More than one in three Australian babies thought to have a peanut allergy do not have the condition, according to a landmark study set to overhaul how food allergies are diagnosed and managed.
The Murdoch Children’s Research Institute and the National Allergy Centre of Excellence, collaborating with 10 paediatric hospitals across Australia, found that 35 per cent of babies who had recently reacted to peanut butter and tested positive on skin-prick or blood tests could safely eat the legume during a medically supervised oral food challenge.
The findings were published in the Journal of Allergy and Clinical Immunology: In Practice.
Professor Kirsten Perrett, director of the National Allergy Centre of Excellence, described the findings as a paradigm shift. “The gold-standard test, the oral food challenge, should be considered in young children so peanuts can safely be reintroduced immediately back into their diet if they do not react,” she said.
The discovery emerged from the ADAPT oral immunotherapy program. Of the 778 babies enrolled in the program, 271 passed the oral food challenge and could lose their peanut allergy label.
Australia has one of the highest reported rates of childhood food allergies, with peanut allergy affecting about one in 30 children. The researchers believe some infants may show a transient allergy that resolves within about six months, or that an initial reaction does not translate to an ongoing one with further exposure.
Among the babies cleared was Arthur, who broke out in hives at five months old after eating a teaspoon of peanut butter. His family had to travel to Melbourne for the oral food challenge at the Royal Children’s Hospital. Ten months after his initial reaction, Arthur passed the test. “It’s a bit weird after avoiding it for so long,” his mother, Leah, said. “But it’s also reassuring every time that he’s fine and there’s no response.”
About 65 per cent of babies did react during the challenge, with 12 per cent experiencing anaphylaxis. The researchers warned parents to never reintroduce allergens that have triggered a previous reaction without oversight from an allergy specialist.
Access to oral food challenges remains a challenge. Public hospital clinics face heavy demand, while the ADAPT program has limited capacity and treats only babies. In the private sector, families often face hundreds of dollars in out-of-pocket costs because Medicare does not have a dedicated item number for oral food challenges. Clinicians hope to expand the approach to other allergens, most likely cashew, the most common tree nut allergy in Australia. It remains unknown how the findings will affect the diagnosis of food allergies in older children and adults.
Analysis
Why This Matters
- The study challenges the decades-old practice of strict peanut avoidance for infants who react and test positive, potentially freeing thousands of families from unnecessary dietary restrictions and anxiety.
- It exposes the limits of standard skin-prick and blood tests, positioning the resource-intensive oral food challenge as the true diagnostic gold standard.
- The findings highlight a major equity issue: access to these definitive tests is heavily concentrated in major cities and often requires significant out-of-pocket costs.
Background
Australia has one of the highest rates of food allergies in the world. Until now, standard practice dictated that babies who showed a reaction to peanut and tested positive through a skin prick or blood test were told to strictly avoid the allergen. The ADAPT program, spanning ten hospitals, was designed to treat infants through oral immunotherapy but unexpectedly revealed that a significant portion were not allergic at all.
Key Perspectives
Prof. Kirsten Perrett, director of the National Allergy Centre of Excellence: The findings are paradigm-shifting and should make the oral food challenge the standard diagnostic tool for infant peanut allergy.
Leah, mother of Arthur: The result was life-changing, but she is calling for better access to oral food challenges, particularly for families in regional Australia who must travel long distances.
ADAPT program researchers: Warn parents against attempting these challenges at home, noting that a majority of babies in the study did have a reaction during testing.
What to Watch
- Whether the ADAPT program is expanded to other common allergens, beginning with cashew.
- Whether Medicare or state health systems introduce dedicated funding for oral food challenges to improve access.
- How national health guidelines and clinical practice evolve in response to the study's findings.
Checked
12 claims in this story checked against 1 source: 11 supported.
Show each claim
- Partly supportedA world-first study found one in three babies cleared of peanut allergy.The Age - Latest News: “One in three babies with suspected peanut allergies cleared of the condition in landmark study.”
- SupportedProfessor Kirsten Perrett said oral food challenges should be considered for young children because a reaction history plus positive tests is insufficient to confirm allergy in many babies.The Age - Latest News: “Perrett said a history of a reaction, plus a positive skin-prick or a blood test, was insufficient to confirm a diagnosis in many babies. “The gold-standard test, the oral food challenge, should be considered in young children so peanuts can safely be reintroduced immediately back into their diet if they do not react,” she said.”
- SupportedMore than one in three Australian babies thought to have a peanut allergy do not have the condition.The Age - Latest News: “More than one in three Australian babies thought to have a peanut allergy do not have the condition, according to a landmark study set to overhaul how food allergies are diagnosed and managed.”
- SupportedThe study found that 35 per cent of babies who had recently reacted to peanut butter and tested positive on a skin-prick or blood test could safely eat peanut during a medically supervised oral food challenge.The Age - Latest News: “35 per cent of babies who had recently reacted to peanut butter, and also tested positive through a skin prick or blood test, could safely eat the legume without reacting during a medically supervised oral food challenge.”
- SupportedThe Murdoch Children’s Research Institute and the National Allergy Centre of Excellence collaborated with 10 paediatric hospitals across Australia on the study.The Age - Latest News: “a world-first study led by the Murdoch Children’s Research Institute and the National Allergy Centre of Excellence, in collaboration with 10 paediatric hospitals across Australia”
- SupportedPerrett described the findings as a paradigm shift.The Age - Latest News: ““It’s paradigm-shifting in terms of how we diagnose infant peanut allergy,” said MCRI population allergy group leader and NACE director Professor Kirsten Perrett.”
- SupportedThe finding emerged from the ADAPT oral immunotherapy program, in which 271 of 778 babies passed the oral food challenge and could lose their allergy label.The Age - Latest News: “A total of 271 of the 778 babies involved in the program passed the oral food challenge, which meant they could lose their allergy label.”
- SupportedThe researchers believe some infants may have a transient allergy that resolves within about six months, or an initial reaction that does not continue with further exposure.The Age - Latest News: “The researchers believe some infants may show a “transient allergy”, which might include hives and swelling, which resolves within a short timeframe of around six months. Another theory is that their initial reaction does not translate to an ongoing reaction with further exposure.”
- SupportedArthur broke out in hives after eating peanut butter at five months old, travelled with his family to the Royal Children’s Hospital for a challenge, and passed it 10 months after his reaction.The Age - Latest News: “When Arthur was five months old, he broke out in hives after eating a teaspoon of peanut butter. [...] He was also referred to the ADAPT program at the Royal Children’s Hospital where, to the surprise of his parents, he passed an oral food challenge 10 months after his initial reaction.”
- SupportedArthur’s mother, Leah, said: “It’s a bit weird after avoiding it for so long. But it’s also reassuring every time that he’s fine and there’s no response.”The Age - Latest News: ““It’s a bit weird after avoiding it for so long,” she said. “But it’s also reassuring every time that he’s fine and there’s no response.””
- SupportedAbout 65 per cent of babies reacted during the challenge, with 12 per cent experiencing anaphylaxis.The Age - Latest News: “About 65 per cent of babies had a reaction during the oral food challenge, with 12 per cent experiencing anaphylaxis.”
- SupportedFamilies in the private sector often face hundreds of dollars in out-of-pocket costs because Medicare has no dedicated item number for oral food challenges.The Age - Latest News: “In the private sector, families often face hundreds of dollars in out-of-pocket costs because Medicare does not have a dedicated item number for oral food challenges.”
