Ready For Primetime

Jodi Shroba, Pediatric Nurse Practitioner; Food Allergy Program Coordinator, Children’s Mercy Kansas City

Peanut allergy is the most common food allergy in children under the age of 18 and the 2nd most common in adults. Peanut allergy tends to be lifelong with only about 20% of people outgrowing it. The recommended treatment is avoidance (not eating the allergen) and to carry epinephrine for allergic reactions.

Enter: OIT

However, in March 2020 the very first FDA approved treatment for peanut allergy came to the market. Palforzia™ is known as oral immunotherapy (OIT) and works by exposing the body to small amounts of peanut so the body will be desensitized (less reactive) upon accidental exposure. This treatment is approved for children 4-17 years of age. This occurs by slowly increasing the amount of the peanut flour ingested (eaten) each day.

The first day is called “initial dose escalation” where the patient comes into the allergy office and receives several increasing doses of peanut powder. The child will take their dose daily at home and return to the allergy office every 2 weeks for their next dose which is called the “escalation phase.” During the visits to the allergy office, they will be observed for 60 minutes. Once they reach 300mg (1 peanut) they are in the “maintenance phase” and will continue this dose daily indefinitely (forever).

This is not a cure for peanut allergy, and patients must continue to avoid peanut ingestion and carry their epinephrine autoinjectors.

Risks:

This treatment does come with risks like mild allergic symptoms such as itchy mouth, throat or stomachache; these are usually mild symptoms that improve with time. Risk of hives, runny nose, congestion, and wheezing can also develop. Since you are ingesting a food you are allergic to, anaphylaxis is always a risk. There is a smaller risk for the development of eosinophilic esophagitis (EoE) which is an inflammatory reaction of the esophagus (the tube that goes from your mouth to your stomach). There is a greater risk of reaction if fasting (not eating for religious or personal reasons), asthma flared, fever greater than 100, or gastro-intestinal (GI) illness such as vomiting. In these cases, your allergy provider will ask you to hold your dose and not increase as quickly. Additionally, there is a recommended “rest period” after your dose each day. It is important that your child does not exercise, participate in activities that will increase heart rate, or take a hot shower during the rest period as these can increase risk of reaction.

Benefits:

So why take this therapy? The benefits include reduction and/or elimination of an allergic reaction upon accidental exposure (eating an allergen by mistake). Quality of life will improve by helping the child and family worry less and feel more comfortable in school and social situations such as restaurants and parties. This treatment will allow most children to participate more comfortably in normal childhood activities that they previously may have been afraid to, due to their peanut allergy.

Costs:

Work with your Allergy provider to determine cost based on your insurance. Financial assistance may also be available.

Questions to Consider:

Peanut OIT is not for everyone and avoidance is still a valid treatment option. However, if you are thinking about OIT for your child, here are some questions to consider before starting this treatment:

Do my child and I often worry about peanut exposure?
Does my child not participate in all the activities that they would like to because of their peanut allergy?
Is our schedule flexible enough to allow visits to the allergy clinic every 2 weeks while in the escalation phase about 6 months?
Is our schedule flexible enough that we have enough time to dose daily (give the medicine every day) and observe the rest period?
Could my child stick to taking daily dosing?
Do I fully understand all the risks involved?

Oral immunotherapy (OIT) to other foods is a treatment option that is offered by some allergy practices, but this is considered off-label treatment. While it holds the same risks and benefits, there is no FDA approved product for other foods.

If you have more questions or would like more information about OIT, speak to your allergy provider.

Peanut Therapy Hits The Market