• Posted August 15, 2025

Why Do Some Kids Benefit More From Exposure Therapy To Food Allergens?

Some kids are helped by exposure therapy to food allergens like peanuts, with their allergies gradually diminishing as they eat small amounts of their food nemesis.

For others, such treatment – also called oral immunotherapy — causes severe allergic reactions.

Researchers now think they know why some kids do well with exposure therapy while others struggle.

Some children with food allergies have highly responsive immune systems, and this makes them less likely to benefit from exposure therapy, researchers reported in the journal Allergy.

“Children who responded well to the therapy already had a less reactive immune system before treatment began,” lead researcher Aleix Arnau-Soler said in a news release. He’s a scientist at the Max Delbrück Center for Molecular Medicine in Berlin.

The blood of children who benefit from exposure therapy specifically has lower levels of immunoglobulins, which are allergy-related antibodies, and cytokines, which are biochemicals that promote inflammation, researchers said.

These results could help identify in advance which children could benefit from exposure therapy, and those who are apt to have an extreme allergic reaction to such therapy, researchers said.

“Some children respond well to this treatment, but others don’t benefit at all,” said senior researcher Young-Ae Lee, group leader of the Molecular Genetics of Allergic Diseases lab at the Max Delbrück Center. “In some cases, the therapy – based on gradually increasing doses of peanut allergens – can even trigger anaphylactic reactions.”

For the study, researchers analyzed blood samples from 38 children with an average age of 7 undergoing exposure therapy for peanut allergy at a Berlin hospital.

The team also found consistent differences in gene expression and gene activity between kids who responded well and those who didn’t.

“These differences were particularly pronounced in certain immune cells that are rarely found in the blood, but more common in the gut, where they perform important functions,” Arnau-Soler said.

Using these differences, doctors might be able to select prime candidates for exposure therapy – and potentially even tailor the length of treatment and amount of allergen fed to them, based on their unique immune profile.

“Our results open the door to personalized approaches to treating peanut allergy – which affects 3% of all children in industrialized countries – more effectively and safely in the future,” Lee said.

“We now have potential biomarkers to find out how well a child will respond to the therapy and what risks are associated with it in each individual case, even before the therapy begins,” she added.

The team is now working to validate its findings in a follow-up study involving more children. They also plan to further investigate the gut-associated immune cells implicated in children’s allergic responses.

“At the same time, we’re developing a predictive model so that in the future we can use a simple blood test to better tailor oral desensitization to the individual child,” Arnau-Soler said.

More information

The Cleveland Clinic has more on oral immunotherapy.

SOURCE: Max Delbrück Center for Molecular Medicine, news release, July 25, 2025