A world-first national peanut allergy treatment program in Australia has revealed that more than a third of infants with a history of reacting to peanut and positive allergy tests were found to tolerate peanut during medically supervised food challenges. According to findings published in The Journal of Allergy and Clinical Immunology: In Practice, 35% of challenged infants showed no allergic reaction, allowing their suspected peanut allergy label to be removed and potentially sparing families years of unnecessary avoidance and anxiety.
The research stems from an evaluation of the ADAPT Peanut Oral Immunotherapy Program, launched in 2024 by the National Allergy Centre of Excellence (NACE), hosted at the Murdoch Children’s Research Institute (MCRI). ADAPT is the first peanut allergy treatment program offered in Australian public hospitals for infants outside a traditional clinical trial setting. The study assessed 1,275 infants under 18 months of age across five Australian states, with 778 undergoing an oral food challenge.
During an oral food challenge, infants are given gradually increasing doses of peanut protein under close medical supervision to monitor for signs of an allergic reaction. The 35% who showed no reaction were considered peanut-tolerant at the time of testing. This allowed families to move beyond a suspected allergy diagnosis and introduce age-appropriate peanut-containing foods, such as smooth peanut butter, into their children’s regular diets under medical guidance.
Dr Tim Brettig, MCRI Population Allergy Group Senior Research Clinician and ADAPT Medical Lead, emphasized the importance of confirming an allergy before committing families to prolonged, potentially life-altering precautions. “We found more than one third of infants who were suspected to have peanut allergy based on their history and initial tests no longer reacted when they underwent a supervised food challenge,” Brettig noted. “Being able to identify those children early allows them to avoid an unnecessary allergy label and the burden of avoiding peanut.”
For the 65% of infants who reacted during testing, the supervised hospital environment allowed medical teams to provide immediate treatment when necessary. Anaphylaxis, a potentially life-threatening allergic reaction, was reported in 12% of challenged infants, with all reactions successfully managed by clinical teams. Importantly, the diagnostic challenges also helped establish an appropriate path forward: 97.5% of infants who reacted successfully began oral immunotherapy, a treatment involving carefully controlled daily doses of peanut protein that are gradually increased under medical guidance to reduce sensitivity to the allergen.
These findings could influence how suspected peanut allergies are diagnosed in infants, particularly in Australia, where peanut allergy affects approximately one in 30 children. Professor Kirsten Perrett, MCRI Population Allergy Group Leader, NACE Director, and ADAPT Program Lead, emphasized the need to reconsider current diagnostic practices. “Oral food challenges are not currently used routinely for every infant with suspected peanut allergy,” Perrett explained. “But our results show that clinical history and allergy testing alone were not enough to accurately diagnose peanut allergy in many cases. A supervised oral food challenge should be routinely considered to confirm the diagnosis before an infant starts oral immunotherapy.”
The study underscores that although skin-prick and blood tests are valuable diagnostic tools, positive results do not always indicate a clinical allergy. Without confirmation, some families may unnecessarily avoid peanut and experience significant anxiety. As Professor Perrett summarized, “With peanut allergy one of the most common childhood food allergies, it’s particularly important that we have an accurate diagnosis when a baby first shows signs of a possible peanut allergy. We want to reduce the burden of food allergy for children and their families, and the ADAPT Program is a step in this direction.”
Researchers stress that oral food challenges must be conducted under appropriate medical supervision because serious allergic reactions, including anaphylaxis, can occur. Parents who suspect their infant has a peanut allergy should consult their pediatrician or an allergy specialist rather than attempting to confirm or rule out an allergy through peanut exposure at home.
