Life without fear: New treatment for peanut allergies
6/27/2022 by Joy Fladager Muth, APRN, C.N.P.
It's the time of year when children are looking forward to summer camps, travel, sporting events, county fairs and spending time with friends. If you have a child with a peanut allergy, these traditionally exciting and fun events also can create intense feelings of panic and fear. Because peanut ingestion can be life-threatening, many children — and the adults in their lives — worry about accidental exposure to peanuts every time they go somewhere.
Until recently, the only treatment option for children with peanut allergy was strict avoidance. Strategies to avoid peanut exposure included special "peanut-free" lunch tables at school, turning down snacks or treats after youth sports or at friends' houses, and hypervigilance around reading food labels. The unwanted effect of these strategies was often high levels of anxiety and social exclusion in children with peanut allergies "feeling different." However, in January 2020, the FDA announced the approval of Palforzia, the first oral immunotherapy option for children between the ages of 4–17 with peanut allergy.
Palforzia does not "cure" peanut allergy, but it can reduce the possibility of a fatal reaction.
How does it work?
It reduces the severity of allergic reactions, including anaphylaxis, which may occur with accidental exposure to peanuts by giving standardized levels of peanut protein regularly.
How is it given?
- First does and second dose, two days apart, administered in a health care setting under observation of a trained health professional.
- Return every two weeks over a six-month period to receive "up dosing," which is a higher concentration of peanut powder under the observation of a trained health professional.
- Between visits, Palforzia capsules of the peanut protein are opened and sprinkled onto food and ingested once daily.
- After six months, continue to administer once daily as maintenance.
Who is eligible?
- Children between 4–17 with a diagnosis of peanut allergy.
- Peanut IgE (blood test) greater than 0.35 and skin testing reaction of 3 inches x 3 inches or greater.
Who is not eligible?
- Adults 18 and older.
- Children under 4.
- Patients with uncontrolled asthma.
- Patients with a history of eosinophilic esophagitis or other eosinophilic esophagitis gastrointestinal disease.
Will my insurance cover it?
Most insurers are covering if the eligibility criteria is met.
What are the most common side effects?
- Abdominal pain, nausea and vomiting.
- Itchy mouth, nose or ears.
- Runny nose, sneezing.
- Cough, wheeze.
What are the risks?
- Palforzia can cause anaphylaxis, which may occur at any time during therapy.
- There is an increased risk of eosinophilic esophagitis.
Will I still need to avoid peanuts and/or carry my epinephrine (EPI) pen?
Yes. Palforzia is not a cure.
An allergy to peanuts is typically not outgrown. It is a lifelong commitment to prevent and protect from exposure. Palforzia will not work for everyone. It can help reduce the chance of a fatal reaction to accidental peanut exposure for children with peanut allergy. So, let's make the commitment to get kids back to looking forward with excitement — not fear — to all activities.
Joy Fladager Muth, APRN, C.N.P., is a nurse practitioner in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine. She is one of six pediatric providers serving as integrated community specialists. In this role, Joy provides expert asthma care and consulting services for primary care pediatric patients with asthma in collaboration with Mayo's Pediatric Pulmonology and Pediatric Allergy specialty providers.