A new clinical trial sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) has demonstrated remarkable success in treating children with high-threshold peanut allergies using a simple, home-based approach with store-bought peanut butter. The groundbreaking findings, published in NEJM Evidence, offer hope for an underserved population of food-allergic children.
Novel Treatment Approach for High-Threshold Allergies
The study targeted children who could initially tolerate at least half a peanut, addressing a significant gap in current treatment options. "Children with high-threshold peanut allergy couldn't participate in previous food allergy treatment trials, leaving them without opportunities to explore treatment options," explained NIAID Director Jeanne Marrazzo, M.D., M.P.H.
The trial enrolled 73 children aged 4 to 14 years, randomly assigning them to either receive the graduated exposure therapy or continue peanut avoidance. This research specifically addresses the needs of an estimated 800,000 U.S. children with high-threshold peanut allergies, who previously had no treatment options beyond complete avoidance.
Treatment Protocol and Safety Profile
The intervention group started with just 1/8 teaspoon of peanut butter daily, gradually increasing their dose every eight weeks under medical supervision until reaching one tablespoon. Notably, the safety profile was exceptional - during home dosing, none of the participants required epinephrine for severe allergic reactions, with only one instance of epinephrine use during supervised dosing visits.
Remarkable Success Rates
The results were striking:
- 100% of children in the treatment group successfully tolerated 9 grams of peanut protein (equivalent to 3 tablespoons of peanut butter)
- Only 10% of the avoidance group achieved similar tolerance levels
- 86.7% of treated children maintained their tolerance even after an 8-week peanut avoidance period
- Overall, 68.4% of the treatment group achieved sustained unresponsiveness
Clinical Implications and Future Directions
The study, conducted at the Elliot and Roslyn Jaffe Food Allergy Institute under the leadership of Dr. Scott H. Sicherer and Dr. Julie Wang, represents a significant advancement in food allergy treatment. The success of this accessible, low-cost approach opens possibilities for treating other food allergens using similar protocols.
The CAFETERIA study (Clinical Trial ID: NCT03907397) demonstrates that with proper medical supervision, a straightforward home-based intervention can dramatically improve quality of life for children with high-threshold peanut allergies. While long-term follow-up is still needed to determine the duration of tolerance, these results offer immediate hope for families managing peanut allergies.
