Peanut allergy treatments compared across 19 trials
What it found
In people with peanut allergy, combining omalizumab with oral immunotherapy ranked highest for helping them tolerate peanut, while oral immunotherapy alone caused more side effects than placebo.
What they found
Studies in people
Low-dose tolerance
All four active treatments helped more people tolerate at least 250 mg of peanut protein than placebo or avoidance. Omalizumab plus oral immunotherapy had the highest chance of being the best option.
High-dose tolerance
Omalizumab plus oral immunotherapy, oral immunotherapy, omalizumab and probiotics plus oral immunotherapy all helped more people tolerate at least 4000 mg of peanut protein than placebo. Omalizumab alone lost this effect when compared with peanut avoidance.
Lasting tolerance
Oral immunotherapy and probiotics plus oral immunotherapy both helped more people stay reaction-free after treatment stopped, compared with placebo. Neither showed a clear advantage over peanut avoidance.
Side effects
Oral immunotherapy alone was linked to more side effects of any grade than placebo. There were no clear differences between treatments in serious side effects, adrenaline use or a throat condition called eosinophilic esophagitis.
Young children
In children aged 1 to 5, both probiotics plus oral immunotherapy and oral immunotherapy helped more children tolerate peanut than placebo or avoidance. Probiotics plus oral immunotherapy ranked slightly higher, but that evidence came mainly from one trial.
Treatment length
Longer oral immunotherapy treatment was linked to better tolerance of peanut. In studies lasting 9 months or less, omalizumab alone ranked higher than oral immunotherapy for low-dose tolerance, though the difference was not statistically significant.
What the authors conclude
“This network meta-analysis suggests that OIT + OMA may offer greater efficacy in achieving desensitization compared to OIT or OMA alone.”
Also in their conclusions
- They say omalizumab plus oral immunotherapy may work better than either treatment alone for helping people tolerate peanut.
- They note that probiotics plus oral immunotherapy performed about as well as omalizumab plus oral immunotherapy, suggesting probiotics could be a cheaper alternative.
- They call for more high-quality trials to confirm these comparisons and check long-term outcomes.
How it was done
Several treatment options exist for peanut allergy, but there are few head-to-head trials comparing them directly. The authors wanted to work out which approach works best.
They pooled 19 randomised controlled trials covering 2,040 people with IgE-mediated peanut allergy. The trials tested omalizumab plus oral immunotherapy, omalizumab alone, oral immunotherapy alone, or probiotics plus oral immunotherapy, against placebo or peanut avoidance.
What it can’t tell you
- The trials used different treatment schedules, doses and lengths, so the pooled results may not apply to any single real-world plan.
- Most trials took place in the United States or Europe, so the findings may not hold for people in other regions.
- The authors say some effect estimates were based on very few studies and few participants, so the size of the benefit may be overestimated.
Who paid
- Funding
- Funded by Peking Union Medical College Hospital Talent Cultivation Program (Category D); the National Natural Science Foundation of China under Grant (from the PubMed record).
- Conflicts
- Declarations. Ethical Approval: Ethical approval was not required for this study, as it is a network meta-analysis based on previously published data. Conflict of Interest: The authors declare no competing interests.
- Authors work at
- Peking Union Medical College Hospital, People's Republic of China
The paper
- Title
- Comparative Efficacy of Combined and Standalone Oral Immunotherapies for Peanut Allergy: a Bayesian Network Meta-Analysis of RCTs
- Type
- Study
- Evidence
- Studies in people
- Summarised from
- Full text
- Cite
- Tian X, Liu S, Li L, Guan K (2025). Comparative Efficacy of Combined and Standalone Oral Immunotherapies for Peanut Allergy: a Bayesian Network Meta-Analysis of RCTs. Clinical reviews in allergy & immunology. doi:10.1007/s12016-025-09118-2Free full textPubMed 41460610DOI
Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error