- Over a third of infants with suspected peanut allergies did not react to peanut in an oral food challenge, according to a new study.
- The researchers say a history of a reaction or a positive test may not be enough to diagnose peanut allergy.
- They suggest that an oral food challenge can help avoid unnecessary treatment and food restrictions.
- However, it should be done under medical supervision to ensure safety.
Peanut allergies have been on the rise in recent decades.
In fact, having a history of reacting to peanuts and positive allergy testing on their own may not be sufficient to diagnose a peanut allergy for many infants.
The study’s authors suggest that a threshold oral food challenge — in which the child is given increasing amounts of the suspected food allergen under medical supervision to look for an allergic reaction — should be routinely considered to help confirm peanut allergy.
This additional testing could safely prevent children who are not allergic to peanuts from undergoing unnecessary treatment with oral immunotherapy.
It could also spare families from burdensome food restrictions and allergy precautions.
The researchers’ goal was to evaluate the accuracy and safety of the Allergy Development to an Accelerated Path to Tolerance (ADAPT) peanut oral immunotherapy program, which was established in 2024 at 10 public children’s hospitals across Australia.
This program provides a standardized approach to evaluating and treating infants with suspected peanut allergies.
The study included infants who had experienced a mild to moderate reaction to peanut before 12 months of age and had evidence of peanut sensitization through allergy testing.
Researchers reviewed medical records to examine how accurately the program’s approach identified peanut allergies and whether it could safely guide treatment.
A key part of the evaluation was a threshold oral food challenge. The challenge involved up to seven doses, ranging from 15 to 1,300 milligrams of peanut protein.
Medical teams monitored the infants for reactions and provided treatment when necessary.
Researchers reviewed records from April 2024 through October 2025. During that period, 1,275 infants were assessed through the program, and 778 underwent an oral food challenge.
The researchers also examined allergy test results and whether infants who reacted during the challenges could begin oral immunotherapy at an appropriate starting dose.
At the time of the oral food challenge, the infants had a median age of 13 months.
Of the 778 infants who underwent an oral food challenge, 507 (65.2%) had an allergic reaction.
However, 271 (34.8%) did not react to peanut during the supervised test, despite having a history of a previous reaction and positive allergy test results.
These findings suggest that relying on medical history and allergy tests alone may lead some infants to be labeled with a peanut allergy when they can actually tolerate the food.
Among the infants who reacted during the challenges, 61 experienced anaphylaxis, a severe allergic reaction that can affect breathing and blood pressure. This represented 12% of infants with a positive challenge and 7.8% of all infants who underwent testing. Medical teams safely managed these severe allergic reactions.
Researchers also found that infants who reacted to peanut generally had higher skin prick test results and Ara h 2-specific IgE levels than those who did not react.
However, these test results did not reliably indicate how much peanut would trigger a reaction or how severe that reaction would be.
Of the 394 infants who began peanut oral immunotherapy, 384 (97.5%) successfully started treatment at a dose below the amount that had triggered a reaction during their food challenge.
The researchers say these findings support considering supervised oral food challenges to confirm suspected peanut allergies before starting treatment or recommending long-term avoidance.
Erin Banta, MD, a board certified allergist and immunologist who treats both children and adults at Latitude Food Allergy Care in Great Neck, New York, said these findings are significant because they provide evidence for early use of oral food challenges in infants with peanut reactions.
“In those with mild-moderate prior reactions to peanut, early oral food challenge may allow for either delabeling of food allergy (in 1/3 of the patients in this study) or diagnosis of food allergy,” she told Healthline.
Banta, who wasn’t involved in the study, added that early delabeling takes a significant burden off the patient and their family.
“On the other hand,” she explained, “early diagnosis allows for early initiation of treatment with oral immunotherapy at a time in the patient’s life associated with the greatest success rates.”
Banta further noted that the study offers different pathways for oral immunotherapy based on the patient’s reaction threshold. This means that some patients may be able to complete treatment more quickly due to their individual threshold dose.
Lindsey Forstie, FNP, a family nurse practitioner with clinical training and experience in allergy and asthma care at Carefree Allergy in Phoenix, AZ, added that while further evaluation may be needed to confirm a peanut allergy diagnosis, it’s important for parents not to try introducing peanuts at home.
“Instead, they should speak with their pediatrician or allergist about appropriate testing and whether a supervised food challenge is safe and necessary,” she said.
According to Forstie, who was also not part of the study, the goal is to avoid unnecessary food restrictions while also keeping children safe.
“The key message is that not every positive allergy test means a child has a food allergy,” she told Healthline. “Accurate diagnosis helps protect children while allowing those who are not allergic to enjoy a more normal, less restrictive diet.”
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