Palforzia: The Oral Immunotherapy for Peanut Allergy
Palforzia, known generically as peanut (Arachis hypogaea) allergen powder-dnfp, is an FDA-approved oral immunotherapy (OIT) used to treat peanut allergy in patients aged 1 to 17. The goal of Palforzia is to lessen the severity of allergic reactions, including anaphylaxis, caused by accidental peanut exposure. It works by gradually desensitizing the immune system to peanut protein, but it is not a cure. Patients must maintain a strict peanut-avoidant diet and have injectable epinephrine available for emergencies throughout the treatment.
How Oral Immunotherapy Works
Oral immunotherapy involves consuming increasing amounts of an allergen over time to reduce the immune system's reaction. In the case of peanut allergy, this means taking a small, precise amount of peanut protein daily to train the immune system to be less sensitive. Because of the risk of allergic reactions, this treatment requires strict medical supervision for each phase.
The Three-Phase Treatment Process
Palforzia treatment follows three distinct phases:
- Initial Dose Escalation: This phase takes place entirely in a healthcare setting with an allergist present. Patients receive gradually increasing amounts of the peanut allergen powder to assess tolerance and monitor for reactions.
- Up-Dosing: After the initial phase, patients begin a series of up-dosing steps. The first amount of each new level is given in the allergist's office, followed by daily home administrations for a set period. This continues for several months until the target maintenance amount is reached.
- Maintenance: Once the maximum tolerated amount is achieved, patients continue with a daily administration of peanut protein to maintain reduced sensitivity. This daily administration is ongoing to sustain the therapeutic effect.
Important Safety Considerations
Given the potential for inducing allergic reactions, Palforzia is only available through a restricted program called the PALFORZIA REMS (Risk Evaluation and Mitigation Strategy) Program. All involved parties, including healthcare providers, pharmacies, and patients, must enroll. PMC website
Key safety requirements and contraindications include having injectable epinephrine readily available, receiving initial dose escalation and the first administration of each up-dosing level in a medical facility, and avoiding use in patients with uncontrolled asthma or certain eosinophilic conditions. Patients should also be monitored after administration as allergic reactions can occur. PMC website
Palforzia vs. Traditional Avoidance vs. Other Treatments
| Feature | Palforzia (OIT) | Strict Avoidance | Omalizumab (Xolair) |
|---|---|---|---|
| Goal | Mitigate reactions from accidental exposure. PMC website | Prevent all allergic reactions. | Broadly reduce allergic reactions, including food allergy. |
| Mechanism | Gradually desensitizes immune system to peanut protein. | Eliminates contact with allergen entirely. | Blocks all IgE antibodies, which trigger allergic reactions. |
| Administration | Oral powder mixed into food, daily administration. | Vigilant dietary and environmental precautions. | Injected every 2–4 weeks. |
| Risk | Can cause allergic reactions, including anaphylaxis. | Risk remains high for accidental exposure. | Potential side effects and cost. Lowers immune response. |
| Key Limitation | Not a cure, requires lifelong daily administration. | Human error and cross-contamination are constant risks. | Does not eliminate the allergy, just raises the threshold for reaction. |
| Cost | Can be very expensive, though may be covered by insurance. | No direct medication cost. | High cost per injection. |
Considerations for Treatment Selection
Choosing a treatment for a peanut allergy requires considering the patient's age, allergy severity, and lifestyle. While strict avoidance is traditional, it carries a constant risk of accidental exposure. Palforzia increases tolerance, offering a buffer against such incidents. Omalizumab, an injectable option, affects multiple food allergies but requires frequent administration. Consulting an allergist is essential to determine the best approach, and all treatment options still necessitate carrying and knowing how to use an epinephrine auto-injector.
Conclusion
For those managing a diagnosed peanut allergy, knowing the available treatments is vital. Palforzia is an oral immunotherapy aimed at reducing risks from accidental exposure. Although not a cure and requiring a long-term commitment, it offers increased protection and reassurance for eligible children and their families. While research into food allergy treatments continues, Palforzia represents a valuable current option. PMC website
