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Review

Emerging Treatment Options for Peanut Allergy

by
Travis Satnarine
1,*,
Alana Xavier de Almeida
2,
Malaika Woody
1,
Krisia Banegas Carballo
1,
Diana Chan
1,
Pytregay Thompson
1,
Gary Kleiner
3 and
Melissa Gans
3
1
Department of Pediatrics, University of Miami/Jackson Health System, Miami, FL 33136, USA
2
Division of Pediatric Immunology, Allergy and Rheumatology, Memorial Healthcare System, Hollywood, FL 33021, USA
3
Division of Allergy and Immunology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL 33136, USA
*
Author to whom correspondence should be addressed.
Allergies 2025, 5(1), 5; https://doi.org/10.3390/allergies5010005
Submission received: 28 November 2024 / Revised: 20 December 2024 / Accepted: 6 February 2025 / Published: 19 February 2025
(This article belongs to the Section Food Allergy)
Browse Figure
Versions Notes

Abstract

:
Peanut allergy, a significant public health issue, poses challenges due to its potential for life-threatening anaphylaxis and profound impact on quality of life. Traditional management approaches, including allergen avoidance and epinephrine administration, are effective in mitigating acute symptoms but do not address the underlying allergy or long-term disease burden. Recent advances in immunotherapy and biologics, as well as innovative technologies such as gene editing and microbiome modulation, have introduced promising pathways for desensitization and sustained unresponsiveness. This review provides a comprehensive exploration of emerging therapies for peanut allergy, including oral, sublingual, and epicutaneous immunotherapy, biologic agents, gene-editing techniques, and novel drug therapies. We discuss their mechanisms, clinical efficacy, and associated challenges, emphasizing the potential for these innovations to revolutionize peanut allergy treatment. Despite significant progress, barriers such as adverse reactions, cost, and limited access remain. Addressing these challenges through further research and standardization could transform the future of peanut allergy management.

1. Introduction

In the United States and Europe, peanut allergy has become an escalating public health concern, with prevalence increasing 3.5-fold over the past two decades to affect approximately 1.4–2% of the population [1]. Characterized by an abnormal IgE-mediated immune response to peanut proteins, this allergy can lead to life-threatening anaphylaxis and has a significant impact on the quality of life for affected individuals and their families [2]. IgE-mediated peanut allergy is associated with a significantly higher number of deaths caused by anaphylaxis among patients treated in emergency departments compared to other IgE-mediated food allergies [2].
Current traditional treatment and management options for patients with IgE-mediated peanut allergy include peanut avoidance, auto-administrated epinephrine carriage, and prompt treatment of allergic symptoms [3]. These practices, however, are limited by the rising cost and burden of self-carrying epinephrine and the significant anxiety associated with food avoidance and surveillance. There is significant anxiety associated with peanut allergy and the social impact it has on patients’ lives [4]. As a result, there has been an increasing focus on developing therapies that can change the course of the disease, provide long-term relief, and improve the quality of life by reducing the reliance on emergency medical treatments and alleviating food-related anxiety [5].
Recent advancements in immunotherapy and novel therapeutic approaches offer new hope for individuals suffering from this potentially life-threatening condition [6,7]. This article explores the latest developments in emerging treatments for peanut allergy, including advances in immunotherapy, biologic agents, and novel vaccine strategies, as seen in Figure 1. By examining recent clinical trials, efficacy data, and underlying mechanisms, we aim to provide a comprehensive overview of how these innovative therapies are reshaping the landscape of peanut allergy management and offer insights into their potential impact on patient outcomes and future research directions.

2. Current Treatment Options

The current standard of care in peanut allergy involves a multi-strategy approach, with avoidance of the allergen as the mainstay of therapy. The goal of allergen avoidance is to reduce the risk of anaphylaxis in those with already-diagnosed food allergies. It is important to note that current guidelines support the early introduction of peanut products in infancy for all patients, particularly at 4–6 months of age, as this is associated with a lower risk of peanut allergy and should be encouraged to prevent allergy [8,9,10,11]. For those already with peanut allergy, the risk of life-threatening anaphylaxis has led to food labeling requirements and even peanut-free schools, though the data on the effectiveness of these measures are mixed. Allergen avoidance sounds simple but is challenging for several reasons and leads to a decreased quality of life for those with peanut allergy. For example, in the United States, food labeling does not have standardized guidelines when an allergen is present in the manufacturing process or when cross-contamination is possible. Only when an allergen is a direct ingredient is there standardized labeling. Often, foods contain vague, unregulated, non-standardized phrases, such as “may contain peanuts”, without other explanation. This leads to inconsistent labeling and may lead patients to limit more than is truly necessary, or worse, could result in accidental ingestion [12]. Many restaurants or manufacturers may be hesitant to completely reassure people that the facility is peanut-free even when it is. Food at restaurants may not be labeled properly, or restaurants may not be able to ensure safety with cross-contamination or even understand that they need to take precautions to ensure there is no cross-contamination. Even when patients ask about allergens at restaurants, they can still end up accidentally ingesting their known allergens. Additionally, particularly for children, the risk of unintentional ingestion is a concern for both parents and children, leading to heightened anxiety and worse quality of life, including restricted participation at social events [13,14]. Given the limitations of allergen avoidance, additional strategies have been devised to manage allergy symptoms and minimize allergic reactions, while research into new therapies continues.
When those with peanut allergy have an anaphylactic reaction, the recommended action is removal of the antigen and rapid administration of intramuscular epinephrine. However, even this standard treatment is changing since in August 2024, the United States Food and Drug Administration (FDA) approved the first intranasal version of epinephrine to treat anaphylaxis in patients over 30 kg, which has been shown to have equally effective systemic absorption in clinical trials [15]. Only after the administration of epinephrine should adjunctive therapies, such as H1 or H2 antagonists or corticosteroids, be considered because the initial use of these medications leads to the suppression of allergic symptoms and the delay of epinephrine treatment, which is associated with poor outcomes [16]. Epinephrine is the only effective definitive treatment for anaphylaxis. After effective epinephrine treatment, antihistamines can be used for cutaneous symptom relief. Corticosteroids may have some benefit in decreasing hospital length of stay but offer no prevention of biphasic reactions, do not prevent repeat ER visits, and have limited benefit in acute anaphylaxis despite their popular use [17]. Additionally, antihistamines and corticosteroids should not be used to prevent anaphylaxis prior to a possible antigen exposure [17]. Current treatment options for peanut allergy are compared in Table 1.
Overall, we are witnessing an exciting period of growth and transformation in the approach to treating and preventing peanut allergies.

3. Emerging Treatment Outcomes

Immunotherapies have been created to treat patients with peanut allergies by inducing desensitization, which can protect against severe reactions to accidental ingestions. In some patients, sustained remission may also be possible. The first peanut immunotherapy was delivered subcutaneously and was first reported in 1992 but was discontinued due to a high rate of systemic reactions [18,19]. Similarly, a rectal vaccine for peanut allergy was trialed but halted due to an unsatisfactory rate of adverse systemic reactions and poor efficacy [20].
Currently, trials of sublingual (SLIT), oral (OIT), and epicutaneous immunotherapy (EPIT) are promising, with OIT being the only FDA-approved therapy so far. SLIT has shown to be effective in desensitization and has a low rate of systemic reactions [21,22,23]; however, this modality requires smaller allergen doses for practical reasons, and the desensitization outcomes may be outperformed by OIT [24,25]. Several studies have demonstrated the efficacy of peanut OIT in children and young adults, with the best results in young children [20,26,27,28,29]. For example, in the IMPACT trial, OIT in children less than 4 years old produced 71% desensitization, and 21% achieved remission [20]. The side effects of OIT are common across all trials. Most reactions produce mild to moderate side effects, most commonly oropharyngeal or gastrointestinal symptoms, but severe reactions and systemic symptoms treated effectively with epinephrine occur in approximately 5–10% of study participants, depending on the study.
EPIT via “peanut patch” placed on the skin is currently being studied in clinical trials, with most preliminary studies showing desensitization in pediatric patients [30,31]. The peanut patch is overall well tolerated, with lower rates of severe reactions than reported in OIT trials [32].
Biologics have also been used in the treatment of peanut allergy. Biologics were first trialed in 2003 for peanut allergy and produced desensitization [33]. Recently, omalizumab, an anti-IgE monoclonal antibody that blocks the IgE receptor binding site, is a monotherapy delivered subcutaneously that has been shown to cause desensitization in those with food allergies, including peanut allergy [34]. There is also ongoing research into the use of omalizumab in combination with immunotherapy [34], with early trials showing rapid oral desensitization with combination therapy [35].

3.1. Immunotherapy Approaches

3.1.1. Oral Immunotherapy (OIT)

Allergen immunotherapy modulates the immune response to increase the allergic reaction threshold by gradually exposing allergic individuals to increasing doses of an allergen. Among the different approaches, oral immunotherapy (OIT) is the most widely used type of immunotherapy for the treatment of IgE-mediated food allergies. During OIT, the allergen exposure reduces basophil sensitivity and decreases effector cell reactivity, resulting in desensitization [20,29,36].
Treatment begins with a low dose of the allergen administered orally, followed by an updosing phase until the maintenance dose is achieved, which is then continued for a variable duration. The aim of this treatment, as with all forms of food allergen immunotherapy, is to reduce the severity of allergic symptoms if an accidental exposure occurs [20,29].
OIT is the most-studied type of immunotherapy for IgE-mediated peanut allergy. Multiple studies have been conducted, including numerous randomized trials. The trials conclude that this therapy is capable of achieving desensitization in most patients (60–80%) and increasing the tolerance threshold [20,24,27,28,36,37,38]. Peanut is the only food for which an oral immunotherapy, Palforzia, has been approved by the Food and Drug Administration (FDA) for patients aged 4 to 17 years old [27].
Adverse events associated with OIT include systemic allergic reactions, ranging from mild to severe anaphylaxis; skin-related side effects, including pruritus, urticarial rash, and angioedema; and gastrointestinal symptoms, which are usually the most common and include dysphagia, abdominal pain, gastritis, mouth pruritus, nausea, vomiting, and eosinophilic esophagitis. Side effects can result in the discontinuation of OIT or can be dose-limiting. Gastrointestinal symptoms usually resolve within a few weeks following discontinuation [20,29,39].
OIT treatment faces many challenges, including the adverse reactions discussed and long-term patient commitment. A subset of patients is unable to achieve sustained unresponsiveness for unknown reasons, and there is a risk of regaining clinical reactivity to peanut once therapy is discontinued or even reduced. Patients may also present with psychological stress associated with potential reactions. Psychological stressors may pose a barrier to initiating OIT treatment but involve high rates of adverse reactions, especially gastrointestinal. The Food and Drug Administration and European Medicines Agency have approved Palforzia® for patients aged 4–17, and studies are working to improve OIT tolerability and standardize protocols [40].

3.1.2. Sublingual Immunotherapy (SLIT)

Sublingual immunotherapy (SLIT) achieves desensitization by administering small amounts of glycerinated liquid allergen extract under the tongue. These antigens are captured by oral Langerhans cells, which initiate the immune response that promotes desensitization. The protocol is similar to OIT, requiring daily administration and starting with a low initial dose, followed by a dose escalation phase, and then a maintenance dose [41]. In contrast to OIT, this immunotherapy is typically dosed in micrograms up to low milligrams [21,42,43].
For OIT, initial escalation is usually done in a clinical setting due to higher doses and reaction risk, while maintenance often continues at home. SLIT uses much lower doses, allowing more frequent home dosing with minimal in-office monitoring [41]. Anaphylaxis risk is higher with OIT, especially in early phases, though it decreases during maintenance. SLIT has a lower risk overall, with mainly mild throat symptoms and fewer severe reactions [41]. Additionally, multiple studies have highlighted its favorable safety profile as another significant benefit. The most common side effect is oropharyngeal pruritus, which is generally mild and transient. Gastrointestinal and systemic symptoms are rare [21,23,24,42,44].
Despite these advantages, SLIT faces several limitations. Similar to OIT, it requires long-term treatment commitment, and treatment protocols are highly variable. SLIT has been found to be less effective compared to OIT, achieving lower levels of desensitization. In a retrospective comparison, participants undergoing OIT were three times more likely to pass a 12-month food challenge than those on SLIT, with OIT participants tolerating up to 5000 mg of peanut protein versus 2500 mg for SLIT participants [45]. In a double-blind study with peanut-allergic children, OIT participants showed a 141-fold increase in tolerance threshold, compared to only a 22-fold increase in the SLIT group [24].
Long-term use of peanut SLIT has been shown to increase the tolerated dose of peanuts, with stronger tolerance also associated with higher treatment doses [21,23]. Despite developing tolerance, only a subset of patients will achieve sustained unresponsiveness. Currently, there are no data on how to predict which patients will achieve sustained unresponsiveness, similar to what is observed with OIT [23,44].

3.1.3. Epicutaneous Immunotherapy (EPIT)

Epicutaneous immunotherapy (EPIT) induces desensitization by the application of allergens through the skin. The allergen is processed by dermal dendritic cells and Langerhans cells, which then migrate to the lymph nodes to initiate antigen-specific immune modulation. EPIT differs significantly from OIT and SLIT in its method and dosage. EPIT uses a peanut patch that administers microgram doses of allergen on intact skin, specifically designed to avoid systemic circulation and thereby minimize the risk of severe reactions associated with higher allergen exposure in OIT [46]. By comparison, OIT delivers milligram doses of allergen orally, involving ingestion that leads to a broader, systemic immune response [32]. SLIT uses milligram-level doses placed under the tongue, which leads to broader immune activation and a stronger desensitization effect but also carries a higher risk of mild adverse reactions [47]. EPIT primarily aims to induce desensitization through cutaneous pathways, utilizing the immune properties of the skin to maintain the localized activation of regulatory T cells, which is less likely to provoke anaphylaxis compared to the more invasive OIT and SLIT methods [30].
There are multiple types of epicutaneous delivery systems. The most used and studied is the Viaskin (DBV Technologies, Montrouge, France) Peanut 250 μg (VP250) patch. Dry powdered peanut allergen is sprayed onto a transparent plastic membrane by electrostatic forces. In contact with the epidermis, Viaskin creates an enclosed chamber and increases skin permeability by utilizing transepidermal water losses. The amount of allergen in the patch remains constant throughout the treatment, while the daily application time of the patch gradually increases [31,32,48,49,50,51].
Other innovative types of EPIT delivery systems are being studied, including the Ablative Fractional Laser (AFL) and the microneedle delivery system. The precise laser epidermal system (P.L.E.A.S.E.) is a type of AFL that enhances transcutaneous drug delivery, particularly for biomacromolecules, by creating microchannels in the dermal or epidermal layers. This is followed by the application of a patch coated with powdered allergen. The goal of this treatment is to enhance the amount of allergen delivered without systemic passage [52,53,54].
The microneedle delivery system involves coated-allergen microneedles that penetrate the epidermis, creating micropores in the stratum corneum. These pores allow macromolecules to cross the epidermis, thereby enhancing drug penetration [55,56,57].
Among the treatments discussed, only the EPIT Viaskin has published human studies for the treatment of food allergies [30,31,32,46,48,49]. The patch has been studied in children as young as one year old [30]. The study supports that higher doses in epicutaneous immunotherapy (EPIT) lead to greater desensitization. Participants treated with 250 µg of Viaskin Peanut showed a higher success rate (48%) and a greater increase in peanut tolerance (130 mg) compared to those receiving 100 µg (46% success, 43 mg increase) and placebo (12% success, no increase). This demonstrates that increasing the dose enhances treatment efficacy [49]. The most common adverse event is a local patch site reaction, including pruritus, edema, and redness [30,31,32,46,48,49]. Long-term studies have shown that daily treatment leads to sustained response in some patients [58,59]. Emerging immunotherapy approaches are compared in Table 2, and their clinical trials and findings are compared in Table 3.

3.2. Biologic Therapies

An important adjuvant in peanut oral immunotherapy for enhancing both efficacy and safety is the use of anti-IgE, which helps reduce reactions during oral desensitization. Omalizumab, an anti-IgE monoclonal antibody approved by the FDA in 2003, is administered subcutaneously and blocks the IgE receptor binding site, rapidly lowering the concentration of total free IgE for peanut and all other specific IgEs [60].
In 2023, a meta-analysis of 36 studies involving 1000 subjects was conducted [61]. The use of omalizumab, an anti-IgE monoclonal antibody that blocks the IgE receptor binding site, as a monotherapy or in combination with oral immunotherapy significantly increased the tolerated dose of foods, allowing the consumption of multiple foods at higher reactivity thresholds. Additionally, in patients with severe and persistent food allergies, omalizumab aided in successful desensitization, though it did not significantly alter the cumulative tolerated dose. In a randomized, placebo-controlled trial, omalizumab significantly increased the reaction threshold for peanut and other common food allergens in children and adolescents with multiple food allergies, demonstrating superior efficacy to placebo over 16 weeks [34].
IgE blockade by omalizumab allowed for a faster escalation of peanut doses during the build-up phase of peanut OIT, leading to fewer reported adverse reactions, fewer dose-related reactions requiring treatment, and fewer doses needed to reach maintenance. It also resulted in a more prolonged reduction in peanut-specific IgE levels [62]. Additionally, there was a reported decrease in episodes of anaphylaxis in patients with recurrent and/or unprovoked anaphylactic reactions, offering additional benefits, particularly for patients at high risk of severe anaphylaxis related to food allergies [61].
While omalizumab continues to be a significant option, next-generation anti-IgE antibodies and agents targeting alarmins are demonstrating distinct advantages. Dupilumab, which targets IL-4 and IL-13, also shows potential as a dual therapy. The introduction of antialarmins expands the range of treatment options for food allergies [63]. Next-generation antibodies, such as ligelizumab and UB-221—an anti-IgE monoclonal antibody with novel mechanisms—exhibit increased potency and novel mechanisms, offering promise for food allergy treatment. Anti-IL-33 (etokimab) and anti-TSLP (anti-thymic stromal lymphopoietin) (tezepelumab) have yielded promising results, with etokimab showing early success in peanut allergy trials [64]. However, additional studies are required to fully evaluate their efficacy and increased benefits over substantial risks.

3.3. Gene Editing and CRISPR Technology

New strategies have made gene editing easy and highly efficient in comparison to the well-known process of homologous recombination [65]. The clustered regularly interspaced short palindromic repeats (CRISPR) gene-editing technology has been utilized to identify genes that are considered the culprit of allergy disease, alter genes to manipulate triggering allergens to reduce allergenicity and disease, and develop gene knockouts. This technology provides outstanding benefits, such as simple design, specificity, reproducibility, and cost efficiency [66].
Through the use of inhibitors and gene silencing technology, scientists have identified Cytochrome p450 family 11 subfamily A member 1 (CYP11A1) as a key regulator of IL-13 production and a crucial molecule in the development of peanut-induced intestinal anaphylaxis in mice [67]. In a study involving activated peripheral blood CD4+ T cells from peanut-allergic children, CYP11A1 gene expression was found to be approximately 50 times higher, and the percentage of CD4+ CYP11A1+ T cells was 20 times greater compared to non-allergic controls [68]. Targeting CYP11A1 has shown a reduction in its gene expression by more than 50%, along with a decrease in IL-13 production, suggesting that CYP11A1 may be a promising target for therapeutic intervention in children with peanut allergies [67].
Given the ethical concerns surrounding gene editing in humans, another approach involves using gene editing to manipulate causative allergens directly. In one study, Dodo et al. developed allergen-reduced peanuts by using RNA interference to silence the Ara h 2 gene. This resulted in significantly reduced or even undetectable levels of Ara h 2 in several genetically modified peanut seeds and a corresponding decrease in IgE binding from peanut-allergic patient serum compared to wild-type seeds [69]. These innovative approaches offer a rapid and effective means to better understand gene functions and potentially reduce peanut allergy. However, it is important to know that these technologies lack human studies and are experimental; hence, they are many years away from being implemented in general practice.

3.4. Novel Drug Therapies

Small Molecules

Recent advances in molecular immunology have revolutionized the management of atopic dermatitis (AD) and related conditions, with the development of Janus kinase (JAK) inhibitors and other pathway-specific therapies. These targeted treatments modulate the immune response by interfering with key signaling pathways, including JAK/STAT and spleen tyrosine kinase (SYK), central to the pathogenesis of inflammatory and allergic conditions.
The JAK/STAT pathway regulates the activity of multiple cytokines involved in AD and food allergies, such as IL-4, IL-5, and IL-13. By inhibiting this pathway, JAK inhibitors reduce inflammation and allergic responses. Abrocitinib, a Janus kinase (JAK) inhibitor targeting the JAK/STAT pathway; upadacitinib; and baricitinib are FDA-approved oral JAK inhibitors for moderate-to-severe AD that offer significant symptomatic relief and quality-of-life improvements [70,71]. Clinical trials and real-world studies demonstrate that abrocitinib and upadacitinib effectively reduce eczema severity, itch, and systemic inflammation with manageable safety profiles [72]. These inhibitors have also shown potential in improving allergen-specific basophil activation, providing a rationale for further research in food allergies. Meta-analyses indicate a manageable infection risk associated with JAK inhibitors in dermatological applications, emphasizing the importance of monitoring during treatment [73].
SYK inhibitors block the IgE-mediated activation of mast cells, preventing the release of inflammatory mediators. Fostamatinib, a spleen tyrosine kinase (SYK) inhibitor blocking IgE-mediated mast cell activation that is approved for other immune-mediated conditions, has shown promise in preclinical studies for food allergy and allergic anaphylaxis [74]. However, their progression to advanced clinical trials for atopic conditions is limited by toxicity and formulation challenges.

4. Challenges and Limitations in Emerging Treatments

Emerging treatments for peanut allergies face several challenges and limitations. One major issue is the risk of adverse reactions, including anaphylaxis, during immunotherapy, which can cause discomfort or potentially life-threatening responses for patients. Long-term commitment to these therapies is necessary, which can be challenging due to the psychological burden of anticipating reactions and the frequent need for medical supervision. Additionally, treatment standardization is lacking, as protocols vary between institutions, making outcomes and safety inconsistent. Cost and access also present significant barriers, as many therapies are expensive and not universally covered by insurance. Finally, while some patients achieve desensitization, sustained unresponsiveness remains elusive for a subset of individuals, complicating the long-term success of these therapies.

Author Contributions

T.S.: Conceptualization and overall coordination; A.X.d.A., M.W., K.B.C., D.C. and P.T.: Drafting and revising the manuscript; G.K. and M.G.: Supervision, critical review, and approval of the final manuscript. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Lange, L.; Klimek, L.; Beyer, K.; Blümchen, K.; Novak, N.; Hamelmann, E.; Bauer, A.; Merk, H.; Rabe, U.; Jung, K.; et al. White paper on peanut allergy—Part 1: Epidemiology, burden of disease, health economic aspects. Allergo J. Int. 2021, 30, 261. [Google Scholar] [CrossRef] [PubMed]
  2. Husain, Z.; Schwartz, R.A. Peanut allergy: An increasingly common life-threatening disorder. J. Am. Acad. Dermatol. 2012, 66, 136–143. [Google Scholar] [CrossRef] [PubMed]
  3. Abrams, E.M.; Chan, E.S.; Sicherer, S. Peanut Allergy: New Advances and Ongoing Controversies. Pediatrics 2020, 145, e20192102. [Google Scholar] [CrossRef] [PubMed]
  4. Tsoumani, M.; Regent, L.; Warner, A.; Gallop, K.; Patel, R.; Ryan, R.; Vereda, A.; Acaster, S.; DunnGalvin, A.; Byrne, A. Allergy to Peanuts imPacting Emotions And Life (APPEAL): The impact of peanut allergy on children, teenagers, adults and caregivers in the UK and Ireland. PLoS ONE 2022, 17, e0262851. [Google Scholar] [CrossRef]
  5. Bublin, M.; Breiteneder, H. Developing Therapies for Peanut Allergy. Int. Arch. Allergy Immunol. 2014, 165, 179. [Google Scholar] [CrossRef]
  6. Cook, Q.S.; Kim, E.H. Update on peanut allergy: Prevention and immunotherapy. Allergy Asthma Proc. 2019, 40, 14–20. [Google Scholar] [CrossRef]
  7. Kim, E.H.; Patel, C.; Burks, A.W. Immunotherapy approaches for peanut allergy. Expert Rev. Clin. Immunol. 2020, 16, 167–174. [Google Scholar] [CrossRef]
  8. Du Toit, G.; Roberts, G.; Sayre, P.H.; Bahnson, H.T.; Radulovic, S.; Santos, A.F.; Brough, H.A.; Phippard, D.; Basting, M.; Feeney, M.; et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N. Engl. J. Med. 2015, 372, 803–813. [Google Scholar] [CrossRef]
  9. Du Toit, G.; Huffaker, M.F.; Radulovic, S.; Feeney, M.; Fisher, H.R.; Byron, M.; Dunaway, L.; Calatroni, A.; Johnson, M.; Foong, R.-X.; et al. Follow-up to Adolescence after Early Peanut Introduction for Allergy Prevention. NEJM Evid. 2024, 3, EVIDoa2300311. [Google Scholar] [CrossRef]
  10. Logan, K.; Bahnson, H.T.; Ylescupidez, A.; Beyer, K.; Bellach, J.; Campbell, D.E.; Craven, J.; Du Toit, G.; Clare Mills, E.N.; Perkin, M.R.; et al. Early introduction of peanut reduces peanut allergy across risk groups in pooled and causal inference analyses. Allergy 2023, 78, 1307–1318. [Google Scholar] [CrossRef]
  11. Togias, A.; Cooper, S.F.; Acebal, M.L.; Assa’ad, A.; Baker, J.R.; Beck, L.A.; Block, J.; Byrd-Bredbenner, C.; Chan, E.S.; Eichenfield, L.F.; et al. Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel. Ann. Allergy Asthma Immunol. 2017, 118, 166–173.e7. [Google Scholar] [CrossRef] [PubMed]
  12. Gupta, R.; Kanaley, M.; Negris, O.; Roach, A.; Bilaver, L. Understanding Precautionary Allergen Labeling (PAL) Preferences Among Food Allergy Stakeholders. J. Allergy Clin. Immunol. Pract. 2021, 9, 254–264.e1. [Google Scholar] [CrossRef] [PubMed]
  13. King, R.M.; Knibb, R.C.; Hourihane, J.O. Impact of peanut allergy on quality of life, stress and anxiety in the family. Allergy 2009, 64, 461–468. [Google Scholar] [CrossRef] [PubMed]
  14. Roy, K.M.; Roberts, M.C. Peanut allergy in children: Relationships to health-related quality of life, anxiety, and parental stress. Clin. Pediatr. 2011, 50, 1045–1051. [Google Scholar] [CrossRef]
  15. Dworaczyk, D.A.; Hunt, A.L.; Di Spirito, M.; Lor, M.; Dretchen, K.L.; Lamson, M.J.; Pollock, J.; Ward, T. A 13.2 mg epinephrine intranasal spray demonstrates comparable pharmacokinetics, pharmacodynamics, and safety to a 0.3 mg epinephrine autoinjector. J. Allergy Clin. Immunol. Glob. 2024, 3, 100200. [Google Scholar] [CrossRef]
  16. Navalpakam, A.; Thanaputkaiporn, N.; Poowuttikul, P. Management of Anaphylaxis. Immunol. Allergy Clin. N. Am. 2022, 42, 65–76. [Google Scholar] [CrossRef]
  17. Shaker, M.S.; Wallace, D.V.; Golden, D.B.K.; Oppenheimer, J.; Bernstein, J.A.; Campbell, R.L.; Dinakar, C.; Ellis, A.; Greenhawt, M.; Khan, D.A.; et al. Anaphylaxis—A 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J. Allergy Clin. Immunol. 2020, 145, 1082–1123. [Google Scholar] [CrossRef]
  18. Oppenheimer, J.J.; Nelson, H.S.; Bock, S.A.; Christensen, F.; Leung, D.Y. Treatment of peanut allergy with rush immunotherapy. J. Allergy Clin. Immunol. 1992, 90, 256–262. [Google Scholar] [CrossRef]
  19. Nelson, H.S.; Lahr, J.; Rule, R.; Bock, A.; Leung, D. Treatment of anaphylactic sensitivity to peanuts by immunotherapy with injections of aqueous peanut extract. J. Allergy Clin. Immunol. 1997, 99 Pt 1, 744–751. [Google Scholar] [CrossRef]
  20. Jones, S.M.; Kim, E.H.; Nadeau, K.C.; Nowak-Wegrzyn, A.; Wood, R.A.; Sampson, H.A.; Scurlock, A.M.; Chinthrajah, S.; Wang, J.; Pesek, R.D.; et al. Efficacy and safety of oral immunotherapy in children aged 1–3 years with peanut allergy (the Immune Tolerance Network IMPACT trial): A randomised placebo-controlled study. Lancet 2022, 399, 359–371. [Google Scholar] [CrossRef]
  21. Kim, E.H.; Keet, C.A.; Virkud, Y.V.; Chin, S.; Ye, P.; Penumarti, A.; Smeekens, J.; Guo, R.; Yue, X.; Li, Q.; et al. Open-label study of the efficacy, safety, and durability of peanut sublingual immunotherapy in peanut-allergic children. J. Allergy Clin. Immunol. 2023, 151, 1558–1565.e6. [Google Scholar] [CrossRef]
  22. Kim, E.H.; Bird, J.A.; Keet, C.A.; Virkud, Y.V.; Herlihy, L.; Ye, P.; Smeekens, J.M.; Guo, R.; Yue, X.; Penumarti, A.; et al. Desensitization and remission after peanut sublingual immunotherapy in 1- to 4-year-old peanut-allergic children: A randomized, placebo-controlled trial. J. Allergy Clin. Immunol. 2024, 153, 173–181.e10. [Google Scholar] [CrossRef]
  23. Kim, E.H.; Yang, L.; Ye, P.; Guo, R.; Li, Q.; Kulis, M.D.; Burks, A.W. Long-term sublingual immunotherapy for peanut allergy in children: Clinical and immunologic evidence of desensitization. J. Allergy Clin. Immunol. 2019, 144, 1320–1326.e1. [Google Scholar] [CrossRef]
  24. Narisety, S.D.; Frischmeyer-Guerrerio, P.A.; Keet, C.A.; Gorelik, M.; Schroeder, J.; Hamilton, R.G.; Wood, R.A. A randomized, double-blind, placebo-controlled pilot study of sublingual versus oral immunotherapy for the treatment of peanut allergy. J. Allergy Clin. Immunol. 2015, 135, 1275–1282.e6. [Google Scholar] [CrossRef] [PubMed]
  25. Keet, C.A.; Frischmeyer-Guerrerio, P.A.; Thyagarajan, A.; Schroeder, J.T.; Hamilton, R.G.; Boden, S.; Steele, P.; Driggers, S.; Burks, A.W.; Wood, R.A. The safety and efficacy of sublingual and oral immunotherapy for milk allergy. J. Allergy Clin. Immunol. 2012, 129, 448–455.e5. [Google Scholar] [CrossRef] [PubMed]
  26. Soller, L.; Abrams, E.M.; Carr, S.; Kapur, S.; Rex, G.A.; Leo, S.; McHenry, M.; Vander Leek, T.K.; Yeung, J.; Cook, V.E.; et al. First Real-World Effectiveness Analysis of Preschool Peanut Oral Immunotherapy. J. Allergy Clin. Immunol. Pract. 2021, 9, 1349–1356.e1. [Google Scholar] [CrossRef] [PubMed]
  27. PALISADE Group of Clinical Investigators. AR101 Oral Immunotherapy for Peanut Allergy. N. Engl. J. Med. 2018, 379, 1991–2001. [Google Scholar] [CrossRef]
  28. O’B Hourihane, J.; Beyer, K.; Abbas, A.; Fernández-Rivas, M.; Turner, P.J.; Blumchen, K.; Nilsson, C.; Ibáñez, M.D.; Deschildre, A.; Muraro, A.; et al. Efficacy and safety of oral immunotherapy with AR101 in European children with a peanut allergy (ARTEMIS): A multicentre, double-blind, randomised, placebo-controlled phase 3 trial. Lancet Child Adolesc. Health 2020, 4, 728–739. [Google Scholar] [CrossRef] [PubMed]
  29. Bird, J.A.; Spergel, J.M.; Jones, S.M.; Rachid, R.; Assa’ad, A.H.; Wang, J.; Leonard, S.A.; Laubach, S.S.; Kim, E.H.; Vickery, B.P.; et al. Efficacy and Safety of AR101 in Oral Immunotherapy for Peanut Allergy: Results of ARC001, a Randomized, Double-Blind, Placebo-Controlled Phase 2 Clinical Trial. J. Allergy Clin. Immunol. Pract. 2018, 6, 476–485.e3. [Google Scholar] [CrossRef] [PubMed]
  30. Greenhawt, M.; Sindher, S.B.; Wang, J.; O’Sullivan, M.; du Toit, G.; Kim, E.H.; Albright, D.; Anvari, S.; Arends, N.; Arkwright, P.D.; et al. Phase 3 Trial of Epicutaneous Immunotherapy in Toddlers with Peanut Allergy. N. Engl. J. Med. 2023, 388, 1755–1766. [Google Scholar] [CrossRef]
  31. Sampson, H.A.; Shreffler, W.G.; Yang, W.H.; Sussman, G.L.; Brown-Whitehorn, T.F.; Nadeau, K.C.; Cheema, A.S.; Leonard, S.A.; Pongracic, J.A.; Sauvage-Delebarre, C.; et al. Effect of Varying Doses of Epicutaneous Immunotherapy vs Placebo on Reaction to Peanut Protein Exposure Among Patients with Peanut Sensitivity: A Randomized Clinical Trial. JAMA 2017, 318, 1798–1809. [Google Scholar] [CrossRef] [PubMed]
  32. Pongracic, J.A.; Gagnon, R.; Sussman, G.; Siri, D.; Oriel, R.C.; Brown-Whitehorn, T.F.; Green, T.D.; Campbell, D.E.; Anvari, S.; Berger, W.E.; et al. Safety of Epicutaneous Immunotherapy in Peanut-Allergic Children: REALISE Randomized Clinical Trial Results. J. Allergy Clin. Immunol. Pract. 2022, 10, 1864–1873.e10. [Google Scholar] [CrossRef] [PubMed]
  33. Fowler, J.; Lieberman, J. Update on clinical research for food allergy treatment. Front. Allergy 2023, 4, 1154541. [Google Scholar] [CrossRef]
  34. Wood, R.A.; Togias, A.; Sicherer, S.H.; Shreffler, W.G.; Kim, E.H.; Jones, S.M.; Leung, D.Y.M.; Vickery, B.P.; Bird, J.A.; Spergel, J.M.; et al. Omalizumab, an anti-IgE monoclonal antibody that blocks the IgE receptor binding site, for the Treatment of Multiple Food Allergies. N. Engl. J. Med. 2024, 390, 889–899. [Google Scholar] [CrossRef] [PubMed]
  35. MacGinnitie, A.J.; Rachid, R.; Gragg, H.; Little, S.V.; Lakin, P.; Cianferoni, A.; Heimall, J.; Makhija, M.; Robison, R.; Chinthrajah, R.S.; et al. Omalizumab, an anti-IgE monoclonal antibody that blocks the IgE receptor binding site, facilitates rapid oral desensitization for peanut allergy. J. Allergy Clin. Immunol. 2017, 139, 873–881.e8. [Google Scholar] [CrossRef]
  36. Bajzik, V.; DeBerg, H.A.; Garabatos, N.; Rust, B.J.; Obrien, K.K.; Nguyen, Q.-A.; O’Rourke, C.; Smith, A.; Walker, A.H.; Quinn, C.; et al. Oral desensitization therapy for peanut allergy induces dynamic changes in peanut-specific immune responses. Allergy 2022, 77, 2534–2548. [Google Scholar] [CrossRef]
  37. Anagnostou, K.; Islam, S.; King, Y.; Foley, L.; Pasea, L.; Bond, S.; Palmer, C.; Deighton, J.; Ewan, P.; Clark, A. Assessing the efficacy of oral immunotherapy for the desensitisation of peanut allergy in children (STOP II): A phase 2 randomised controlled trial. Lancet 2014, 383, 1297–1304. [Google Scholar] [CrossRef]
  38. Reier-Nilsen, T.; Michelsen, M.M.; Lødrup Carlsen, K.C.; Carlsen, K.-H.; Mowinckel, P.; Nygaard, U.C.; Namork, E.; Borres, M.P.; Håland, G. Feasibility of desensitizing children highly allergic to peanut by high-dose oral immunotherapy. Allergy 2019, 74, 337–348. [Google Scholar] [CrossRef]
  39. Virkud, Y.V.; Burks, A.W.; Steele, P.H.; Edwards, L.J.; Berglund, J.P.; Jones, S.M.; Scurlock, A.M.; Perry, T.T.; Pesek, R.D.; Vickery, B.P. Novel baseline predictors of adverse events during oral immunotherapy in children with peanut allergy. J. Allergy Clin. Immunol. 2017, 139, 882–888.e5. [Google Scholar] [CrossRef]
  40. Foti Randazzese, S.; Panasiti, I.; Caminiti, L.; Catamerò, F.; Landi, M.; De Filippo, M.; Votto, M.; Olcese, R.; Favuzza, F.; Giovannini, M.; et al. Current state and advances in desensitization for peanut allergy in pediatric age. Pediatr. Allergy Immunol. Off. Publ. Eur. Soc. Pediatr. Allergy Immunol. 2024, 35, e14127. [Google Scholar] [CrossRef]
  41. Zhang, W.; Sindher, S.B.; Sampath, V.; Nadeau, K. Comparison of sublingual immunotherapy and oral immunotherapy in peanut allergy. Allergo J. Int. 2018, 27, 153. [Google Scholar] [CrossRef] [PubMed]
  42. Kim, E.H.; Bird, J.A.; Kulis, M.; Laubach, S.; Pons, L.; Shreffler, W.; Steele, P.; Kamilaris, J.; Vickery, B.; Burks, A.W. Sublingual immunotherapy for peanut allergy: Clinical and immunologic evidence of desensitization. J. Allergy Clin. Immunol. 2011, 127, 640–646.e1. [Google Scholar] [CrossRef] [PubMed]
  43. Fleischer, D.M.; Burks, A.W.; Vickery, B.P.; Scurlock, A.M.; Wood, R.A.; Jones, S.M.; Sicherer, S.H.; Liu, A.H.; Stablein, D.; Henning, A.K.; et al. Sublingual immunotherapy for peanut allergy: A randomized, double-blind, placebo-controlled multicenter trial. J. Allergy Clin. Immunol. 2013, 131, 119–127.e7. [Google Scholar] [CrossRef] [PubMed]
  44. Burks, A.W.; Wood, R.A.; Jones, S.M.; Sicherer, S.H.; Fleischer, D.M.; Scurlock, A.M.; Vickery, B.P.; Liu, A.H.; Henning, A.K.; Lindblad, R.; et al. Sublingual immunotherapy for peanut allergy: Long-term follow-up of a randomized multicenter trial. J. Allergy Clin. Immunol. 2015, 135, 1240–1248.e3. [Google Scholar] [CrossRef] [PubMed]
  45. Chin, S.J.; Vickery, B.P.; Kulis, M.D.; Kim, E.H.; Varshney, P.; Steele, P.; Kamilaris, J.; Hiegel, A.M.; Carlisle, S.K.; Smith, P.B.; et al. Sublingual versus oral immunotherapy for peanut-allergic children: A retrospective comparison. J. Allergy Clin. Immunol. 2013, 132, 476. [Google Scholar] [CrossRef]
  46. Jones, S.M.; Agbotounou, W.K.; Fleischer, D.M.; Burks, A.W.; Pesek, R.D.; Harris, M.W.; Martin, L.; Thebault, C.; Ruban, C.; Benhamou, P.-H. Safety of epicutaneous immunotherapy for the treatment of peanut allergy: A phase 1 study using the Viaskin patch. J. Allergy Clin. Immunol. 2016, 137, 1258–1261.e10. [Google Scholar] [CrossRef]
  47. Scurlock, A.M.; Burks, A.W.; Sicherer, S.H.; Leung, D.Y.M.; Kim, E.H.; Henning, A.K.; Dawson, P.; Lindblad, R.W.; Berin, M.C.; Cho, C.B.; et al. Epicutaneous immunotherapy for treatment of peanut allergy: Follow-up from the Consortium for Food Allergy Research. J. Allergy Clin. Immunol. 2020, 147, 992. [Google Scholar] [CrossRef]
  48. Fleischer, D.M.; Greenhawt, M.; Sussman, G.; Bégin, P.; Nowak-Wegrzyn, A.; Petroni, D.; Beyer, K.; Brown-Whitehorn, T.; Hebert, J.; Hourihane, J.O.; et al. Effect of Epicutaneous Immunotherapy vs Placebo on Reaction to Peanut Protein Ingestion Among Children with Peanut Allergy: The PEPITES Randomized Clinical Trial. JAMA 2019, 321, 946–955. [Google Scholar] [CrossRef]
  49. Jones, S.M.; Sicherer, S.H.; Burks, A.W.; Leung, D.Y.M.; Lindblad, R.W.; Dawson, P.; Henning, A.K.; Berin, M.C.; Chiang, D.; Vickery, B.P.; et al. Epicutaneous immunotherapy for the treatment of peanut allergy in children and young adults. J. Allergy Clin. Immunol. 2017, 139, 1242–1252.e9. [Google Scholar] [CrossRef]
  50. Mondoulet, L.; Dioszeghy, V.; Ligouis, M.; Dhelft, V.; Puteaux, E.; Dupont, C.; Benhamou, P.-H. Epicutaneous Immunotherapy Compared with Sublingual Immunotherapy in Mice Sensitized to Pollen (Phleum pratense). ISRN Allergy 2012, 2012, 375735. [Google Scholar] [CrossRef]
  51. Bird, J.A.; Sánchez-Borges, M.; Ansotegui, I.J.; Ebisawa, M.; Martell, J.A.O. Skin as an immune organ and clinical applications of skin-based immunotherapy. World Allergy Organ. J. 2018, 11, 38. [Google Scholar] [CrossRef] [PubMed]
  52. Kumar, M.N.K.; Zhou, C.; Wu, M.X. Laser-facilitated epicutaneous immunotherapy to IgE-mediated allergy. J. Control. Release Off. J. Control. Release Soc. 2016, 235, 82–90. [Google Scholar] [CrossRef] [PubMed]
  53. Chen, X.; Shah, D.; Kositratna, G.; Manstein, D.; Anderson, R.R.; Wu, M.X. Facilitation of transcutaneous drug delivery and vaccine immunization by a safe laser technology. J. Control. Release Off. J. Control. Release Soc. 2012, 159, 43–51. [Google Scholar] [CrossRef] [PubMed]
  54. Tripp, C.H.; Voit, H.; An, A.; Seidl-Philipp, M.; Krapf, J.; Sigl, S.; Romani, N.; Del Frari, B.; Stoitzner, P. Laser-assisted epicutaneous immunization to target human skin dendritic cells. Exp. Dermatol. 2021, 30, 1279–1289. [Google Scholar] [CrossRef]
  55. Amani, H.; Shahbazi, M.-A.; D’Amico, C.; Fontana, F.; Abbaszadeh, S.; Santos, H.A. Microneedles for painless transdermal immunotherapeutic applications. J. Control. Release Off. J. Control. Release Soc. 2021, 330, 185–217. [Google Scholar] [CrossRef]
  56. Shakya, A.K.; Ingrole, R.S.J.; Joshi, G.; Uddin, M.J.; Anvari, S.; Davis, C.M.; Gill, H.S. Microneedles coated with peanut allergen enable desensitization of peanut sensitized mice. J. Control. Release Off. J. Control. Release Soc. 2019, 314, 38–47. [Google Scholar] [CrossRef]
  57. Landers, J.J.; Janczak, K.W.; Shakya, A.K.; Zarnitsyn, V.; Patel, S.R.; Baker, J.R.; Gill, H.S.; O’Konek, J.J. Targeted allergen-specific immunotherapy within the skin improves allergen delivery to induce desensitization to peanut. Immunotherapy 2022, 14, 539–552. [Google Scholar] [CrossRef]
  58. Brown-Whitehorn, T.F.; de Blay, F.; Spergel, J.M.; Green, T.D.; Peillon, A.; Sampson, H.A.; Campbell, D.E. Sustained unresponsiveness to peanut after long-term peanut epicutaneous immunotherapy. J. Allergy Clin. Immunol. Pract. 2021, 9, 524–526. [Google Scholar] [CrossRef]
  59. Fleischer, D.M.; Shreffler, W.G.; Campbell, D.E.; Green, T.D.; Anvari, S.; Assa’ad, A.; Bégin, P.; Beyer, K.; Bird, J.A.; Brown-Whitehorn, T.; et al. Long-term, open-label extension study of the efficacy and safety of epicutaneous immunotherapy for peanut allergy in children: PEOPLE 3-year results. J. Allergy Clin. Immunol. 2020, 146, 863–874. [Google Scholar] [CrossRef]
  60. Hong, T.S.; Hu, A.; Fahim, G.; Hermes-DeSantis, E.R. Emerging Therapies for Peanut Allergy. J. Pharm. Pract. 2022, 35, 289–297. [Google Scholar] [CrossRef]
  61. Zuberbier, T.; Wood, R.A.; Bindslev-Jensen, C.; Fiocchi, A.; Chinthrajah, R.S.; Worm, M.; Deschildre, A.; Fernandez-Rivas, M.; Santos, A.F.; Jaumont, X.; et al. Omalizumab, an anti-IgE monoclonal antibody that blocks the IgE receptor binding site, in IgE-Mediated Food Allergy: A Systematic Review and Meta-Analysis. J. Allergy Clin. Immunol. Pract. 2023, 11, 1134–1146. [Google Scholar] [CrossRef] [PubMed]
  62. Stranks, A.J.; Minnicozzi, S.C.; Miller, S.J.; Burton, O.T.; Logsdon, S.L.; Spergel, J.M.; Nadeau, K.C.; Pongracic, J.A.; Umetsu, D.T.; Rachid, R.; et al. IgE blockade during food allergen ingestion enhances the induction of inhibitory IgG antibodies. Ann. Allergy Asthma Immunol. Off. Publ. Am. Coll. Allergy Asthma Immunol. 2019, 122, 213–215. [Google Scholar] [CrossRef] [PubMed]
  63. Sindher, S.B.; Fiocchi, A.; Zuberbier, T.; Arasi, S.; Wood, R.A.; Chinthrajah, R.S. The Role of Biologics in the Treatment of Food Allergy. J. Allergy Clin. Immunol. Pract. 2024, 12, 562–568. [Google Scholar] [CrossRef] [PubMed]
  64. Schuetz, J.P.; Anderson, B.; Sindher, S.B. New biologics for food allergy. Curr. Opin. Allergy Clin. Immunol. 2024, 24, 147–152. [Google Scholar] [CrossRef] [PubMed]
  65. Wang, Y.; Hils, M.; Fischer, A.; Wölbing, F.; Biedermann, T.; Schnieke, A.; Fischer, K. Gene-edited pigs: A translational model for human food allergy against alpha-Gal and anaphylaxis. Front. Immunol. 2024, 15, 1358178. [Google Scholar] [CrossRef]
  66. Xu, Y.; Li, Z. CRISPR-Cas systems: Overview, innovations and applications in human disease research and gene therapy. Comput. Struct. Biotechnol. J. 2020, 18, 2401–2415. [Google Scholar] [CrossRef]
  67. Wang, M.; Schedel, M.; Gelfand, E.W. Gene editing in allergic diseases: Identification of novel pathways and impact of deleting allergen genes. J. Allergy Clin. Immunol. 2024, 154, 51–58. [Google Scholar] [CrossRef]
  68. Wang, M.; Strand, M.J.; Lanser, B.J.; Santos, C.; Bendelja, K.; Fish, J.; Esterl, E.A.; Ashino, S.; Abbott, J.K.; Knight, V.; et al. Expression and activation of the steroidogenic enzyme CYP11A1 is associated with IL-13 production in T cells from peanut allergic children. PLoS ONE 2020, 15, e0233563. [Google Scholar] [CrossRef]
  69. Dodo, H.W.; Konan, K.N.; Chen, F.C.; Egnin, M.; Viquez, O.M. Alleviating peanut allergy using genetic engineering: The silencing of the immunodominant allergen Ara h 2 leads to its significant reduction and a decrease in peanut allergenicity. Plant Biotechnol. J. 2008, 6, 135–145. [Google Scholar] [CrossRef]
  70. Wollenberg, A.; Ikeda, M.; Chu, C.-Y.; Eichenfield, L.F.; Seyger, M.M.B.; Prakash, A.; Angle, R.; Zhu, D.; Pontes, M.; Paller, A.S. Longer-term safety and efficacy of baricitinib for atopic dermatitis in pediatric patients 2 to <18 years old: A randomized clinical trial of extended treatment to 3.6 years. J. Dermatol. Treat. 2024, 35, 2411834. [Google Scholar] [CrossRef]
  71. Armario-Hita, J.C.; Pereyra-Rodriguez, J.J.; González-Quesada, A.; Herranz, P.; Suarez, R.; Galan-Gutiérrez, M.; Rodríguez-Serna, M.; Ortiz de Frutos, J.; Carrascosa, J.M.; Serra-Baldrich, E.; et al. Treatment of atopic dermatitis with abrocitinib in real practice in Spain: Efficacy and safety results from a 24-week multicenter study. Int. J. Dermatol. 2024, 63, e289–e295. [Google Scholar] [CrossRef] [PubMed]
  72. Zirpel, H.; Ludwig, R.J.; Olbrich, H.; Kridin, K.; Ständer, S.; Thaçi, D. Comparison of safety profile in patients with atopic dermatitis treated with dupilumab or conventional systemic treatment: Real world data from the US network. J. Dermatol. Treat. 2024, 35, 2421429. [Google Scholar] [CrossRef] [PubMed]
  73. Ireland, P.A.; Verheyden, M.; Jansson, N.; Sebaratnam, D.; Sullivan, J. Infection risk with JAK inhibitors in dermatoses: A meta-analysis. Int. J. Dermatol. 2024, 64, 24–36. [Google Scholar] [CrossRef]
  74. Perricone, C.; Pozzolo, R.D.; Cafaro, G.; Calvacchi, S.; Bruno, L.; Tromby, F.; Colangelo, A.; Gerli, R.; Bartoloni, E. Sudden improvement of alopecia universalis and psoriatic arthritis while receiving upadacitinib: A case-based review. Reumatismo 2024. [Google Scholar] [CrossRef] [PubMed]
Allergies 05 00005 g001
Figure 1. Current and emerging strategies in peanut allergy treatment and management.
Figure 1. Current and emerging strategies in peanut allergy treatment and management.
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Table 1. Current treatment options for peanut allergy.
Table 1. Current treatment options for peanut allergy.
Treatment ApproachDescriptionAdvantagesLimitations
Allergen AvoidanceAvoidance of peanuts and peanut-containing products.Reduces risk of anaphylaxis.Challenging due to inconsistent food labeling and risk of accidental exposure.
EpinephrineIntramuscular or intranasal administration during anaphylaxis.Definitive treatment for anaphylaxis.Requires immediate access; burden of self-carrying; cost may be prohibitive.
Antihistamines and CorticosteroidsAdjunctive treatments for symptom relief post-epinephrine administration.Relief of cutaneous symptoms and potential decrease in hospital stay.Ineffective for acute anaphylaxis; cannot prevent biphasic reactions.
Table 2. Comparison of immunotherapy approaches.
Table 2. Comparison of immunotherapy approaches.
Immunotherapy TypeDelivery MethodDose RangeKey AdvantagesCommon Side EffectsChallenges
OITOral ingestion of allergenMilligram-level dosesHigh efficacy; FDA-approved for peanut allergy.Gastrointestinal symptoms; systemic reactions.Psychological stress; long-term commitment.
SLITAllergen under the tongueMicrograms to low milligramsFewer severe reactions; home dosing possible.Oropharyngeal pruritus; mild systemic symptoms.Lower efficacy compared to OIT.
EPITAllergen patch on skinMicrogram dosesMinimizes severe reactions; child-friendly.Local site reactions (pruritus, redness).Limited human studies; lower desensitization.
Table 3. Key clinical studies on desensitization therapy and biological treatments for peanut allergy.
Table 3. Key clinical studies on desensitization therapy and biological treatments for peanut allergy.
TreatmentStudy/TrialNumber of SubjectsEfficacy RateFrequency of Side Effects
Oral Immunotherapy (OIT)PALISADE Trial (Peanut Allergy Oral Immunotherapy Study of AR101 for Desensitization)49667.2% tolerated 600 mg vs. 4% placebo95% had adverse events; 59.7% moderate; 4.3% severe
Sublingual Immunotherapy (SLIT)PITS (Peanut Sublingual Immunotherapy50 randomized60% desensitization vs. 0% placebo; 48% remission vs. 0% placebo Oropharyngeal itching more common in SLIT group; other adverse events similar
Epicutaneous Immunotherapy (EPIT)EPITOPE Trial (Epicutaneous Treatment of Peanut Allergy in Toddlers)362 randomized67% response vs. 33.5% placebo100% adverse events (mostly mild); 1.6% treatment-related anaphylaxis
Biologic Agents (e.g., Omalizumab)OUtMATCH Trial (Omalizumab as Monotherapy and as Adjunct Therapy to Multi-Allergen Oral Immunotherapy)177 randomized67% (peanut)More injection-site reactions in omalizumab group
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Satnarine, T.; Xavier de Almeida, A.; Woody, M.; Banegas Carballo, K.; Chan, D.; Thompson, P.; Kleiner, G.; Gans, M. Emerging Treatment Options for Peanut Allergy. Allergies 2025, 5, 5. https://doi.org/10.3390/allergies5010005

AMA Style

Satnarine T, Xavier de Almeida A, Woody M, Banegas Carballo K, Chan D, Thompson P, Kleiner G, Gans M. Emerging Treatment Options for Peanut Allergy. Allergies. 2025; 5(1):5. https://doi.org/10.3390/allergies5010005

Chicago/Turabian Style

Satnarine, Travis, Alana Xavier de Almeida, Malaika Woody, Krisia Banegas Carballo, Diana Chan, Pytregay Thompson, Gary Kleiner, and Melissa Gans. 2025. "Emerging Treatment Options for Peanut Allergy" Allergies 5, no. 1: 5. https://doi.org/10.3390/allergies5010005

APA Style

Satnarine, T., Xavier de Almeida, A., Woody, M., Banegas Carballo, K., Chan, D., Thompson, P., Kleiner, G., & Gans, M. (2025). Emerging Treatment Options for Peanut Allergy. Allergies, 5(1), 5. https://doi.org/10.3390/allergies5010005

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