Peanut allergy treatments compared across 19 trials in people
What it found
Combining peanut oral immunotherapy with the drug omalizumab worked best for helping allergic people tolerate peanuts.
Peanut therapy alone caused more side effects than a dummy pill in people.
What they found
Studies in people
Best treatment combination
Peanut therapy combined with omalizumab ranked highest for helping people tolerate small and large amounts of peanut protein. It scored 97.20% for low-dose tolerance and 96.69% for high-dose tolerance in probability rankings.
Probiotics added to therapy
Adding specific probiotics to peanut therapy ranked second for building tolerance. It also showed moderate success in keeping people tolerant after stopping treatment.
Peanut therapy alone
Taking peanut protein by itself improved tolerance but ranked lower than the combination approaches. Longer treatment times led to better results in people.
Omalizumab used alone
Using only the drug omalizumab ranked lowest among the active treatments. It did not significantly help people tolerate large amounts of peanut protein compared to simply avoiding peanuts.
Side effects of therapy
Peanut therapy alone caused more side effects than a dummy pill. However, these events were mostly mild and not linked to serious harm in people.
What the authors conclude
- They suggest that combining peanut therapy with omalizumab may work better than either approach alone for building tolerance.
- They note that adding probiotics could be a lower-cost option that performs similarly to the drug combination.
- They advise that these findings need confirmation through more high-quality trials due to limited data and differences between studies.
How it was done
Peanut allergy can cause severe reactions, and current treatments mainly involve strict avoidance. Researchers wanted to compare different therapies because direct head-to-head trials were lacking.
They combined results from 19 randomised trials involving 2040 people with peanut allergy. The trials tested peanut oral immunotherapy alone, the drug omalizumab alone, both together, or peanut therapy plus probiotics. They looked at how much peanut protein people could eat without serious symptoms and tracked side effects.
What it can’t tell you
- This analysis combines many different trials, so it cannot perfectly predict how one specific person will respond.
- Most studies took place in the United States or Europe, so the results might not apply equally to other populations.
- The exact size of the benefit for the combination therapy might be overstated because very few people in the control groups improved.
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 30 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error