Guarnieri KM, Slack IF, Gadoury-Lévesque V, et al. - By examining a real-world peanut oral immunotherapy (OIT) cohort, researchers tried to gain further understanding regarding optimal patient selection, expected outcomes, and treatment endpoints for clinical peanut OIT. Participants were 174 children receiving peanut OIT at a pediatric allergy clinic. To date, maintenance dosing has been achieved in 144 cases, and of these, 50 patients transitioned to ad lib twice-weekly peanut ingestion. Cessation of OIT was seen in 30 patients. An inverse correlation of age at initiation with achievement of maintenance was identified. During OIT, ≥1 adverse reaction occurred in 66% of patients. Of those on ad lib peanut ingestion, 2 suffered mild reactions post-lapses in peanut intake. Overall, clinical peanut OIT was shown to confer similar outcomes to research protocols. In older pediatric populations as well as in those with high peanut-specific IgE concentrations, OIT can be successful, though outcomes are influenced by these factors. Successful transition to intermittent ad lib peanut intake can be guided by clinical as well as laboratory criteria.