peanut powder under a doctor’s supervision over two years.
The hope… pic.twitter.com/TD4HhlKTQv— CGTN America (@cgtnamerica) August 6, 2024
The findings have prompted experts to recommend offering peanut oral food challenges to children with low-risk markers before initiating treatments like oral immunotherapy. This approach could prevent unnecessary treatments while ensuring children receive appropriate care based on their actual allergy status rather than overly cautious assumptions. For parents navigating the complex world of food allergies, this could mean significantly less anxiety and lifestyle restriction for many families.
Treatment Advances for True Peanut Allergies
For children who do have confirmed persistent peanut allergies, treatment options have significantly advanced in recent years. The FDA-approved oral immunotherapy product Palforzia gradually exposes children to increasing amounts of peanut protein to build tolerance. Additionally, a National Institutes of Health clinical trial found that peanut oral immunotherapy safely desensitized most highly peanut-allergic children aged 1 to 3 years, with one-fifth achieving remission—defined as the ability to consume 5 grams of peanut protein without an allergic reaction six months after completing therapy.
The research consistently shows that younger children and those with lower initial levels of peanut-specific antibodies are more likely to achieve remission, highlighting the importance of early intervention for those who truly need it. Long-term studies of treatments like the VIASKIN® peanut patch also demonstrate increasing benefits over time, providing hope for families managing severe peanut allergies that cannot resolve naturally. These targeted approaches represent a significant improvement over the traditional management strategy of strict avoidance.
The Impact on Quality of Life
Managing food allergies takes a significant psychological toll on children and families. Research indicates that children with food allergies experience higher rates of anxiety and bullying than their peers. The prospect of avoiding unnecessary treatment has implications beyond physical health. For parents like Vivienne Lai, whose child tested positive for multiple allergens, the emotional impact is profound. “She initially was able to tolerate these foods, so it was a huge shock when the allergy test came back positive for so many different allergens,” Lai explains, highlighting the life-altering nature of allergy diagnoses.
By improving diagnostic accuracy and identifying children who may outgrow their allergies naturally, healthcare providers can better allocate resources and reduce unnecessary anxiety for families. The evolving approach to peanut allergy management represents a more nuanced, individualized strategy that promises better outcomes and improved quality of life for the millions of families affected by this condition.
