Patients Tolerate Oral Immunotherapy Better with Autoclaved vs Blanched Peanuts, with Casey Cohen, PhD

A study discovered that patients tolerate peanut oral immunotherapy with autoclaved peanuts better than oral immunotherapy with raw, roasted, or blanched peanuts.1

“We found that the allergic people could actually tolerate way higher doses of the autoclave peanut when compared to the blanched peanut, and we think this could be some very helpful first step into seeing if this could be used as a potential substrate for treatment,” Casey Cohen, PhD, from McGill University, told HCPLive at 2025 American Academy of Allergy, Asthma, & Immunology (AAAAI) annual meeting taking place in San Diego from February 28 – March 3.

Cohen and colleagues’ research on autoclaved peanut oral immunotherapy was presented as a late-breaker during the meeting. Already, the team knew from earlier studies in their laboratory that autoclaving peanuts under a high temperature and pressure may reduce the binding of peanut-specific immunoglobulin. Investigators wanted to see whether individuals with peanut allergies experienced an allergic reaction to a greater dose of autoclaved peanut.

The team recruited 10 peanut-allergic individuals from Montreal Children’s Hospital to participate in 2 double-blind oral food challenges using blanched or autoclaved peanuts. The sample had 3 females and a median age of 25 years old. Investigators collected data on tolerated doses, skin prick test wheal diameters, and allergic reactions.

The peanuts were autoclaved at 266 °F for 30 minutes. With autoclaved peanuts, participants could tolerate a maximum dose of 300 mg and a cumulative dose of 44 mg, compared with a 9 mg median tolerated dose of blanched peanuts.

No participants on autoclaved peanuts needed epinephrine, meanwhile all blanched peanut challenges required ≥ 1 dose of epinephrine. Participants had less severe reactions with autoclaved peanuts.

“We are very confident that not only is it this autoclaving—this process—diluting the peanut from its proceeds, but we think it's actually changing it in a different way, making this a very unique substrate,” Cohen said. “It's changing it in such a way that we might have all these new things in this peanut there's still some level of those allergens there, which is important to reduce tolerance, but way less of it intact. We get different pieces of all different lengths and sizes and shapes, and I think that is where really the money might be for this potential new treatment for peanut allergy.”

There are no relevant disclosures for Cohen.

References

Cohen, C, Rivero, D, Ali, A, et al. Peanut-Allergic Subjects Tolerate Higher Doses of Autoclaved Peanuts Compared to Blanched During Oral Food Challenges. Late-breaker presented at AAAAI 2025 in San Diego from February 28 – March 3.