Peanut drops under the tongue in young allergic children
What it found
In 1- to 4-year-old children with peanut allergy, peanut drops placed under the tongue led to far more children tolerating peanut after 36 months than placebo.
Almost half of treated children still tolerated peanut three months after stopping treatment.
What they found
Studies in people
Tolerating peanut after treatment
After 36 months, treated children tolerated a median of 4443 mg of peanut protein compared with 143 mg for placebo. 60% of treated children passed the food challenge versus none on placebo.
Remission after stopping
After 3 months of avoiding peanut, 48% of treated children still passed the food challenge, compared with none on placebo.
Younger children did better
Among treated children, 75% of 1- to 2-year-olds passed the 36-month challenge, falling to 50% in 2- to 3-year-olds and 43% in 3- to 4-year-olds. Remission followed the same pattern.
Immune changes
Treated children had significant drops in peanut skin prick test size and rises in peanut-specific IgG4 and the IgG4/IgE ratio over the study. Placebo children showed no such changes.
Side effects
Oropharyngeal itching was more common with peanut drops (80%) than placebo (28%). Skin, gut, breathing and multi-system symptoms were similar between groups, and no child needed epinephrine for dosing reactions.
What the authors conclude
“Peanut SLIT safely induces desensitization and remission in 1- to 4-year-old children, with improved outcomes seen with younger age at initiation.”
Also in their conclusions
- They conclude that peanut drops under the tongue successfully and safely induced desensitization in most 1- to 4-year-old peanut-allergic children.
- They state that almost half of treated participants also showed remission lasting three months after stopping therapy.
- They advise that larger trials are needed to confirm these findings.
How it was done
Peanut allergy is rarely outgrown and is the food allergy most often linked to fatal reactions. The authors wanted to test whether peanut drops under the tongue could help very young children, since earlier studies hinted that starting treatment younger might work better.
They randomly assigned 50 peanut-allergic children aged 1 to 4 years at two US sites to receive either peanut drops under the tongue or a placebo, with 25 children in each group. Treatment lasted 36 months, followed by a food challenge, then 3 months of peanut avoidance and another food challenge for those who responded.
What it can’t tell you
- The study was small, with 50 children, and many dropped out, so the remission results are less certain.
- It only looked at children aged 1 to 4, so the results may not apply to older children or adults.
- It cannot show whether the treatment prevents accidental allergic reactions in everyday life.
Who paid
- Funding
- Funded by NIAID NIH HHS; NCATS NIH HHS; NCCIH NIH HHS (from the PubMed record).
- Conflicts
- CONFLICTS OF INTEREST. EHK reports advisory board membership with ALK-Abello, Kenota Health, and Ukko Inc; consultancy with AllerGenis, Allergy Therapeutics Ltd, Belhaven BioPharma, Duke Clinical Research Institute, Genentech, Nutricia, and Revolo; and receives grant funding to his institution from the National Center for Complementary and Integrative Health (NCCIH), National Institute of Allergy and Infectious Diseases (NIAID), and Food Allergy Research and Education (FARE). JAB reports consultancy with AllerGenis, Allergy Therapeutics Ltd, Before Brands, DBV Technologies, FARE, Genentech, HAL Allergy, Novartis, and Nutricia; and receives grant funding to his institution from Aimmune Therapeutics, Astellas, DBV Technologies, FARE, Genentech, NIAID, Novartis, Regeneron, and Siolta; CAK is an Associate Editor at the Journal of Allergy and Clinical Immunology; is on the Board of the American Board of Allergy and Immunology; and receives royalties from Up-to-Date. MDK reports consultancy with Ukko, Inc. and receives research support to his institution from NIAID and the US Department of Defense. AWB reports advisory board membership with Aimmune Therapeutics, Consortia TX, and Ukko Inc; consultancy with Allergy Therapeutics Ltd and DBV Technologies; royalties from UpToDate, Elsevier, and Wolter Kluwer; and receives grant funding to his institution from NCCIH, NIAID, FARE, and the Burroughs Wellcome Fund. The remaining authors declare no conflicts of interest.
- Authors work at
- University of North Carolina School of Medicine, NC; University of Texas Southwestern Medical Center, Tex; University of North Carolina at Chapel Hill, NC
The paper
- Title
- Desensitization and remission after peanut sublingual immunotherapy in 1- to 4-year-old peanut-allergic children: A randomized, placebo-controlled trial
- Type
- Randomised controlled trial
- Evidence
- Studies in people
- Summarised from
- Full text
- Cite
- Kim EH, Bird JA, Keet CA, et al (2024). Desensitization and remission after peanut sublingual immunotherapy in 1- to 4-year-old peanut-allergic children: A randomized, placebo-controlled trial. The Journal of allergy and clinical immunology. doi:10.1016/j.jaci.2023.08.032Free full textPubMed 37815782DOI
Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error