Peanut Allergy
Natural History and Early Intervention
Peanut allergy typically presents early in life and persists into adulthood1-3
Peanut allergy is a prevalent, clinically significant food allergy that typically presents in the first years of life, often with the first known ingestion, and does not resolve on its own for most children.1,4-6
≈1.6
million children in the US have peanut allergy5
Up to 80%
Remain allergic into adulthood2,3,7
InfancyChildhoodAdolescenceAdulthood
Intervention and early diagnosis have the potential to change the trajectory of peanut allergy and help improve long-term outcomes8,9
Peanut allergy management is shifting from solely avoidance and emergency preparedness toward proactive immunotherapy aimed at desensitization.7,10
Lower peanut allergy prevalence with early peanut consumption
In the LEAP trial, high-risk infants assigned to early peanut consumption had a lower prevalence of peanut allergy at 60 months of age vs those assigned to peanut avoidance.11*
*3.2% vs 17.2%; P<0.001; intent-to-treat analysis, both cohorts combined.
Younger immune systems may be more easily modified
Data from LEAP and other immunotherapy studies suggest this is likely due to lower levels of allergen-specific lgE.12-16
Early intervention may improve the likelihood of desensitization
Immune plasticity may also support sustained unresponsiveness when treatment begins early.17-20
Reactions can be unpredictable and severe, regardless of prior history5,21
Even among people who actively avoid peanut, accidental exposure is common and can have serious consequences.22,23
≈50%of patients with peanut allergy reported a subsequent reaction following accidental exposure22,24
≈33% to 50%of accidental exposures may result in anaphylaxis23
59.2%
of children with peanut allergy have experienced a prior severe reaction5
39%
of pediatric anaphylaxis ICU admissions are caused by peanut allergy, making it the leading cause of pediatric anaphylaxis ICU admissions in North America25
Explore the skin’s potential as a route for food allergy immunotherapy
Why the skin?Treatment Landscape and Unmet Needs
Approved therapies can reduce reaction frequency and severity, but treatment-related risks and limitations remain.7,10,22,23,26,27
Benefits17,18,20,26-29
- Desensitization (reaction threshold shift)
- Reduced reaction severity
- Potential for incorporating the food into daily life, if desired
- Improved quality of life
- Empowerment
Limitations and Considerations20,26,29-35
- Reactions (potentially severe)
- Eosinophilic esophagitis
- Fear of injections
- Lifestyle restrictions
- Eligibility/appropriateness
- Daily ingestion
- High treatment burden
There is a need for a treatment approach that is safe; has a low burden for patients, families, and providers; and has the potential for disease modification.29,36
Characteristics of an ideal food allergy treatment
Efficacy28,29,36
Desensitization and reduction in reaction severity, with the potential for disease modification
Safety and Tolerability29,36
A favorable and predictable safety and tolerability profile
Practicality28,29,36
Easy administration, minimal clinical infrastructure, and no restrictions on daily life
03 — Living With Peanut Allergy
Living With Peanut Allergy
Peanut allergy disrupts daily activities, social participation, and emotional well-being23,37
Peanut allergy affects daily life and emotional well-being for patients and families, demanding constant vigilance around food and contributing to social exclusion and anxiety.37-39
EXPERT PERSPECTIVE · 00:24
“Peanut-allergic individuals have a huge emotional burden to carry. And unfortunately, that also transmits to the family… the allergy becomes a part of everyday life. It is a new normal.”Hear more about living with peanut allergy
Connect With Our Medical Affairs Team
Submit a medical information inquiry or contact your local Medical Science Liaison.
- 1. Al-Muhsen S, Clarke AE, Kagan RS. Peanut allergy: an overview. CMAJ. 2003;168(10):1279-1285.
- 2. Warren C, Lei D, Sicherer S, Schleimer R, Gupta R. Prevalence and characteristics of peanut allergy in US adults. J Allergy Clin Immunol. 2021;147(6):2263-2270.e5.
- 3. Lee ECK, Trogen B, Brady K, Ford LS, Wang J. The natural history and risk factors for the development of food allergies in children and adults. Curr Allergy Asthma Rep. 2024;24(3):121-131.
- 4. Lack G, Fox D, Northstone K, Golding J; Avon Longitudinal Study of Parents and Children Study Team. Factors associated with the development of peanut allergy in childhood. N Engl J Med. 2003;348(11):977-985.
- 5. Gupta RS, Warren CM, Smith BM, et al. The public health impact of parent-reported childhood food allergies in the United States. Pediatrics. 2018;142(6):e20181235.
- 6. Peters RL, Guarnieri I, Tang MLK, et al. The natural history of peanut and egg allergy in children up to age 6 years in the HealthNuts population-based longitudinal study. J Allergy Clin Immunol. 2022;150(3):657-665.e13.
- 7. Santos AF, Riggioni C, Agache I, et al. EAACI guidelines on the management of IgE-mediated food allergy. Allergy. 2025;80(1):14-36.
- 8. Roberts G, Bahnson HT, Du Toit G, et al. Defining the window of opportunity and target populations to prevent peanut allergy. J Allergy Clin Immunol. 2023;151(5):1329-1336.
- 9. Gupta RS, Epstein E, Wood RA. The role of pediatricians in the diagnosis and management of IgE-mediated food allergy: a review. Front Pediatr. 2024;12:1373373.
- 10. Satnarine T, Xavier de Almeida A, Woody M, et al. Emerging treatment options for peanut allergy. Allergies. 2025;5(1):5.
- 11. Du Toit G, Roberts G, Sayre PH, et al; LEAP Study Team. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372(9):803-813.
- 12. Mahr TA, Lieberman JA, Haselkorn T, et al. Characteristics of peanut allergy diagnosis in a US health care claims database (2011-2017). J Allergy Clin Immunol Pract. 2021;9(4):1683-1694.e5.
- 13. Fleischer DM, Sicherer S, Greenhawt M, et al. Consensus communication on early peanut introduction and the prevention of peanut allergy in high-risk infants. Allergy Asthma Clin Immunol. 2015;11(1):23.
- 14. Togias A, Cooper SF, Acebal ML, 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. J Allergy Clin Immunol. 2017;139(1):29-44.
- 15. Fleischer DM, Chan ES, Venter C, et al. A consensus approach to the primary prevention of food allergy through nutrition: guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical Immunology. J Allergy Clin Immunol Pract. 2021;9(1):22-43.e4.
- 16. Gabryszewski SJ, Dudley J, Faerber JA, et al. Guidelines for early food introduction and patterns of food allergy. Pediatrics. 2025;156(5):e2024070516.
- 17. Vickery BP, Berglund JP, Burk CM, et al. Early oral immunotherapy in peanut-allergic preschool children is safe and highly effective. J Allergy Clin Immunol. 2017;139(1):173-181.e8.
- 18. Jones SM, Kim EH, Nadeau KC, 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(10322):359-371.
- 19. Smeekens JM, Kulis MD, Kim EH, Patil SU. Induction of tolerance to food allergens—“Younger is better.” Pediatr Allergy Immunol. 2025;36(10).
- 20. Mustafa SS, Capucilli P, Tuong L-A, Sanchez-Tejera D, Vadamalia K, Ramsey A. Infant and toddler peanut oral immunotherapy: initiation before age 2 increases ad libitum peanut consumption. J Allergy Clin Immunol Pract. 2025;13(4):885-892.
- 21. Cherkaoui S, Ben-Shoshan M, Alizadehfar R, et al. Accidental exposures to peanut in a large cohort of Canadian children with peanut allergy. Clin Transl Allergy. 2015;5:16.
- 22. Kansen HM, Le TM, Knulst AC, et al. Three-year follow-up after peanut food challenges: accidental reactions in allergic children and introduction failure in tolerant children. J Allergy Clin Immunol. 2020;145(2):705-707.e7.
- 23. Lieberman JA, Gupta RS, Knibb RC, et al. The global burden of illness of peanut allergy: a comprehensive literature review. Allergy. 2021;76(5):1367-1384.
- 24. Sicherer SH, Furlong TJ, Muñoz-Furlong A, Burks AW, Sampson HA. A voluntary registry for peanut and tree nut allergy: characteristics of the first 5149 registrants. J Allergy Clin Immunol. 2001;108(1):128-132.
- 25. Ramsey NB, Guffey D, Anagnostou K, Coleman NE, Davis CM. Epidemiology of anaphylaxis in critically ill children in the United States and Canada. J Allergy Clin Immunol Pract. 2019;7(7):2241-2249.
- 26. XOLAIR (omalizumab). Prescribing information. Genentech, Inc.; 2024.
- 27. Allergy & Asthma Network. Peanut allergy treatment. Published June 19, 2025. Accessed January 6, 2026. https://allergyasthmanetwork.org/food-allergies/peanut-allergy-treatment/
- 28. Greenhawt M, Marsh R, Gilbert H, Sicherer S, DunnGalvin A, Matlock D. Understanding caregiver goals, benefits, and acceptable risks of peanut allergy therapies. Ann Allergy Asthma Immunol. 2018;121(5):575-579.
- 29. Ravindran M, Sampson HA, Kim EH, Bee KJ, Green TD, Burks AW. Epicutaneous immunotherapy for the treatment of peanut allergy. Allergy. 2025;80(1):63-76.
- 30. Greenhawt M, Fleischer D. Considerations for a shared decision-making conversation when initiating food oral immunotherapy. J Food Allergy. 2022;4(2):53-59.
- 31. Sampson HA, Bird JA, Fleischer D, Shreffler WG, Spergel JM. Who are the potential patients for omalizumab for food allergy? Ann Allergy Asthma Immunol. 2024;132(5):569-571.
- 32. Parrish CP. Management of peanut allergy: a focus on novel immunotherapies. Am J Manag Care. 2018;24(19 suppl).
- 33. Hund SK, Sampath V, Zhou X, Thai B, Desai K, Nadeau KC. Scientific developments in understanding food allergy prevention, diagnosis, and treatment. Front Immunol. 2025;16:1572283.
- 34. Chagarlamudi H, Smith HG, Kim EH. A review of sublingual immunotherapy for treatment of peanut allergy. J Food Allergy. 2025;7(1):14-20.
- 35. Anagnostou A, Bird JA, Chinthrajah S, et al. The use and implementation of omalizumab as food allergy treatment: consensus-based guidance and Work Group Report of the Adverse Reactions to Foods Committee of the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2025;155(1):62-69.e1.
- 36. Anagnostou A. Shared decision-making in food allergy: navigating an exciting era. Ann Allergy Asthma Immunol. 2024;132(3):313-320.
- 37. Couratier P, Montagne R, Acaster S, et al. Allergy to Peanuts imPacting Emotions And Life (APPEAL): the impact of peanut allergy on children, adolescents, adults and caregivers in France. Allergy Asthma Clin Immunol. 2020;16:86.
- 38. Dahlsgaard KK, Lewis MO. Want to help your patients with food allergy anxiety? Do proximity challenges! Ann Allergy Asthma Immunol. 2025;134(5):525-532.
- 39. Kachru R. Psychosocial issues and quality of life associated with food allergy. J Food Allergy. 2020;2(1):95-98.
Epicutaneous immunotherapy is under clinical investigation and has not yet been approved by any health or regulatory authority.