Children only need small daily doses of peanuts to gain protection, study finds

For many families living with peanut allergy, everyday life can feel like walking through a minefield. A crumb on a table, a shared dessert, a mislabeled snack can all trigger fear. Now, new research from The Hospital for Sick Children in Toronto and Montreal Children’s Hospital suggests that children may not need large daily doses of peanut to gain protection. Very small amounts might do the job, with fewer side effects and a treatment schedule that feels more manageable.

In Canada, nearly 2 per cent of children and adults live with peanut allergy. For many of them, strict avoidance is the only strategy, even though a single mistake can cause a serious reaction. Peanut oral immunotherapy, often called peanut OIT, tries to change that reality.

In OIT, a child eats tiny amounts of peanut protein under medical care. The dose increases slowly over time until they reach a regular “maintenance” amount. That daily maintenance dose keeps the immune system trained so it is less likely to overreact to accidental exposure.

Current programs usually aim for higher maintenance doses. Those larger amounts can take months to reach and often bring side effects, such as stomach pain, hives or more serious reactions like anaphylaxis. Some kids hate the taste. Others find the stress of repeated mild reactions too much. Many families stop before finishing.

Researchers wanted to know whether a much smaller amount could still help the immune system learn, while causing fewer problems. If that worked, peanut OIT might become a more realistic option for many more families.

The new study, is the first to directly compare a standard peanut OIT dose with a very low dose in children.

The team enrolled 51 children with confirmed peanut allergy. Each child was randomly placed into one of three groups. One group received low dose treatment that built up to a 30 milligram maintenance dose of peanut protein. A second group received a standard dose that built up to 300 milligrams. The third group continued strict avoidance and did not receive peanut OIT.

All children in the treatment groups started very small and gradually increased their amount until they reached their assigned maintenance dose. They then continued that daily dose for the rest of the study period. At the end, researchers tested how much peanut each child could tolerate before reacting.

Both peanut OIT groups showed clear gains in their reaction threshold compared with the avoidance group. In simple terms, children who ate peanut regularly, at either dose, could handle more peanut than those who avoided it completely. Even the very low dose group did better than avoidance.

The most encouraging result for families is that the 30 milligram maintenance group had fewer side effects than the 300 milligram group. Children on the low dose experienced fewer allergic reactions during therapy and none withdrew from treatment.

“Children who were in the 30mg maintenance group had fewer adverse reactions than the 300mg maintenance group, and none withdrew from treatment,” the authors reported. That detail matters when you think about keeping a child on a plan for months or years.

“This is a small enough dose that even children who do not like the taste can continue treatment,” said co senior author Dr. Thomas Eiwegger, an adjunct scientist in the Translational Medicine program. He added that this is the first time standard doses have been compared with such a low amount, and the true minimum helpful dose might be even smaller than 30 milligrams.

Both treatment groups saw similar gains in how much peanut they could tolerate. That means many children in the low dose group reached a level of protection comparable to those on the higher dose, but with fewer problems along the way.

For the clinicians leading the work, the results are about flexibility and access. “We were excited to find that peanut OIT maintenance doses can be much lower than previously thought and still contribute to positive outcomes,” said co first author Dr. Julia Upton, Head of the Division of Immunology and Allergy at SickKids. “The more options we have, the more we can support patients’ experience and provide meaningful, tailored care.”

A lower maintenance dose also shortens the climb. Children reach their target amount sooner, which means less time spent in clinics for dose increases and observation. That can reduce strain on families and on health systems that already face heavy demand for allergy care.

"Our research team notes that families may use this new knowledge in different ways. Some may choose to stay on very low doses for long periods, accepting a modest safety buffer against accidental exposures. Others might begin with a small dose to build confidence, then slowly increase over time as their child adjusts," Eiwegger told The Brighter Side of News.

“The study found that very small amounts of peanuts, that are associated with less reactions, could be used as effectively as large amounts for oral immunotherapy, making it safer and accessible to more Canadians, even those who are very sensitive to the allergen,” said co senior author Dr. Moshe Ben Shoshan, a pediatric allergy and immunology specialist at Montreal Children’s Hospital.

The authors see this trial as a step toward safer, more practical peanut OIT plans. Larger studies will need to confirm these findings over longer periods and in broader groups. Still, this first head to head comparison suggests that in allergy treatment, as in many parts of life, a little can go a long way.

The study does not claim that children on low dose OIT can freely eat peanuts. Instead, it shows that even tiny daily amounts can raise the level at which a reaction occurs. That higher threshold can turn a life threatening accident into a mild or moderate reaction, or avoid symptoms entirely. For many parents, that shift can ease constant worry and open the door to a more relaxed daily life.

These results suggest that peanut OIT does not have to rely on high daily doses to provide meaningful protection. Very small maintenance amounts, such as 30 milligrams, can raise the reaction threshold and reduce the risk from accidental exposures, while causing fewer side effects. That shift could make oral immunotherapy more appealing to families who worry about safety, taste or time commitment.

Clinics may be able to design simpler, lower dose protocols that require fewer visits and less intensive monitoring. That could expand access in regions with limited specialist care and help more children benefit from OIT. The findings also support a more personalized approach, where dose targets match a family’s goals, tolerance for risk and lifestyle.

For researchers, the trial sets a foundation for exploring even lower doses and longer follow up. Future work can examine how long benefits last, whether protection grows over many years and how low dose OIT compares with other emerging treatments. Insights from this study may also guide similar low dose strategies for other food allergies.

Most importantly, the work moves the field toward therapies that fit into real lives. By showing that “less” can still be effective, the study offers a path to make protection from peanut allergy safer, gentler and within reach for more children.

Research findings are available online in the Journal of Allergy and Clinical Immunology.

Like these kind of feel good stories? Get The Brighter Side of News' newsletter.