Peanut drops under the tongue for allergy in young children
What it found
Daily peanut drops placed under the tongue helped most allergic children aged one to four tolerate much more peanut protein after three years.
Nearly half kept that protection three months after stopping treatment.
What they found
Studies in people
Tolerating more peanut protein
After 36 months, children getting peanut drops could handle a median of 4443 mg of peanut protein during testing. The placebo group handled only 143 mg. Sixty percent of the treated children passed the full test compared to none on placebo.
Protection after stopping treatment
Children who passed the 36-month test stopped the drops for three months. Forty-eight percent of the treated children still passed the test after this break. No one in the placebo group did.
Younger children did best
The youngest children had the highest success rates. Among one- to two-year-olds getting peanut drops, 75% became desensitized and 58% stayed protected after the break. Rates were lower in the older groups.
Changes in allergy markers
Blood tests showed shifts in allergy-related proteins over time in the treated children. Skin prick reactions to peanut also shrank. These changes did not happen in the placebo group.
Mouth itching was common
Eighty percent of children getting peanut drops reported mouth itching compared to 28% on placebo. Other side effects like stomach, skin, or breathing problems were about the same in both groups. No child needed epinephrine for dosing symptoms.
What the authors conclude
- They conclude that placing peanut liquid under the tongue safely helped young allergic children tolerate more peanut protein.
- Their results suggest starting this treatment between ages one and two leads to the best outcomes.
- They call for larger trials to confirm these findings in young children.
How it was done
Peanut allergy usually starts early in life and is rarely outgrown, causing stress for families who must avoid it completely. Earlier work suggested that giving tiny amounts of peanut under the tongue might work better when started at a younger age.
Fifty children with peanut allergy, aged one to four, were randomly given either daily peanut liquid or a dummy liquid under the tongue for 36 months. After three years they were tested to see how much peanut protein they could eat without a reaction. Those who passed stopped treatment for three months and were tested again.
What it can’t tell you
- This trial involved only 50 children across two sites, so the results may not apply to all children with peanut allergies.
- The study followed children for three years of treatment and three months off, so scientists do not yet know if the protection lasts longer than that.
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 30 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error