May 11, 2023/Allergies

Could There Be a Cure for Peanut Allergies in Children?

New treatment offers hope for outgrowing the life-threatening condition

A piece of toast with creamy peanut butter surrounded by cracked peanuts

If your child has a life-threatening peanut allergy, ongoing research suggests they may be able to grow up and do the unthinkable: Eat and enjoy a peanut butter and jelly sandwich.


Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

A treatment program focused on peanut-allergic preschoolers and babies has proven effective at helping children overcome their food allergy, says allergists Sandra Hong, MD, and Jaclyn Bjelac, MD.

It’s a life-changing — and perhaps lifesaving — outcome. Let’s learn more from Dr. Hong and Dr. Bjelac, part of the leadership team at Cleveland Clinic’s Food Allergy Center of Excellence.

The need for peanut allergy treatment

Currently, it’s estimated that nearly 1.5 million children in the United States live with a peanut allergy. They wake up every day with the knowledge that one bite of the oh-so-prevalent food could be deadly.

A food allergy is a condition where your body’s immune system identifies a food (such as peanuts) as harmful. Your immune system launches into attack mode and releases antibodies to combat the threat.

The reaction can lead to hives, vomiting or — in worst-case scenarios — constrict airways and lead to death. “The percentage of fatal food allergy reactions is disproportionately attributable to peanuts in the United States,” says Dr. Bjelac.

Facts about peanut allergies

Peanuts are one of the nine major food allergens that cause the most serious allergic reactions. More than 6.1 million people in the United States have a peanut allergy. It’s the most common allergy among children.

Approximately 200,000 people a year in the United States land in the emergency room due to a food allergy reaction, such as anaphylaxis. That’s equal to one ER trip every three minutes of every day.

Digging deeper into the numbers, more than 40% of children with food allergies have experienced a severe allergic reaction.

A cure for peanut allergies?

Ready for an irony? It seems the best way to help children overcome peanut allergies is to slowly expose them to the food.

An early peanut oral immunotherapy (EPOIT) treatment program developed at Cleveland Clinic has been effective at “reteaching the immune system to stop overreacting to peanuts,” explains Dr. Hong.


In the program, children age 4 and younger who are allergic to peanuts built a tolerance to peanuts by ingesting minuscule amounts of the food in a step-by-step, allergist-supervised process. Doses are increased gradually over many months.

The minimal goal is to help these children achieve at least “bite-proof” tolerance to peanuts, meaning they can consume nearly two peanut kernels without a reaction. That guards against an accidental nibble of a food with peanuts leading to a health emergency.

“That can be hugely liberating,” says Dr. Bjelac. “If you bite into a cookie and suddenly realize it has peanut in it, nothing should happen. It’s a level of protection that wasn’t there before.”

Even better? Many participants in the treatment program see their immune system response change so much that they can fully eat peanut products. (Read about one child’s successful experience.)

“They can live their lives as if they never had a peanut allergy,” Dr. Bjelac adds.

Peanut allergy treatment process

The key with EPOIT is the age of the participants, as reactions to food allergens typically are less severe in early childhood. “Their immune system is so malleable, so flexible, that they can tolerate it,” notes Dr. Hong. “There is this narrow window where we can do this.”

The series of peanut challenges given to participants involve tiny amounts of the food. In the initial treatment cycle, for example, the daily dose is 8 milligrams of peanut protein. Small increases follow every two weeks if there aren’t any setbacks.

Every uptick in peanut butter dosage takes place in an allergist’s office in case there’s a reaction. (“This is not something you do at home,” stresses Dr. Hong.) The child is monitored for an hour after the higher dose.

The process takes about four to six months, with maintenance dosing then continuing for at least a year.

Of the children in the Cleveland Clinic program, more than 80% develop “bite-proof” tolerance or are building up to that level. “For us to be able to help someone move past a food allergy — it’s the most rewarding part of our careers,” says Dr. Hong.

Changes in food allergy treatment

Building tolerance to an allergen through exposure is a relatively new concept and a reversal from clinical guidelines shared by allergists just a decade ago.


As food allergy numbers began spiking in the 1990s, doctors recommended that allergenic foods such as milk, eggs and peanuts be removed from the diets of children with a high risk of allergies.

But that thinking began to change, as research showed that eliminating specific foods didn’t slow the development of food allergies. In fact, the groundbreaking Learning Early About Peanut (LEAP) allergy study in 2015 found that peanut allergies decreased in at-risk children with an early introduction of the food.

“It was completely the opposite of what we had believed,” notes Dr. Hong.

Another outgrowth of the study? In 2017, the National Institute of Allergy and Infectious Diseases recommended that peanuts be introduced to infants as young as 4 months old to help prevent a peanut allergy from emerging.

The future outlook for children with peanut allergies

Currently, 1 in 5 children with a peanut allergy outgrows the condition before adulthood. Dr. Hong and Dr. Bjelac say treatment advances could reverse those numbers, with as many as 4 in 5 children leaving their peanut worries behind with the boogeyman and other childhood fears.

In 2020, the U.S. Food and Drug Administration (FDA) approved a medication called Palforzia® to lessen allergic reactions to peanuts in children ages 4 to 17. It’s the first treatment drug for children with peanut allergies.

In addition, there’s work being done on epicutaneous immunotherapy, where a patch with small amounts of peanut allergen sends peanut protein through the skin to build tolerance.

Dr. Hong believes the number of children with severe peanut allergies will soon begin to decline.

“We’re moving toward a cure,” she says, “and a lot less worry for families.”

Learn more about our editorial process.

Related Articles

child at lunch with allergies
April 24, 2023/Children's Health
Protection Plan: What To Do if Your Child Has a Peanut Allergy

Be prepared, read up, team up, trust your gut and advocate

female on couch, holding mug, under blanket, blowing nose, cat on couch
January 22, 2024/Allergies
Why Are My Allergies Acting Up in Winter?

Indoor allergens know no season!

Aspirin poured onto table from bottle
December 6, 2023/Allergies
Why You’re Sensitive to Aspirin

A reaction to the medication may trigger preexisting asthma and result in sinus or skin reactions

person with fall allergies
October 30, 2023/Allergies
Achoo! Learn More About Fall Allergies

Autumn allergens typically begin to bloom — and release their pesky pollen — around August

While sitting on floor, parent wipes toddler's nose with tissue.
August 1, 2023/Allergies
Does Your Kid Have Seasonal Allergies? How To Tell and How To Help

Sneezing, coughing and clear mucus shouldn’t be ignored

person sneezing while walking on sidewalk
July 9, 2023/Allergies
Why Do You Sneeze When You Look at the Sun?

ACHOO syndrome is your trigeminal nerve’s exaggerated response to bright light

person blowing their nose outside
May 16, 2023/Allergies
Allergies Don’t Cause a Fever — At Least, Not Directly

Infections like sinusitis, colds, flu and COVID-19 can cause a fever, but allergies aren’t infections

nasal spray
May 15, 2023/Allergies
This Is Why Your Nasal Spray Stopped Working (and What To Do About It)

‘Rebound congestion’ happens when your body starts to rely on decongestant nasal spray

Trending Topics

Person in yellow tshirt and blue jeans relaxing on green couch in living room reading texts on their phone.
Here’s How Many Calories You Naturally Burn in a Day

Your metabolism may torch 1,300 to 2,000 calories daily with no activity

woman snacking on raisins and nuts
52 Foods High In Iron

Pump up your iron intake with foods like tuna, tofu and turkey