Peanut oral immunotherapy has been shown to effectively decrease sensitization in peanut-allergic individuals; however, clinical endpoints for completion of therapy remain unclear. We followed long-term outcomes in a real-world peanut OIT cohort that transitioned to ad lib peanut consumption once meeting predefined clinical and laboratory criteria. Data were collected for 199 patients initiating peanut oral immunotherapy (OIT) at a pediatric Allergy clinic between 2011-2020. Patients proceeded through clinic updosing to daily maintenance dose of 2 teaspoons peanut butter, or lower dose for toddlers or those with severe peanut aversion. Patients were permitted to transition to ad lib peanut consumption once meeting the following criteria: (1) tolerance of a full-serving of peanut (7000mg peanut protein) in oral food challenge, (2) Skin prick wheal <8mm, and (3) serum peanut-specific IgE level <1 kUA/L. Patients were advised to continue peanut consumption at least twice weekly during ad lib regimen. Clinical outcomes were monitored by clinic visits or telephone contact. Fifty-one of 199 patients transitioned to ad lib consumption after a median of 285 days since reaching daily maintenance (91-1183 days). Median time on ad lib status was 581 days (20-2,275 days). Two grade I reactions--oral itching and perioral rash--occurred after lapse in peanut intake for 2 weeks and 2 months, respectively. Eight patients (16%) continued to self-report peanut allergy, and 24 (48%) continued to carry epinephrine injectors. Peanut OIT patients identified prospectively by clinical and laboratory criteria can successfully transition from daily maintenance dosing to intermittent ad lib peanut consumption.