At 5 months old, Arthur’s face reddened and hives appeared after his parents first gave him peanut. The reaction eased within an hour, but his family still needed to know whether peanut was truly unsafe for him.
That question matters for many Australian families. Peanut allergy affects about 1 in 30 children in Australia, which has some of the highest reported rates of childhood food allergies in the world. Yet a national study has found that a reaction and positive allergy tests do not always mean a baby is allergic. Confirming the diagnosis could spare some children years of avoiding a food they can safely eat, while helping others start treatment with better guidance.
The research was led by Murdoch Children’s Research Institute and the National Allergy Centre of Excellence, working with 10 public children’s hospitals across Australia. Researchers assessed 1,275 infants under 18 months old. Of those, 778 had an oral food challenge: a supervised test in which a child receives increasing amounts of peanut while medical staff watch for a reaction.
Among infants who had recently reacted to peanut and had a positive allergy test, 35% showed no reaction during the challenge. These babies were considered peanut-tolerant, and their allergy diagnosis could be removed. They could then eat peanut regularly in an age-appropriate form, such as peanut butter, rather than continue avoiding it out of caution.
The test also helped guide care for babies who did react. Overall, 65% of the challenged infants had a reaction, and 12% experienced anaphylaxis, a severe allergic reaction. The hospital teams safely managed every episode. Almost all infants who reacted went on to peanut oral immunotherapy, a treatment that uses daily peanut doses to build tolerance. With doses guided by challenge results, 97.5% successfully began treatment.
The findings are part of an evaluation of ADAPT, a peanut oral immunotherapy program launched in 2024. It is the first such treatment program for infants offered in Australian public hospitals outside a clinical trial. The study was published in The Journal of Allergy and Clinical Immunology: In Practice.
Dr. Tim Brettig, a senior research clinician with MCRI’s Population Allergy Group and ADAPT’s medical lead, said the results show why suspected allergy should be confirmed before a child takes on long-term treatment or avoidance. NACE director and ADAPT lead Kirsten Perrett said history and allergy tests alone were not accurate enough in many cases, and that supervised challenges should be routinely considered before immunotherapy begins.
The study suggests a practical way to make allergy care more precise: test safely under medical supervision, then match advice and treatment to what happens. For families like Arthur’s, that can replace uncertainty with a clearer answer. The researchers’ findings may also help public hospitals reduce the burden of food allergy while ensuring babies who need treatment can begin it at a dose suited to them.