New research reveals many infant peanut allergy diagnoses may be incorrect

Consensus Summary

A landmark study has revealed that up to 35 per cent of infants diagnosed with peanut allergies may not actually be allergic, according to findings from the ADAPT Peanut Oral Immunotherapy Program. Researchers from the Murdoch Children’s Research Institute and the National Allergy Centre of Excellence (NACE) conducted oral food challenges on infants who had previously reacted to peanuts and tested positive for allergies. Surprisingly, a third of these infants showed no reaction during the challenge, suggesting their initial diagnoses were incorrect. The study involved hundreds of infants across multiple Australian states, with both ABC and 7NEWS reporting on the groundbreaking results that could reshape how peanut allergies are diagnosed in babies.

The research builds on growing concerns that many peanut allergy diagnoses in infants may be overstated. Historically, allergies have been confirmed through clinical history and blood or skin tests, but the new study demonstrates that these methods alone are insufficient. The ADAPT program, launched in 2024, required infants to undergo supervised oral food challenges before starting immunotherapy. This approach not only identified false positives but also provided a pathway for infants to safely reintroduce peanuts into their diets. The findings underscore the importance of oral challenges in confirming diagnoses, as they reveal cases where infants might have outgrown their sensitivity or never had a true allergy.

Key figures in the study emphasized the emotional and practical impact of misdiagnoses. Professor Kirsten Perrett, director of NACE, told ABC that the results were ‘surprising,’ as many infants with a history of reactions and positive tests did not react during the challenge. Similarly, Tim Brettig, a senior clinician involved in the study, expressed excitement to 7NEWS about the high rate of non-reaction, noting that it could reduce unnecessary dietary restrictions for families. Parents like Leah and Jake Cameron, whose son Arthur had his allergy diagnosis removed after the challenge, shared their relief, describing the adjustment of avoiding peanuts as stressful and anxiety-inducing. Their story highlights the real-world consequences of incorrect diagnoses.

While both sources agree on the core findings, there are differences in the specifics. ABC reports the study involved 1,275 infants under 18 months, whereas 7NEWS focuses on 778 infants who underwent the oral challenge. Additionally, ABC provides broader context about the study’s collaboration with 10 hospitals and mentions potential expansion to cashew allergies, while 7NEWS highlights the emotional relief for parents and the unexpected nature of the results. Both outlets stress the need for controlled environments during oral challenges, given that 12 per cent of infants experienced anaphylactic reactions during testing, but they frame the risks differently—ABC emphasizes the logistical challenges for GPs, while 7NEWS focuses on the controlled setting required for safety.

The study’s implications extend beyond individual families, as it could lead to broader changes in how peanut allergies are managed in Australia. Researchers suggest that oral food challenges should become a standard part of allergy diagnosis, though they caution that these tests must be conducted in medical settings due to the risks involved. The findings also raise questions about why some infants initially react to peanuts but later tolerate them without issue. While the study provides clear evidence of overdiagnosis, it does not yet explain the underlying mechanisms. Moving forward, the focus will likely remain on refining diagnostic processes and expanding programs like ADAPT to other common allergies, such as cashews, to reduce the burden on families.