Threshold Oral Food Challenge Can Delabel Infants With Peanut Allergy

THURSDAY, Nov. 12, 2026 (HealthDay News) — Use of threshold oral food challenges (TOFC) to confirm peanut allergy before starting oral immunotherapy (OIT) enables early delabeling of infants with prior reactions to peanuts and sensitization, according to a study published online Nov. 4 in The Journal of Allergy and Clinical Immunology: In Practice.

Timothy Brettig, M.B.B.S., Ph.D., from the National Allergy Centre of Excellence in Parkville, Australia, and colleagues examined the diagnostic accuracy and safety of TOFC to confirm peanut allergy and determine an OIT starting dose before initiating OIT. Infants aged younger than 12 months with a history of Consortium for Food Allergy Research grade 1 to 2 reaction to peanut and sensitization were eligible.

A total of 1,275 infants were assessed; of these infants, 778 underwent TOFC. The researchers found that TOFC were positive in 65.2 percent, with a median eliciting dose of 120 mg. Overall, 12 percent of positive OFC had anaphylaxis. Compared with negative TOFC, positive TOFC had higher median skin prick test and Ara h 2-specific immunoglobulin E results; the reaction threshold and severity were not predicted. Overall, 97.5 percent of the 394 infants initiating OIT successfully initiated treatment at a dose below the TOFC-determined threshold.

“We found more than one-third of infants who were suspected to have peanut allergy based on their history and initial tests no longer reacted when they underwent a supervised food challenge,” Brettig said in a statement. “Being able to identify those children early allows them to avoid an unnecessary allergy label and the burden of avoiding peanut.”

Several authors disclosed ties to the biopharmaceutical industry.

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