Multi-Nut OFC Feasible, Comparable to Home Introduction in Infants With Peanut Allergy

Findings from the TreEat study presented at AAAAI 2026 by Vicki McWilliam, MND, PhD

Mar. 11, 2026 at 2:58am

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A supervised hospital-based multi-nut oral food challenge did not outperform standard home introduction in preventing tree nut allergy in peanut-allergic infants, according to preliminary data from the TreEAT trial. However, the study found that the multi-nut approach was safe, with no infants experiencing anaphylaxis, and ongoing analyses may identify benefits in parental anxiety and quality of life outcomes.

Why it matters

The study addresses a practical clinical gap, as families of peanut-allergic infants are often advised to introduce tree nuts at home without prior sensitization screening, but many feel uncomfortable doing so. The multi-nut butter approach was designed to offer a supported, efficient alternative that could address parental anxiety while facilitating introduction across four allergens in a single hospital visit.

The details

The TreEAT trial enrolled 212 infants aged 4-11 months with confirmed peanut allergy, randomized to either hospital-based multi-nut OFC (n = 107) or home introduction of individual nuts (n = 105). On the primary outcome of tree nut allergy at 18 months, preliminary analysis showed no significant difference between the two groups, with 18.9% in the multi-nut OFC arm developing allergy to one or more tree nuts versus 12.4% in the home introduction arm. Critically, no infant in either group experienced anaphylaxis, despite approximately 33% being sensitized to tree nuts at baseline.

  • The TreEAT trial was presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2026 Annual Meeting held in Philadelphia, Pennsylvania, from February 27 to March 2, 2026.

The players

Vicki McWilliam

Senior Allergy Dietitian at the Royal Children's Hospital, Clinician-Scientist Fellow at the Murdoch Children's Research Institute, and Honorary Senior Research Fellow at the University of Melbourne.

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What they’re saying

“We did find it to be a successful and safe way to introduce the nuts in a combination product, which is maybe when we look at our quality of life outcomes and our parental anxiety outcomes, this might be something that comes out as a strong benefit of doing it as a multi nut butter versus doing it at home.”

— Vicki McWilliam, Senior Allergy Dietitian, Clinician-Scientist Fellow, and Honorary Senior Research Fellow (HCPLive)

What’s next

Ongoing analyses examining parental anxiety and quality of life outcomes may yet identify a meaningful advantage for the supervised multi-nut model where the primary endpoint did not.

The takeaway

This study provides a safety reassurance that routine pre-screening for tree nut sensitization may drive unnecessary avoidance in peanut-allergic infants, and suggests the multi-nut butter approach could be a feasible and supported alternative to home introduction, potentially offering benefits in parental anxiety and quality of life that the primary endpoint did not capture.