Is It Time to Offer Peanut Oral Immunotherapy to Toddlers?

Approximately 8% of children in the United States have any food allergy, and approximately 2% of all children are allergic to peanut.1 Peanut allergy accounts for the greatest number of fatalities due to food allergy.2 Food allergy is associated with diminished patient and parent health-related quality of life including increased food anxiety, social limitations, and emotional distress.3 Lower eliciting doses for peanut are directly associated with lower health-related quality of life, likely due to the greater risk for reactions due to accidental ingestions.3 The current standard of care for treatment of peanut allergy at any age is to recommend strict dietary avoidance and educate patients and their families on how to treat an allergic reaction should an accidental exposure occur. Reaction histories were based on a graded scale from grade 1 (mild), grades 2 and 3 (moderate), and grades 4 and 5 (severe).6 Children had to have an objective history of reaction to peanut during an optional baseline oral food challenge (OFC) to a cumulative dose of