Should I consider oral immunotherapy for my child with a peanut allergy?


Food allergies are very common in children. In fact, between 0.5-3% of children are reported to have peanut or tree nut allergies. We all probably know at least a few children who are affected by this issue. Peanut allergy can cause a lot of anxiety for children and their families, especially when they worry about potential cross-contamination of various foods with nuts. Avoidance of peanuts and peanut butter is the straightforward part.

A New Oral Immunotherapy for Peanut Allergy

Recently, a new oral immunotherapy was approved by the FDA to treat peanut allergy. This therapy is called Palforzia and is indicated for children ages 4-17 years who have documented peanut allergy. Palforzia consists of 11 increasing doses of peanut protein to protect the child against accidental peanut ingestion once at the maintenance dose. Palforzia is created by a pharmaceutical company, and the dosing is strictly regulated as a drug. The peanut taste and smell have been removed. It is given as capsules opened and sprinkled over a food carrier. Palforzia must be taken daily to maintain desensitization to peanuts.

Palforzia administration consists of a modified food-challenge visit to the allergist. While there, the child will take several doses of peanut until they complete the day one protocol. Then they will go home and continue to take the dose prescribed daily for two weeks. Every two weeks, the child will need to return to the allergist for up-dosing and will then begin taking an increased dose of the product. There is a total of 11 increasing doses.

Risks

While Palforzia has been shown to prevent anaphylaxis if taken correctly at the maintenance dose, it does not come without its own risks. Since the child will be ingesting peanut protein daily, there is a risk of anaphylaxis due to Palforzia exposure. While taking this drug at the maintenance dose prevents symptoms after accidental ingestion of peanut due to cross-contamination, the child will not be able to consume peanuts freely. Epinephrine auto-injectors should still be carried at all times. There is also no specific end point when the child should discontinue Palforzia.  Once the drug is not taken daily, the tolerance to peanuts is lost.

It is a very exciting time for physicians and patients with food allergies now that new treatment options are becoming readily available. However, Palforzia may not be indicated for all patients with peanut allergy. Please discuss with your pediatrician and/or allergist if you think your child may be interested in Palforzia. The Pediatric Allergy Department at St. Louis Children’s Hospital will be accepting patients for Palforzia this spring.

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