Reassessment of Childhood Peanut Allergy Reveals Tolerance

Peanut allergy is commonly diagnosed in childhood and may persist as a medical label into adulthood despite the development of clinical tolerance, leading to potential misclassification and unnecessary dietary and occupational restrictions. We report a 19-year-old male patient with a childhood diagnosis of peanut allergy that precluded military enlistment in the United States despite years of reported asymptomatic peanut ingestion. Evaluation demonstrated persistent sensitization on skin prick testing, low-level peanut-specific IgE, and isolated sensitization to Ara h 8 on component-resolved diagnostics (CRD). Following structured reassessment, a supervised oral food challenge (OFC) was performed and tolerated without symptoms. The peanut allergy diagnosis was removed, and the patient was cleared for military accession. This case demonstrates that integration of clinical history, CRD, and OFC enables accurate risk stratification and safe delabeling of peanut allergy, with particular relevance in high-stakes settings.