Peanut allergy delabelling or oral immunotherapy (OIT) for infants at Epworth.

Abstract

The HealthNuts study identified peanut allergy occurs in 3% of infants in Melbourne. With 70% of cases persisting beyond childhood, the traditional strategy of strict avoidance offers limited benefit and poses ongoing risk from accidental ingestion and anaphylaxis. Peanut OIT is a therapy that aims to increase an infant’s threshold before reacting to peanut, thereby improving safety and quality of life for parents. Infants with a confirmed peanut allergy—defined by positive SPT or serum IgE and clinical history—will be evaluated. The vast majority will undergo inpatient OFC to determine reactivity threshold unless there is a history of severe reaction (Grade 3–4 anaphylaxis). Preliminary data shows 35–40% of infants with diagnosed peanut allergy are tolerant at OFC, allowing for delabelling. This significantly alters long-term food allergy trajectory for these children. Over the past year, the ADAPT OIT program has been implemented in 12 public paediatric tertiary centres across Australia. The Royal Children’s Hospital in Melbourne is the sole site providing this care in Victoria, but without added funding or infrastructure, demand far exceeds capacity.