By Basant El-Faramawy
A landmark Australian study has found that more than a third of infants suspected of having a peanut allergy may not actually be allergic, potentially sparing hundreds of children from unnecessary dietary restrictions and treatment.
Study details and findings
Researchers from the National Allergy Centre of Excellence (NACE) partnered with 10 pediatric public hospitals across Australia to assess 1,275 infants under 18 months old. Over 750 children underwent an oral food challenge, receiving increasing doses of peanut under medical supervision to test for allergic reactions.
The study, published in the Journal of Allergy and Clinical Immunology: In Practice, showed that 35 percent of infants with a recent reaction to peanuts and a positive allergy test did not react during the food challenge. These children were deemed peanut tolerant and could have their allergy label removed.
Among the remaining 65 percent who did react, 12 percent experienced anaphylaxis, though all episodes were safely managed by medical teams. Those with confirmed allergies were started on peanut oral immunotherapy, with about 97 percent successfully beginning treatment at doses guided by their challenge results.
Implications for diagnosis
“Oral food challenge should be routinely considered in infant peanut allergy evaluation,” the researchers wrote. Tim Brettig, senior author of the study from the Murdoch Children's Research Institute in Victoria, said identifying non-allergic children early allows them to avoid an unnecessary allergy label and the burden of avoiding peanuts.
NACE director Kirsten Perrett emphasized that clinical history and allergy testing alone were not enough to accurately diagnose peanut allergy in many cases. She said a supervised oral food challenge should be routinely considered to confirm the diagnosis before an infant starts oral immunotherapy.
Context
Peanut allergy is the most common food allergy, affecting up to three percent of children in Western nations. Australia has the highest reported rates of childhood food allergies globally, with peanut allergy affecting about one in 30 children. The condition can cause symptoms ranging from mild hives to life-threatening anaphylaxis.
