Oral Immunotherapy for Children With Peanut Allergy

This clinical trial aims to investigate if oral immunotherapy can help children with peanut allergy tolerate peanut. Children aged 6 months to 4 years can take part in the trial. Main question: What percentage of children can tolerate peanut after oral immunotherapy, compared with children who avoid peanut? Children are assigned to these two groups by chance. Children receiving oral immunotherapy will: * Take a small, increasing amount of peanut daily for 1-1.5 years * Attend clinic or online visits each time the dose is increased * Record missed doses All children will: * Provide blood samples to measure allergy-related markers * Undergo an oral food challenge with peanut after 1-1.5 years to assess how much they can tolerate * Report allergic reactions (parent-reported) * Complete questionnaires (parent-reported) * Participate in an end-of-study telephone interview with an allergy nurse (parent-reported)

Inclusion Criteria: * Aged 6 to 48 months * Peanut allergy confirmed at an oral food challenge * Reaction threshold below 300 mg of peanut protein at the oral food challenge * Specific IgE to peanut \> 0.35 kU/L * Family motivated for oral immunotherapy following shared decision-making using a decision aid Exclusion Criteria: * Uncontrolled asthma, eczema, rhinoconjunctivitis, urticaria, or eosinophilic esophagitis * Treatment with biologic or immunosuppressive medication * Tree nut allergy requiring avoidance of trace amounts * Non-Danish-speaking families * Anticipated non-adherent families