Peanut allergy is one of the most common food allergies. Allergen-specific oral immunotherapy (OIT) and sublingual immunotherapy (SLIT) for peanut allergy aim to induce desensitization and then tolerance to peanuts. However, there is still considerable uncertainty about the safety of these two approaches and if the risk is justified by the benefit of the therapy. We performed a systematic review and meta-analysis to assess the efficacy and safety of OIT and SLIT in patients with peanut allergy. We performed searches of the MEDLINE, CINAHL, EMBASE, ISI Web of Science, and Cochrane databases (through March 18, 2013) for randomized controlled trials (RCTs) that compared OIT or SLIT with a placebo in patients with peanut allergy. The study selection and data extraction were independently performed by two reviewers. The primary outcome was the proportion of patients whose condition improved. We also analyzed immunologic changes and adverse events. A meta-analysis was performed using a random effects model. Three RCTs that comprised a total of 86 subjects were analyzed. OIT or SLIT had a significantly positive effect on peanut allergy (odds ratio [OR], 38.44; 95% confidential interval [CI], 6.01-245.81). Several immunologic changes associated with the induction of tolerance were improvements. There is no difference between the OIT or SLIT group and placebo group in the number of patients who required epinephrine during the study (OR, 0.51; 95% CI, 0.03-10.20). This study showed a statistically significant benefit of peanut immunotherapy in patients with peanut allergy. However, these findings are based on an analysis of a small number of RCTs. Additional larger, well-designed and double-blind RCTs are needed.