# Oral Immunotherapy with Standardized Peanut Extract: A Game-Changer for Peanut Allergy
###### Abstract  
Peanut allergy is a persistent and potentially life-threatening condition affecting millions worldwide, necessitating effective therapeutic strategies beyond strict avoidance. Oral immunotherapy (OIT) has emerged as a promising approach, with peanut (_Anclis hypogaea_) allergen powder dnfp (Palforzia Aimmune therapeutics Brisbane Califl) being the first FDA-approved standardized OIT for peanut allergy. This review synthesizes current clinical evidence on PTAH (peanut-tolerant _Anclis hypogaea_), focusing on its efficacy, safety, and long-term outcomes. A systematic literature search was conducted, analyzing key phase 3 trials, including PALISADE, ARTEMIS, and POSEIDON, as well as long-term extension studies such as ARC004 and ARC008. Findings indicate that PTAH significantly increases the peanut protein threshold tolerated by allergic individuals, reducing the risk of severe reactions upon accidental exposure. While adverse events such as gastrointestinal symptoms and anaphylaxis occur, they are generally manageable and decline over time with continued therapy. Notably, younger children in the POSEIDON trial exhibited higher desensitization rates, suggesting the potential benefits of early intervention. Long-term studies demonstrate sustained immune modulation, with reductions in peanut-specific IgE and an increase in IgG4, indicative of developing tolerance. Despite limitations such as adherence challenges and the need for ongoing maintenance dosing, PTAH represents a paradigm shift in peanut allergy management, offering improved safety and quality of life for patients and caregivers. P claim  
than other food allergens [3; 4]. Although slightly lower, prevalence in countries like Italy and across Europe has also shown an upward trend in recent decades [4]. This increase is alarming given the serious implications of peanut allergy, which remains the leading cause of food-induced anaphylaxis and accounts for a disproportionate number of fatal allergic reactions globally [5]. The European Anaphylaxis Registry [6] shows that peanuts are a major cause of anaphylaxis triggers in children and adolescents, accounting for 26.3% and 18.3% of cases, respectively [7]. According to the most recent meta-analysis, peanut-induced mortalities had an incidence of 2.13 per million person-years, a significant amount among food allergies [7]. Unlike other food allergies, such as those towards milk and eggs, which mostly resolve in childhood or adolescence, PA persists into adulthood in 75-80% of the cases [3]. This condition considerably burdens patients and their families, restricting dietary choices, social interactions, and overall quality of life. For many, the risk of accidental exposure, despite strict avoidance measures, contributes to a state of hypervigilance that can lead to chronic anxiety [8]. The current management of peanut allergy includes dietary avoidance of peanuts and, for patients at risk of anaphylaxis, the use of self-injectable adrenaline [9; 10]. While this approach reduces the risk of severe reactions, it does not alleviate the psychosocial burden of living with the risk of accidental exposure. In addition, strict avoidance is cumbersome, especially for children who may encounter peanuts in social or school settings where cross-contamination is common. Finally, dietary avoidance may also increase the risks of nutritional deficiencies and compromised growth in young children [11]. The limitations of this approach highlight the need for therapies that not only tackle the risk of accidental exposure but also address the root immunological mechanisms of the allergy. In recent years, oral immunotherapy (OIT) has emerged as a promising therapeutic option for peanut allergy [12; 13; 14]. OIT involves the controlled, gradual introduction of peanut protein in small, carefully measured doses to increase the threshold number of allergic reactions [2].