Oral food challenges and oral immunotherapy offer hope and confidence for families managing food allergies in young children

(Press-News.org) ORLANDO (Nov. 6, 2025) – Two new studies being presented at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Orlando shine a spotlight on oral immunotherapy and oral food challenges (OFCs) in children, showing that both procedures are safe for young patients and can be life-changing for families navigating food allergies.

In one study, researchers explored how oral immunotherapy (OIT) – which relies on supervised oral food challenges to gradually desensitize children to the foods to which they are allergic – affects quality of life. Seventy-four children ages 0–12 underwent OIT between 2020–2022, targeting allergens such as peanut, tree nuts, sesame, egg, and milk. Parents completed standardized quality-of-life questionnaires before and after treatment.

The researchers found that 64% of children were able to freely eat the allergen after OIT, while the remainder maintained protective doses to guard against accidental exposure. Parents reported dramatic enhancements in day-to-day life, with scores on the Food Allergy Quality of Life Questionnaire improved significantly after OIT. Nearly 90% of families noted better confidence and reduced anxiety around meals, social situations, and cross-contamination risks.

“In our study, Quality of Life scores got better in 88% of patients, indicating oral immunotherapy can transform daily life for young patients and their families,” said Lamya Jaigirdar, DO, lead author of the study. “The burden of food allergy goes beyond physical health—it affects mental well-being and can involve social engagement. Seeing such clear improvements is encouraging for the whole family.”

A second abstract, a medically challenging case, describes two high-risk infants with confirmed peanut allergy who achieved  complete tolerance through a structured, medication-free oral immunotherapy protocol that began with raw peanut introduction prior to roasted peanut exposure.

Two infants, one 6 months-old and one 10 months-old, were started on a therapy of doses of raw peanuts, and then, once tolerance was achieved, were given roasted peanuts. Both were later able to consume peanuts daily without symptoms, and at 3-year follow-up, both patients tolerate all forms of peanut without restriction or reaction.

“To our knowledge, this is the first reported success of peanut allergy reversal in infancy,” said allergist Rachel Kado, MD, co-author of the study and ACAAI member. “We know that early introduction of peanut reduces allergy risk, but there are no protocols for treating confirmed peanut allergy in infancy. The raw-then-roasted peanut protocol offers a promising new approach and should be considered in early immunotherapy strategies for high-risk allergic infants.”

Taken together, the two studies underscore the pivotal role of OFCs in food allergy care – both as a diagnostic tool and as a cornerstone of therapies like OIT. For families, they can provide clarity, peace of mind, and in many cases, newfound freedom in daily life.

Abstract Title: Quality of Life of Pediatric Patients After Completing Oral Immunotherapy (Full abstract below)

Presenter: Lamya Jaigirdar, DO

Abstract Title: First Documented Peanut Allergy Immunotherapy Success in Infants Using Raw-Then-Roasted Exposure (Full abstract below)

Presenter: Morgan Schmidt, BA

For more information about diagnosis and treatment of food allergies, or to find an allergist in your area, visit AllergyandAsthmaRelief.org. The ACAAI Annual Scientific Meeting is Nov. 6-10. For more news and research from the ACAAI Scientific Meeting, go to our newsroom and follow the conversation on X/Twitter #ACAAI25.

About ACAAI

The American College of Allergy, Asthma & Immunology (ACAAI) is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. Founded in 1942, the College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy, and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit AllergyandAsthmaRelief.org. Join us on Facebook, Pinterest, Instagram, Threads and X.

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QUALITY OF LIFE OF PEDIATRIC PATIENTS AFTER COMPLETING ORAL IMMUNOTHERAPY

L. Jaigirdar*1, S. Amin1, M. Segal2, M. Lauer2, P. Mehta2, 1. Philadelphia, PA; 2. Wyndmoor, PA.

Introduction: For food allergy patients, quality of life (QoL) is compromised by dietary restrictions, limited social activities, psychological distress, and food-related anxiety. DunnGalvin et al. created the Food Allergy Quality of Life Questionnaire–Parental Form (FAQLQ-PF) to assess the impact in the aforementioned domains in children aged 0–12. This study explores the effect of Oral Immunotherapy (OIT) on QoL in this age group.
Methods: This is a single-arm pre-post study of patients aged 0–12 who underwent OIT between 2020–2022. Parents completed the FAQLQ-PF before their child started OIT and after completion. The FAQLQ-PF includes questions rated from 0 (not at all) – 6 (extremely). Data was analyzed using Wilcoxon signed-rank and standardized response mean (SRM) utilizing MATLAB R2025a.
Results: Of 74 patients who initiated OIT, 64 completed treatment. Among those who completed treatment, 28 have no other major food allergy and completed the pre-OIT FAQLQ-PF, and 25 out of 28 completed the post-OIT FAQLQ-PF. OIT was conducted for allergens including peanut, tree nuts, sesame, egg, and milk; 64% of patients are now free eating, and 36% maintain at doses to protect from cross-contamination. The FAQLQ-PF score was calculated as the mean across all questions. FAQLQ-PF scores improved in 88% of patients. The median score decreased from 2.29 (IQR: 1.05–3.50) pre-OIT to 0.57 (IQR: 0.20–1.68) post-OIT. Wilcoxon signed-rank test showed statistical significance of QoL before and after OIT (W=14, p<.0001) with SRM=.95 indicating strong responsiveness in QoL post-OIT (Figure 1).
Conclusion: The results highlight OIT’s potential to significantly improve QoL in pediatric patients with food allergies.

FAQLQ-PF Scores Before and After OIT (Table available upon request)\

There is a significant decrease in FAQLQ-PF scores Post-OIT, indicating improved quality of life for these patients after OIT

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FIRST DOCUMENTED PEANUT ALLERGY IMMUNOTHERAPY SUCCESS IN INFANTS USING RAW-THEN-ROASTED EXPOSURE
R. Kado1, M. Schmidt*2, A. Keller*3, J. Saperstein*3, 1. Bloomfield Hills, MI; 2. White Lake, MI; 3. Bloomfield, MI.

Introduction: Peanut allergy is a leading cause of anaphylaxis in children, with limited curative therapies available for sensitized infants. While early introduction reduces allergy risk, no protocols exist for treating confirmed peanut allergy in infancy.
Case Descriptions: This case series describes two high-risk infants with confirmed peanut allergy who achieved complete tolerance through a structured, medication-free oral immunotherapy protocol that began with raw peanut introduction prior to roasted peanut exposure.

Patient A, a 6-month-old with severe atopic dermatitis and strong family history, was started on incremental doses of raw African runner peanuts. Mild IgE-mediated reactions occurred but resolved without intervention. Roasted peanuts were introduced only after raw tolerance was achieved. By 8 months, the patient tolerated 4 roasted peanuts daily, maintained for 2 years.

Patient B, a 10-month-old with confirmed peanut allergy (SPT 8mm; IgE 0.86 kU/L), followed the same protocol. He experienced similar mild reactions, achieved raw tolerance, then advanced to roasted peanut without pharmacologic support. By 12 months, he consumed peanuts daily without symptoms.
Discussion: At 3-year follow-up, both patients tolerate all forms of peanut without restriction or reaction. The staged introduction—starting with raw peanuts due to their lower allergenicity—was critical to success and may be a key strategy for high-risk infants.

Conclusion: This is the first reported success of peanut allergy reversal in infancy. The raw-then-roasted peanut protocol offers a promising new approach and should be considered in early immunotherapy strategies for high-risk allergic infants.

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