Receiving the diagnosis of a peanut allergy can be concerning for individuals and parents of younger children. Thinking about avoiding peanuts, peanut butter, and foods that contain peanuts can be discouraging when they’ve been a beloved and nutritious food. The diagnosis leads to many questions and one of the first may be “Can you outgrow a peanut allergy?” The short answer is maybe. The immune system is dynamic, which means that it is possible to become tolerant of peanuts, even after a diagnosis of peanut allergy. Fortunately, not all peanut allergies are lifelong, and some people will naturally outgrow their allergy. Along with the encouraging news about potential new treatments on the horizon, a diagnosis of peanut allergy today does not necessarily mean peanut allergy for a lifetime.
What do we know about the natural history of peanut allergy?
When you hear the phrase “natural history” in this context, we’re talking about the natural progression or prognosis of the condition of being allergic to peanut proteins. Said differently, the natural history is what may happen if an individual develops a peanut allergy and no specific intervention (such as immunotherapy currently under FDA review) is conducted. In an Australian study of 156 challenge-proven peanut allergic children, 22% outgrew their peanut allergy by age 4. (Peters, 2015) Limitations to this study includes loss of follow up due to attrition and that less than half of the participants provided a blood sample at 4 years old, meaning the results were based on a reduced sample size.
Can we identify children most likely to outgrow their peanut allergy?
The short answer to this question is…maybe. According to a study of 391 food allergy children, those with a specific IgE of 2kUA/L or lower to peanut were 59% likely to pass an oral food challenge, suggesting that the higher the IgE level, the less likely an individual is to pass the challenge (and the other way around). This study provides useful guidance for clinicians and individuals with allergy on when oral food challenges might be warranted based on the greatest chance of passing, yet is limited based on specific and patient risk factors. If and when to perform oral food challenges should be determined as a shared decision between physician and patient based on individual needs.
In addition, annual monitoring of IgE blood levels trending down can give a clue to changes in the immune system that could signal resolution, according to experts. Yet, the only way to know for sure whether a child has outgrown their allergy is to perform an oral food challenge. In an oral food challenge, an individual diagnosed with peanut allergy eats small and increasing amounts of peanut foods in a structured and medically supervised setting, until either a reaction occurs or a full serving has been consumed without a reaction.
The bottom line for individuals with peanut allergy is to continue to work closely with a board certified allergist to determine the natural progression of a peanut allergy and to determine whether resolution is likely to occur on its own. The good news is that some individuals will outgrow their peanut allergy. For those that do not, avoidance is the recommendation, and treatments are on the horizon. Learn more about breakthroughs in the treatment of peanut allergies here.