The natural history of peanut allergy

Background: It has traditionally been assumed that peanut allergy is rarely outgrown. Objective: The goal of this study was to determine the number of children w ith peanut allergy who become tolerant of peanut. Methods: Patients aged 4 to 20 years with a diagnosis of peanut allergy wer e evaluated by questionnaire, skin testing, and a quantitative antibody flu orescent-enzyme immunoassay. Patients who had been reaction free in the pas t year and had a peanut IgE (PN-IgE) level less than 20 kilounits of antibo dy per liter (kU(A)/L) were offered an open or double-blind, placebo-contro lled peanut challenge. Results: A total of 223 patients were evaluated, and of those, 85 (PN-IgE < 0.35-20.4 kU(A)/L [median 1.42 kU(A)/L]) participated in an oral peanut ch allenge. Forty-eight (21.5%) patients had negative challenge results and we re believed to have outgrown their peanut allergy (aged 4-17.5 years [media n 6 years]; PN-IgE < 0.35-20.4 kU(A)/L [median 0.69 kU(A)/L]). Thirty-seven failed the challenge (aged 4-13 years [median 6.5 years]; RAST < 0.35-18.2 kU(A)/L [median 2.06 kU(A)/L]). Forty-one patients with PN-IgE levels less than 20 kU(A)/L declined to undergo challenge, and 97 were not eligible fo r challenge because their PN-IgE levels were greater than 20 kU(A)/L or the y had had a recent reaction. Sixty-seven percent of patients with PN-IgE le vels less than 2 kU(A)/L and 61% with levels less than 5 kU(A)/L had negati ve challenge results. Of those who underwent challenge, PN-IgE levels for t hose who passed versus those who failed were different at the time of chall enge (P = .009), but not at the time of diagnosis (P = .25). Conclusion: This study demonstrates that peanut allergy is outgrown in abou t 21.5% of patients. Patients with low PN-IgE levels should be offered a pe anut challenge in a medical setting to demonstrate whether they can now tol erate peanuts.