Background: Peanut allergy affects up to 2% of the general population and carries not only the risk of potentially life-threatening allergic reactions but also negatively impacts day to day life for patients and their families. Advances in knowledge in immunotherapy is providing families with options for proactive treatment. Objective: To examine the available data for oral immunotherapy (OIT) and epicutaneous immunotherapy (EPIT) for peanut allergy. Methods: This review discusses recent studies that evaluated the safety and efficacy of OIT and EPIT to induce desensitization to peanut and identifies factors that should be considered when guiding families in treatment decisions. Results: Results of studies have demonstrated that immunotherapy can raise the threshold of peanut allergen to induce allergic reactions for many patients, thereby potentially reducing the risk for allergic reactions and decreasing the daily burden of peanut allergy. However, adverse reactions, which range from mild to severe, are possible with immunotherapy. Shared decision-making will be important to determine the best approach for peanut allergy management for each individual and his or her family. Conclusion: OIT and EPIT will offer patients and families more options for managing peanut allergies. Recent data from phase III studies on OIT and EPIT as well as real-world data on OIT advance the understanding of the efficacy and safety of these approaches. On-going studies aim to identify biomarkers to enhance patient selection criteria as well as develop additional therapeutic approaches.