ClinicalTrials.gg
Not yet recruitingNCT07764159Updated Aug 13, 2026

Multi-Food Oral Immunotherapy for Peanut and Tree Nuts

An interventional study of Multi-Food Oral Immunotherapy (Multi-OIT) with Peanut and Tree Nuts Proteins and Standard of Care (Elimination Diet) in Food Allergies, Food Allergy in Children and Peanut Allergies, sponsored by Medical University of Warsaw. Not yet recruiting at 4 sites in Poland. Open to participants aged 1 Year to 12 Years. Per ClinicalTrials.gov, last updated 2026-08-13.

Sponsored by Medical University of Warsaw · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
39
Allocation
Randomized
Ages
1 Year to 12 Years
Sex
All
01

Study summary

This study aims to evaluate the efficacy and safety of multi-food oral immunotherapy (multi-OIT) using peanut and tree nuts proteins in children with confirmed food allergy to at least two allergens. Participants will be randomized in a 2:1 ratio to receive either multi-OIT or standard management consisting of an elimination diet. The primary objective is to evaluate immunotherapy efficacy defined as achieving tolerance to a cumulative dose of 4444 mg of protein during an oral food challenge (OFC-2) for at least one allergen that elicited a reaction during baseline challenge (OFC-1), compared with the control group. Secondary outcomes include the proportion of participants tolerating multiple allergens at the target cumulative dose; the incidence, type, and severity of adverse events classified according to the World Allergy Organization (WAO) grading system; changes in immunological parameters, including allergen-specific IgE and IgG4 levels; changes in skin prick test responses; changes in the quality of life of patients and their families.

Read the detailed description

This is an interventional, open-label, multicenter, randomized clinical trial enrolling 39 children aged 1-12 years with confirmed allergy to at least two of the following allergens: peanut, cashew, walnut, hazelnut and almond.

Participants will be randomized in a 2:1 ratio to either the experimental group receiving multi-food oral immunotherapy (multi-OIT) or the control group receiving standard of care consisting of an elimination diet and rescue medications. Multi-OIT will be administered using a standardized mixture of peanut and tree nuts proteins, with a dose-escalation phase followed by a maintenance phase targeting 300 mg of protein per allergen per day. Treatment duration will be approximately 18 months.

All participants will undergo oral food challenges at baseline (OFC-1) and at the end of the study (OFC-2). The primary efficacy endpoint is defined as the proportion of participants achieving tolerance to a cumulative dose of 4444 mg of protein during OFC-2 for at least one allergen that elicited a reaction during OFC-1, compared with the control group. Safety will be monitored throughout the study based on adverse events recorded in symptom diaries and classified according to established grading systems.

Secondary outcomes include the proportion of participants tolerating multiple allergens at the target cumulative dose, the frequency and severity of adverse events classified according to the World Allergy Organization (WAO) grading system, changes in immunological parameters (including allergen-specific IgE and IgG4), skin prick test responses and quality of life of patients and their families.

Participants in the control group will be offered the option to receive immunotherapy after completion of the study.

02

Conditions studied

  • Food Allergies
  • Food Allergy in Children
  • Peanut Allergies
  • Tree Nut Allergies
  • Oral Immunotherapy for Food Allergy
03

In context

Food Hypersensitivity

376 studies on the registry are indexed under Food Hypersensitivity; 90 are open to participants now.

This study's planned enrollment of 39 is below the median of 60 across 246 interventional studies indexed under Food Hypersensitivity.

Browse Food Hypersensitivity studies →

Lead sponsor

Medical University of Warsaw is the lead sponsor of 326 studies on the registry; 87 are open to participants now.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
1 Year to 12 Years
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Age 1-12 years;
  • Confirmed allergy to at least two allergens included in the protocol, i.e., peanut and/or tree nuts: cashew, walnut, hazelnut, and almond;
  • Positive skin prick test (SPT) (wheal diameter ≥ 3 mm) and/or specific IgE (sIgE) level > 0.35 kUA/L for at least two of the analyzed allergens;
  • Positive OFC-1 (oral food challenge) of grade I-IV according to the WAO classification for at least two allergens, with a positive reaction occurring after administration of a dose ≥ 3 mg and ≤ 3000 mg of allergen protein;
  • Participants may be enrolled based on the abbreviated procedure as outlined in the study description;
  • Written obtained from a legal guardian, and, where applicable, assent from the child in accordance with their age and level of maturity;
  • Good prognosis for compliance and cooperation of the patient and their caregivers.

Exclusion criteria

Exclusion Criteria:

  • Allergic reaction at the lowest challenge dose of 1 mg of allergen protein for any allergen, or no allergic reaction after administration of the maximum dose of 3000 mg of allergen protein for at least four of the analyzed allergens;
  • History of anaphylaxis with a grade V reaction according to the WAO classification, either during an oral food challenge or in the patient's medical history;
  • Severe asthma;
  • Poorly controlled asthma according to GINA 2025 (lack of symptom control and/or ≥2 exacerbations requiring systemic or ≥1 exacerbation requiring hospitalization within the last 12 months), or in children able to perform spirometry: \< -1.64 Z-score and/or FEV1/FVC \< -1.64 Z-score;
  • Eosinophilic gastrointestinal disease;
  • Other chronic diseases requiring ongoing treatment which, in the investigator's opinion, may increase the risk associated with study participation or interfere with the interpretation of results, including severe cardiac disease, epilepsy, metabolic disorders, or diabetes;
  • Previous immunotherapy with food allergens;
  • Concurrent immunotherapy with aeroallergens;
  • Treatment with biologic agents, beta-blockers, ACE inhibitors, or calcium channel blockers;
  • Oral corticosteroid therapy meeting any of the following criteria: daily treatment for >1 month within the last 12 months; at least two courses lasting ≥7 days within the last 12 months; one course lasting ≥7 days within the last 3 months;
  • Lack of consent to participate in the study or insufficient cooperation of the patient and/or caregivers. In such cases, patients will receive standard medical care, including allergen avoidance and provision of emergency medication.

Well-controlled asthma, allergic rhinitis, and atopic dermatitis are not exclusion criteria.

Terms in these criteria, in plain language(3)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

FEV1

From a breathing test (spirometry): how much air you can blow out in the first second. Often given as a percentage of what is expected for your age, height and sex.

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Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
39 participants (estimated)

Study arms

  • Experimental
    Multi-Food Oral Immunotherapy (Multi-OIT)

    Participants will receive multi-food oral immunotherapy (multi-OIT) using a standardized mixture of peanut and tree nuts proteins (cashew, walnut, hazelnut, and almond). Treatment includes a dose-escalation phase (1-300 mg protein per allergen) followed by a maintenance phase for 12 months (+/- 3 months) with a target daily dose of 300 mg of protein per allergen. Dose increases will be performed under medical supervision, and daily dosing will be continued at home. The total treatment duration is approximately 18 months.

    Other: Multi-Food Oral Immunotherapy (Multi-OIT) with Peanut and Tree Nuts Proteins

  • Active comparator
    Standard of Care (Elimination Diet)

    Participants will continue standard management consisting of strict elimination of peanut and tree nuts from the diet and use of rescue medications, including epinephrine, in case of accidental exposure. Participants will be monitored according to the study schedule and will undergo follow-up assessments comparable to the experimental group.

    Other: Standard of Care (Elimination Diet)

Interventions

  • OtherMulti-Food Oral Immunotherapy (Multi-OIT) with Peanut and Tree Nuts Proteins

    Multi-food oral immunotherapy using a standardized mixture of peanut and tree nuts proteins (cashew, walnut, hazelnut, and almond), administered in a dose-escalation phase followed by a maintenance phase with a target daily dose of 300 mg of protein per allergen.

  • OtherStandard of Care (Elimination Diet)

    Standard management consisting of strict dietary avoidance of peanut and tree nuts, along with the use of rescue medications, including epinephrine, in the event of accidental allergen exposure.

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What researchers measure

Primary outcomes

  1. Immunotherapy Efficacy

    Evaluation of immunotherapy efficacy defined as achieving tolerance to a cumulative dose of 4444 mg of protein during OFC-2 for at least one allergen that elicited a reaction during OFC-1, compared with the control group.

    Time frame: Up to 21 months after starting oral immunotherapy

Secondary outcomes

  1. Proportion of Participants Tolerating at least 2, 3, 4 or 5 Allergens at a Cumulative Dose of 4444 mg During OFC-2

    Proportion of participants who tolerate a cumulative dose of 4444 mg of protein for at least 2, 3, 4, or 5 allergens during OFC-2 (post-treatment oral food challenge). Tolerance is defined as consumption of the full cumulative dose without dose-limiting allergic symptoms. The outcome will be summarized as the proportion of participants meeting each threshold and compared between study groups.

    Time frame: Up to 21 months after starting oral immunotherapy

  2. Change in Maximum Tolerated Allergen Dose from OFC-1 to OFC-2

    Change in the maximum tolerated dose (mg of protein) of allergens during oral food challenge from OFC-1 (baseline) to OFC-2 (post-treatment). The maximum tolerated dose is defined as the highest cumulative dose ingested without dose-limiting allergic symptoms. Changes will be analyzed within and between study groups.

    Time frame: Up to 21 months after starting oral immunotherapy

  3. Incidence, Type and Severity of Adverse Events During Immunotherapy Compared with Control (WAO Grading)

    Number, type, and severity of adverse events during immunotherapy compared with the control group, assessed based on symptom diaries and classified by severity according to the WAO scale.

    Time frame: Up to 21 months after starting oral immunotherapy

  4. Change in Skin Prick Test (SPT) Wheal Diameter for Peanut and Tree Nut Allergens from Baseline to Final Assessment

    Measurement of change in wheal diameter (mm) for peanut and tree nut allergens as assessed by skin prick testing (SPT) between baseline (OFC-1) and final assessment (OFC-2). Wheal size will be recorded as the mean diameter and compared within and between study groups.

    Time frame: Up to 21 months after starting oral immunotherapy

  5. Change from Baseline in Allergen-Specific IgE (sIgE) and IgG4 Levels

    Change in serum concentrations of sIgE and IgG4 from baseline to post-treatment assessment. Measurements will be performed using standardized immunoassays and analyzed as continuous variables to evaluate immunologic response to therapy.

    Time frame: Up to 21 months after starting oral immunotherapy

  6. Change in Food Allergy-Related Quality of Life (FAQLQ)

    Change in quality of life of patients and their families from baseline to post-treatment assessment, as measured using the Food Allergy Quality of Life Questionnaire (FAQLQ). Scores will be analysed as continuous variables to assess the impact of treatment on daily functioning and well-being. Scores range from 1 to 7, with higher scores indicating worse quality of life.

    Time frame: Up to 21 months after starting oral immunotherapy

07

Study locations

4 sites
  • Department of Pediatric Pulmonology, Allergology and Clinical Immunology, Institute of Pediatrics, Karol Jonscher Clinical Hospital, Poznań University of Medical Sciences
    Poznan, Greater Poland Voivodeship 60-572, Poland
  • Department of Pediatrics, Children's Diseases Clinic, Jagiellonian University Medical Colleg, Division of Pulmonology, Allergology and Dermatology, University Children's Hospital in Kraków
    Krakow, Lesser Poland Voivodeship 30-663, Poland
  • Allergy Unit, Department of Pulmonary Diseases, Children's Hospital in Dziekanów Leśny
    Dziekanów Leśny, Masovian Voivodeship 05-092, Poland
  • Department of Paediatric Pulmonology and Allergology, Medical University of Warsaw
    Warsaw, Masovian Voivodeship 02-091, Poland
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References and documents

Publications

  • Lodge CJ, Waidyatillake N, Peters RL, Netting M, Dai X, Burgess J, Hornung CJ, Perrett KP, Tang MLK, Koplin JJ, Dharmage SC. Efficacy and safety of oral immunotherapy for peanut, cow's milk, and hen's egg allergy: A systematic review of randomized controlled trials. Clin Transl Allergy. 2023 Jul;13(7):e12268. doi: 10.1002/clt2.12268. PubMed 37488726 ↗
  • Pasioti M, Xepapadaki P, Mathioudakis AG, Lakoumentas J, Efstathiou E, Papadopoulos NG. Current options in the management of tree nut allergy: A systematic review and narrative synthesis. Pediatr Allergy Immunol. 2024 May;35(5):e14132. doi: 10.1111/pai.14132. PubMed 38727626 ↗
  • Andorf S, Manohar M, Dominguez T, Block W, Tupa D, Kshirsagar RA, Sampath V, Chinthrajah RS, Nadeau KC. Feasibility of sustained response through long-term dosing in food allergy immunotherapy. Allergy Asthma Clin Immunol. 2017 Dec 21;13:52. doi: 10.1186/s13223-017-0224-7. eCollection 2017. PubMed 29296108 ↗
  • Upton JEM, Toscano-Rivero D, Ke D, Berenjy A, Lejtenyi D, Beaudette L, Yin X, Li CH, Duan LY, Cohen CG, Kim V, Marzouk S, Grunebaum E, McCusker CT, Mazer B, Eiwegger T, Ben-Shoshan M. Peanut Oral Immunotherapy Using 30 and 300 mg Maintenance Doses. J Allergy Clin Immunol Pract. 2026 Jan;14(1):223-232.e7. doi: 10.1016/j.jaip.2025.10.007. Epub 2025 Oct 16. PubMed 41109568 ↗
  • Upton JEM, Li CH, Berenjy A, Galper A, Yin X, Celik A, Duan L, Wong S, Ditlof CM, San Diego KE, Hoang JA, Ben-Shoshan M, Kothari A, Hung L, Monteiro M, Phue WH, Moraes TJ, Eiwegger T. Safety and Efficacy of Very Low-Dose Multi-Nut Oral Immunotherapy in Children. Clin Transl Allergy. 2025 Dec;15(12):e70125. doi: 10.1002/clt2.70125. PubMed 41385738 ↗
  • Turner PJ, Ansotegui IJ, Campbell DE, Cardona V, Carr S, Custovic A, Durham S, Ebisawa M, Geller M, Gonzalez-Estrada A, Greenberger PA, Hossny E, Irani C, Leung ASY, Levin ME, Muraro A, Oppenheimer JJ, Ortega Martell JA, Pouessel G, Rial MJ, Senna G, Tanno LK, Wallace DV, Worm M, Morais-Almeida M; WAO Anaphylaxis Committee and WAO Allergen Immunotherapy Committee. Updated grading system for systemic allergic reactions: Joint Statement of the World Allergy Organization Anaphylaxis Committee and Allergen Immunotherapy Committee. World Allergy Organ J. 2024 Feb 10;17(3):100876. doi: 10.1016/j.waojou.2024.100876. eCollection 2024 Mar. PubMed 38361745 ↗
  • Sampson HA, Arasi S, Bahnson HT, Ballmer-Weber B, Beyer K, Bindslev-Jensen C, Bird JA, Blumchen K, Davis C, Ebisawa M, Nowak-Wegrzyn A, Patel N, Peters RL, Sicherer S, Spergel J, Turner PJ, Yanagida N, Eigenmann PA. AAAAI-EAACI PRACTALL: Standardizing oral food challenges-2024 Update. Pediatr Allergy Immunol. 2024 Nov;35(11):e14276. doi: 10.1111/pai.14276. PubMed 39560049 ↗
  • Jones SM, Kim EH, Nadeau KC, Nowak-Wegrzyn A, Wood RA, Sampson HA, Scurlock AM, Chinthrajah S, Wang J, Pesek RD, Sindher SB, Kulis M, Johnson J, Spain K, Babineau DC, Chin H, Laurienzo-Panza J, Yan R, Larson D, Qin T, Whitehouse D, Sever ML, Sanda S, Plaut M, Wheatley LM, Burks AW; Immune Tolerance Network. Efficacy and safety of oral immunotherapy in children aged 1-3 years with peanut allergy (the Immune Tolerance Network IMPACT trial): a randomised placebo-controlled study. Lancet. 2022 Jan 22;399(10322):359-371. doi: 10.1016/S0140-6736(21)02390-4. PubMed 35065784 ↗
  • Erdle SC, Cook VE, Cameron SB, Yeung J, Kapur S, McHenry M, Chan ES, Mak R, Rex GA, Wong T, Soller L. Real-World Safety Analysis of Preschool Tree Nut Oral Immunotherapy. J Allergy Clin Immunol Pract. 2023 Apr;11(4):1177-1183. doi: 10.1016/j.jaip.2023.01.031. Epub 2023 Feb 1. PubMed 36736958 ↗
  • Huang J, Puglisi LH, Cook KA, Kelso JM, Wangberg H. Safety and Feasibility of Peanut, Tree Nut, and Sesame Oral Immunotherapy in Infants and Toddlers in a Real-World Setting. J Allergy Clin Immunol Pract. 2025 Jan;13(1):185-191.e3. doi: 10.1016/j.jaip.2024.09.025. Epub 2024 Sep 30. PubMed 39357559 ↗
  • Begin P, Winterroth LC, Dominguez T, Wilson SP, Bacal L, Mehrotra A, Kausch B, Trela A, Hoyte E, O'Riordan G, Seki S, Blakemore A, Woch M, Hamilton RG, Nadeau KC. Safety and feasibility of oral immunotherapy to multiple allergens for food allergy. Allergy Asthma Clin Immunol. 2014 Jan 15;10(1):1. doi: 10.1186/1710-1492-10-1. PubMed 24428859 ↗
  • Nguyen K, Lewis MO, Hanna E, Alfaro MKC, Corrigan K, Buonanno J, Datta R, Brown-Whitehorn T, Spergel JM, Cianferoni A. Safety of Multifood Oral Immunotherapy in Children Aged 1 to 18 Years at an Academic Pediatric Clinic. J Allergy Clin Immunol Pract. 2023 Jun;11(6):1907-1913.e1. doi: 10.1016/j.jaip.2023.03.002. Epub 2023 Mar 10. PubMed 36907355 ↗
  • Santos AF, Riggioni C, Agache I, Akdis CA, Akdis M, Alvarez-Perea A, Alvaro-Lozano M, Ballmer-Weber B, Barni S, Beyer K, Bindslev-Jensen C, Brough HA, Buyuktiryaki B, Chu D, Del Giacco S, Dunn-Galvin A, Eberlein B, Ebisawa M, Eigenmann P, Eiwegger T, Feeney M, Fernandez-Rivas M, Fiocchi A, Fisher HR, Fleischer DM, Giovannini M, Gray C, Hoffmann-Sommergruber K, Halken S, O'B Hourihane J, Jones CJ, Jutel M, Knol EF, Konstantinou GN, Lack G, Lau S, Mejias AM, Marchisotto MJ, Meyer R, Mortz CG, Moya B, Muraro A, Nilsson C, de Oliveira LCL, O'Mahony L, Papadopoulos NG, Perrett KP, Peters R, Podesta M, Poulsen LK, Roberts G, Sampson H, Schwarze J, Smith P, Tham E, Untersmayr E, Van Ree R, Venter C, Vickery B, Vlieg-Boerstra B, Werfel T, Worm M, Du Toit G, Skypala I. EAACI guidelines on the management of IgE-mediated food allergy. Allergy. 2025 Jan;80(1):14-36. doi: 10.1111/all.16345. Epub 2024 Oct 30. PubMed 39473345 ↗
  • Brough HA, Caubet JC, Mazon A, Haddad D, Bergmann MM, Wassenberg J, Panetta V, Gourgey R, Radulovic S, Nieto M, Santos AF, Nieto A, Lack G, Eigenmann PA. Defining challenge-proven coexistent nut and sesame seed allergy: A prospective multicenter European study. J Allergy Clin Immunol. 2020 Apr;145(4):1231-1239. doi: 10.1016/j.jaci.2019.09.036. Epub 2019 Dec 20. PubMed 31866098 ↗
  • Chojnowska-Wojtowicz M, Lyzwa K, Zielinska J, Zagorska W, Grzela K. Prevalence of nut allergen sensitization among children in central Poland. Postepy Dermatol Alergol. 2023 Feb;40(1):40-46. doi: 10.5114/ada.2022.124730. Epub 2023 Feb 27. PubMed 36909898 ↗
  • Lyons SA, Clausen M, Knulst AC, Ballmer-Weber BK, Fernandez-Rivas M, Barreales L, Bieli C, Dubakiene R, Fernandez-Perez C, Jedrzejczak-Czechowicz M, Kowalski ML, Kralimarkova T, Kummeling I, Mustakov TB, Papadopoulos NG, Popov TA, Xepapadaki P, Welsing PMJ, Potts J, Mills ENC, van Ree R, Burney PGJ, Le TM. Prevalence of Food Sensitization and Food Allergy in Children Across Europe. J Allergy Clin Immunol Pract. 2020 Sep;8(8):2736-2746.e9. doi: 10.1016/j.jaip.2020.04.020. Epub 2020 Apr 21. PubMed 32330668 ↗

Individual participant data

Plan to share: Yes — De-identified individual participant data (IPD) that underlie the results reported in this study will be made available to qualified researchers upon reasonable request. Data requests may be submitted beginning 9 months after publication of the primary study results. Approved data will be accessible for a period of up to 24 months, with potential extensions considered on a case-by-case basis. Access will be granted to researchers conducting independent scientific research, following review and approval of a detailed research proposal and a corresponding Statistical Analysis Plan (SAP). A Data Sharing Agreement (DSA) must be executed prior to data release. For additional information or to submit a data access request, please contact: katarzyna.grzela@wum.edu.pl.

Supporting information: Study protocol, Statistical analysis plan, Informed consent form

Time frame: Data requests may be submitted beginning 9 months after publication of the primary study results. Approved data will be made available for a period of up to 24 months. Requests for extension beyond this period will be considered on a case-by-case basis.

Access criteria: Access to de-identified individual participant data (IPD) may be requested by qualified researchers conducting independent scientific research. Access will be granted following review and approval of a research proposal and a corresponding Statistical Analysis Plan (SAP), and upon execution of a Data Sharing Agreement (DSA). For additional information or to submit a request, please contact katarzyna.grzela@wum.edu.pl

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Aug 13, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT07764159
Responsible party
Sponsor
First posted
Aug 13, 2026
Start date
Sep 2026 (estimated)
Primary completion
Sep 2031 (estimated)
Completion
Dec 2031 (estimated)
Last update
Aug 13, 2026

Study contacts

Katarzyna Grzela, PhD, MD
Contact
katarzyna.grzela@wum.edu.pl
+48 22 3179417

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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