The prevalence of peanut allergy in the United States and other Westernized countries has tripled in the past 15 years, now affecting more than 1% of the population. Strict peanut avoidance is the current standard of care. In the past decade, a number of small, largely uncontrolled clinical trials have suggested that oral immunotherapy (OIT) can effectively desensitize most children with peanut allergy. Some in the allergy community now feel that OIT is ready for clinical practice. In this review, the evidence base in the medical literature is examined. Although peanut OIT shows promise, the evidence currently available on its effectiveness, risk benefit, and potential long-term consequences is insufficient to support its use in clinical practice. Appropriately designed, prospective clinical trials are urgently needed to determine whether OIT is a safe, effective form of therapy for food allergy.