Treatment for Peanut Allergy

Our NGPG Allergy and Asthma locations are approved sites to provide the first FDA approved treatment for peanut allergy. Palforzia® is an oral immunotherapy treatment (OIT) for peanut allergic children ages 4 to 17. The treatment functions as a safety net in cases of accidental ingestion or cross-contamination. However, it is not a cure for peanut allergy and patients still must adhere to a peanut free diet and maintain injectable epinephrine to be used in cases of severe allergic reactions.

How does it work?

Patients receive increasing doses of Palforzia® in the office and at home in order to become desensitized to peanut. This means it would take a larger exposure to peanut to trigger an allergic reaction. Patients are introduced to peanut protein in gradually increasing amounts over the course of the first few months of therapy. This is done by mixing the contents of the Palforzia® capsules into a soft food (applesauce, pudding, yogurt, etc) and taking the doses once per day at home.

What are the benefits of treatment?

The main benefit of this treatment is development of a “safety net” in case a child accidentally ingests a food containing peanut. This medication has been shown to increase the amount of peanut needed to trigger a reaction and to decrease the severity of reaction in cases of accidental ingestion. This provides peace of mind for patients and care givers.

Is this a cure?

The treatment is not a cure. Patients must still adhere to a strict peanut free diet. We still recommend all peanut allergic patients have an epinephrine autoinjector in cases of a severe allergic reaction.

Who is eligible to receive treatment?

Patients ages 4-17 with a confirmed peanut allergy could qualify for this treatment. It requires a long term commitment involving frequent office visits during the up dosing phase, so the schedule may not work for all patients. Those with eosinophilic esophagitis or uncontrolled asthma cannot receive the treatment.

How will this affect daily life?

Treatment does require significant commitment on the part of the patient’s family. There are 12 visits for treatments in the office as well as a commitment to take the treatment every day at home. It is a long-term commitment. Since this is not a cure, the treatment must be continued daily, possibly indefinitely, in order to sustain the protection it affords. Researchers are investigating whether it may be possible for some patients to successfully discontinue the treatment at some point.

We ask our parents/care givers to commit to observing daily dosing of the medication, even with our teenage patients. Missed doses can result in a loss of protection and, therefore, an increased risk of allergic reaction if the patient were to resume at the same dosage. We will review how to handle missed doses at the screening visit if you elect to proceed with this therapy.

What is the treatment schedule?

There are a total of 13 visits for treatment which must be done at either of our NGPG Allergy and Asthma locations

Visit one is a screening visit at which time the history and physical will be performed, appropriate testing done, and paperwork will be completed. At a minimum, peanut skin and blood testing will be performed. Spirometry (breathing tests) will also be done if your child has current or a history of asthma.

The initial dose escalation (IDE) visit consists of 5 increasing doses of Palforzia®. The first 4 doses are each separated by 30 minutes with a final observation period of one hour after the 5th dose is given. We ask patients to expect this visit to last up to 4.5 hours.

The following day, your child will come in to receive his/her daily dose of Palforzia® which would be continued at home. After taking this dose, your child will be monitored for one hour for signs of an allergic reaction.  He/she would take this same dose at home every day until the next scheduled visit.

Every 2 weeks, your child will return for the next up dosing visit. Again, he/she will take the appropriate dose and be monitored for one hour afterward for signs of any allergic reaction. He/she would take this same dose at home every day until the next scheduled visit.

At the 11th up dosing visit, your child will receive the maintenance dosage of Palforzia® which he/she will continue at home indefinitely.

Is this safe?

Treatment with Palforzia® does carry a risk of an allergic reaction. While many of the reactions noted during the studies were mild to moderate, more serious reactions (anaphylaxis) did occur which required the use of epinephrine. The provider will review signs and symptoms of allergic reactions and appropriate treatments should they occur.

How much does this cost? Is it covered by insurance?

Every insurance company determines its own coverage of certain treatments. The screening visit, we will submit a benefits investigation. Based on the paperwork submitted, you will be contacted by the specialty pharmacy to review your out of pocket cost and any potential assistance that may be available. There would be routine charges from NGPG Allergy and Asthma for the office visits, monitoring and testing involved in screening and treatment visits.