Study of Oral Food Challenge Biomarkers (SAFER) (SAFER)

Study of Oral Food Challenge Biomarkers (CoFAR-15)

This is a multi-center, mechanistic study. It is designed to learn more about signs in the body, called biomarkers, that might show if someone will have a reaction to peanut during a feeding test. The trial will enroll children ages 12 months to17 years old who are suspected of having an allergy to peanut.

The primary objective is to identify a biomarker (or a combination of biomarkers) that will predict oral food challenge (OFC) (feeding test) results for participants with suspected peanut allergy.

Study Overview

• Status: Not yet recruiting
• Conditions: Allergy
• Intervention / Treatment: Drug: Oral Food Challenge (OFC): Peanut Protein

Detailed Description

The SAFER study is a multi-center, mechanistic study designed to identify biomarkers that can predict the outcome of a participant's reactions to a peanut oral food challenge. Participants aged 12 months to 17 years with suspected peanut allergy will complete an oral food challenge to peanut. The accrual goal of the study is to reach a minimum of 500 participants who complete the oral food challenge and provide blood needed to assess biomarkers. Recruitment may continue beyond 500 to ensure there are at least 350 reactors (i.e., participants who experience dose-limiting symptoms during the OFC) and 100 non-reactors. Recruitment will aim to achieve approximate balance across three age groups: 12-47 months, 4-11 years, and 12-17 years.

An initial screening visit will be conducted to evaluate eligibility and collect the biomarkers prior to the oral food challenge. The food challenge can take place on the same day as screening or within 4 weeks of the screening visit.

During participation, clinical assessments will be conducted, questionnaires completed, and biological samples collected from the participant before, during, and after the challenge.

After the food challenge and the safety monitoring period is completed, the participant will have completed participation in the study.

• Study Type: Observational
• Enrollment (Estimated): 500

Contacts and Locations

Study Locations

• United States
  • Arkansas
    • Little Rock, Arkansas, United States, 72202
      • Arkansas Children's Hospital Research Institute: Department of Pediatrics, Allergy & Immunology
  • California
    • Palo Alto, California, United States, 94304
      • Stanford School of Medicine: Sean N. Parker Center for Allergy & Asthma Research
  • Illinois
    • Chicago, Illinois, United States, 60611-2927
      • Northwestern University Feinberg School of Medicine: Allergy Division
  • Maryland
    • Baltimore, Maryland, United States, 21287-0010
      • Johns Hopkins Children's Center: Department of Allergy & Immunology
  • Massachusetts
    • Boston, Massachusetts, United States, 02115
      • Boston Children's Hospital: Allergy and Asthma Program
  • Michigan
    • Detroit, Michigan, United States, 48201
      • The University of Michigan: Division of Allergy and Clinical Immunology
  • New York
    • New York, New York, United States, 10029
      • Icahn School of Medicine at Mount Sinai: Department of Pediatrics Allergy & Immunology
  • North Carolina
    • Chapel Hill, North Carolina, United States, 27599
      • North Carolina Children's Hospital: Department of Pediatrics, Division of Allergy, Immunology and Rheumatology
  • Ohio
    • Cincinnati, Ohio, United States, 45229
      • Cincinnati Children's Hospital Medical Center: Division of Allergy and Immunology
  • Tennessee
    • Nashville, Tennessee, United States, 37232
      • Vanderbilt University Medical Center: Division of Pediatric Allergy, Immunology, and Pulmonary Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Approximately 500 participants with suspected peanut allergy, 12 months to 17 years of age

Description

Inclusion Criteria:

1. Parent or guardian must be able to understand and provide written informed consent and participant must be able to understand and provide assent (if applicable)
2. Are 12 months - 17 years of age during Screening.

3. Are sensitized to peanut, as demonstrated by one of the following:

   a. A participant-reported reaction to peanut (at any time) deemed by the investigator to be consistent with an IgE-mediated reaction and one of the following within the past 12 months

   i. Positive Skin Prick Test (SPT) to peanut (wheal diameter that is ≥ 3mm larger than saline control) ii. Positive peanut-specific IgE (sIgE; ≥ 0.10 kUA/L) determined by ImmunoCap

   b. An Ara h 2 sIgE ≥ 1.0 kUA/L, measured within the past 12 months

4. Are currently avoiding peanut

Exclusion Criteria:

1. Are pregnant
2. Are currently receiving treatment or have received treatment within the prior 2 years for peanut allergy
3. Have a history of life-threatening anaphylaxis to peanut, defined as neurological compromise or requiring intubation
4. Have received treatment with dupilumab/Dupixent® within the prior 2 years, OR treatment with omalizumab/Xolair®, other biologics, or systemic immunomodulatory agents within the prior year
5. Inability to comply with the required aspects of the study protocol
6. Have past or current medical conditions or findings from the physical examination, not already listed, that, in the judgment of the site investigator, may pose additional risks related to participation in the study, interfere with the participant's ability to comply with study requirements, or impact the quality or interpretation of the study data
7. Have been treated with oral steroid or beta blockers within 14 days of the Oral Food Challenge (OFC)
8. Are unable to discontinue medications, as specified in the Protocol CoFAR-15 MOP, for the minimum wash-out periods prior to Skin Prick Test (SPT) or OFC
9. Have poorly controlled atopic dermatitis (AD) at Screening, per the PI's discretion

10. Have poorly controlled or severe asthma/wheezing at Screening, as defined as experiencing or including any of the following:

    1. Meeting the Global Initiative for Asthma (GINA) criteria for uncontrolled asthma
    2. History of two or more systemic corticosteroid courses within six months of Screening or one course of systemic corticosteroids within three months of Screening to treat asthma/wheezing;
    3. Prior intubation/mechanical ventilation for asthma/wheezing;
    4. One hospitalization or ED visit for asthma/wheezing within six months of Screening;
    5. Forced expiratory volume in one second (FEV1) <80% of predicted or FEV1/forced vital capacity (FVC) <75% of predicted, with or without controller medications (only for participants who are aged seven years or older and are able to perform spirometry);
    6. Inhaled corticosteroid (ICS) dosing of >500 mcg daily fluticasone (or equivalent ICS based on the CoFAR Inhaled Corticosteroid Equivalency Tables MOP)
11. Refuse blood sample collection during Screening
12. The SPT performed during Screening is negative to peanut allergen without dilution (wheal diameter that is < 3mm larger than saline control).

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Oral Food Challenge Cohort; Approximately 500 children and adolescent participants between the ages of 1-17 years who are suspected of having an allergy to peanut will be asked to complete a Peanut Oral Food Challenge. An individual's participation in this study will consist of screening for eligibility and an oral food challenge visit, which may occur on the same day or up to 28 days apart.

Drug: Oral Food Challenge (OFC): Peanut Protein; Peanut protein flour will be used in the OFC procedure. The maximum cumulative dose of peanut protein for completion of the oral food challenge (OFC) is 6043 mg. Participants aged 3 years or younger are not required to receive the final 2000 mg dose to complete the OFC; however, it may be administered at the discretion of the investigator if considered clinically relevant and safe.; Other Names: OFC

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cumulative Reactive Dose (CRD) Threshold	The cumulative quantity of peanut protein consumed during an oral food challenge at which dose-limiting symptoms occur, categorized as: 3-143 mg (low threshold); 443-1043 mg (medium threshold); 2043-highest cumulative, age-dependent dose (high threshold); or no reaction. The maximum cumulative dose of peanut protein for completion of the oral food challenge (OFC) is 4043 mg for participants aged 1 to 3 years and 6043 mg for participants aged 4 to 17 years. Participants ≤3 years are not required to receive the final 2000mg dose to complete the OFC, however, it may be administered at the discretion of the investigator if considered clinically relevant and safe.	OFC Visit on Day 1
Binary Reaction Status (reactor/non-reactor) to the oral food challenge (OFC)	A Reactor is any participant who experiences dose-limiting symptoms at or prior to the highest cumulative, age-dependent OFC dose. A Non-reactor is any participant who does not experience dose-limiting symptoms during an OFC that is completed to the age-specific highest dose.	OFC Visit on Day 1

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
All reported treatments during the oral food challenge (OFC) or observational period.	Any treatments used to resolve dose-limiting symptoms in response to the OFC, including during and after the OFC, will be summarized descriptively for participants who had at least 1 dose of peanut protein during the OFC (including those that started but did not fully complete the OFC).	OFC Visit on Day 1
All adverse events experienced during the OFC or observation period.	Any adverse events, defined as severe dose-limiting symptoms that are related to the OFC, that are experienced during and after the OFC will be summarized descriptively in participants who had at least 1 dose of peanut protein during the OFC (including those that started but did not fully complete the OFC).	OFC Visit on Day 1
All symptoms reported during the OFC or observation period.	All OFC symptoms (i.e. including those that do not meet definition of an adverse event) experienced during the OFC or after the OFC will be summarized descriptively in participants who had at least 1 dose of peanut protein during the OFC (including those that started but did not fully complete the OFC).	OFC Visit on Day 1

Collaborators and Investigators

• Sponsor: National Institute of Allergy and Infectious Diseases (NIAID)
• Collaborators: Rho Federal Systems Division, Inc.; Consortia for Food Allergy Research (CoFAR)
• Investigators: Study Chair: Robert Wood, M.D., Johns Hopkins Children's Center: Department of Allergy & Immunology; Study Chair: Supinda Bunyavanich, M.D., M.P.H., M.Phil., Icahn School of Medicine at Mount Sinai: Department of Pediatrics Allergy & Immunology; Study Chair: Charles Schuler, M.D., The University of Michigan: Division of Allergy and Clinical Immunology

Publications and helpful links

Helpful Links

• National Institute of Allergy and Infectious Diseases (NIAID)
• Division of Allergy, Immunology, and Transplantation (DAIT)

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): October 1, 2027
• Study Completion (Estimated): October 1, 2027

Study Registration Dates

• First Submitted: September 30, 2025
• First Submitted That Met QC Criteria: December 10, 2025
• First Posted (Actual): December 12, 2025

Study Record Updates

• Last Update Posted (Actual): December 12, 2025
• Last Update Submitted That Met QC Criteria: December 10, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Biomarkers; Peanut Allergy; Oral Food Challenge; Food Allergy; CoFAR-15; SAFER
• Additional Relevant MeSH Terms: Nut and Peanut Hypersensitivity; Immune System Diseases; Hypersensitivity, Immediate; Hypersensitivity; Food Hypersensitivity; Peanut Hypersensitivity
• Other Study ID Numbers: DAIT CoFAR-15

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The plan is to share data upon completion of the study in: Immunology Database and Analysis Portal (ImmPort), a long-term archive of clinical and mechanistic data from DAIT/NIAID-funded awards and contracts.
• IPD Sharing Time Frame: On average, within 24 months after database lock for the trial.
• IPD Sharing Access Criteria: Open access.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No