Peanut allergy can be one of the most problematic allergies in both children and adults. It affects about 2% of the population in the UK and it can often cause reactions as severe as anaphylaxis. Unfortunately, its incidence is also on the increase, with about a 3.5-fold increase in the last two decades.
Up until recently, the only management strategy was peanut avoidance or symptomatic management. Palforzia immunotherapy has now been introduced as a treatment agent for severe peanut allergies. It is licensed in the UK for children aged 4 to 17 with a confirmed peanut allergy. The good news is that it is available both in the NHS and privately.
Privately, the cost of Palforzia treatment in the UK can be anywhere between £10,000 and £18,000. This usually includes the cost of the drug and any follow up consultations required in the first 12 months.
What is Palforzia?
Palforzia was developed by Aimmune Therapeutics, which was a British company before it was acquired by Nestle in 2020.
The medication to treat peanut allergy became the first and only FDA, EMA and MHRA approved treatment. This was specifically designed to mitigate allergic reactions to peanuts in children and adolescents aged 4 to 17 years with a confirmed diagnosis of peanut allergy.
Palforzia is a form of oral immunotherapy (OIT) that aims to increase tolerance to peanuts over time.
Treatment Process
The treatment consists of a carefully calibrated powder, derived from peanuts, that is administered orally. The process begins with very small doses, which are gradually increased over a period, allowing the immune system to become accustomed to the presence of peanut proteins without triggering a severe allergic reaction.
The process is divided into three primary phases: Initial Dose Escalation, Up-Dosing, and Maintenance. Each phase plays a critical role in gradually acclimatizing the patient’s immune system to tolerate peanut exposure.
Initial Dose Escalation
As the very first stage, this must always occur under medical supervision in a clinical environment. It can be completed in a single day and can take about 5-6 hours.
Patients receive increasing doses of Palforzia, starting with a very small amount and gradually escalating to a dose that signifies the beginning of the next phase. This careful monitoring is crucial to avoid clinical deterioration in case of unexpected side effects.
Up-Dosing
The next stage consists of titrating up the dose of Palforzia over about 6 months. The incremental increase is done usually once a fortnight, with regular visits to the specified immunotherapy centre.
During these regular assessments, you will have the opportunity to discuss any concerns, side effects and ongoing plan with an allergy clinician.
Maintenance
If all goes well during the up dosing stage, the final stage is maintenance.
Upon reaching this, patients must continue to consume a daily maintenance dose of Palforzia. This phase is ongoing and marks the stage where the patient has achieved a significant level of peanut tolerance. The maintenance dose aims to sustain this tolerance over time, requiring adherence to ensure continued effectiveness.
The immunotherapy centres will usually offer regular follow ups, or at least after a year of
How effective is Palforzia?
The pivotal Phase 3 trial, known as PALISADE, enrolled hundreds of peanut-allergic individuals to evaluate the treatment’s effectiveness. The results were promising, demonstrating that a significant proportion of participants could tolerate a considerably higher amount of peanut protein after completing the treatment compared to the placebo group.
Although effective, the majority of patients did have side effects. The severity of these varied from abdominal pain to systemic allergic reactions. They were also mostly found to occur during the up dosing stage. This is why the whole process must be done in a clinical environment prepared to manage systemic allergic reactions.
For example, 38% of participants had lip swelling, 19% felt throat tightness and about 32% had itchiness and urticaria in the dose escalation stage.
Further studies, including the follow-up ARTEMIS trial conducted in Europe, reinforced these findings, showing improved tolerance and reduced allergic reactions among treated participants. These studies have highlighted Palforzia’s potential to significantly reduce the severity of allergic reactions, including anaphylaxis, following accidental peanut exposure.
Benefits and Risks
Palforzia’s regulatory approval in various countries is a solid step forward in treating peanut allergies, offering several benefits to those afflicted. The treatment can significantly reduce the anxiety and dietary restrictions that come with living with a peanut allergy, improving the quality of life for patients and their families. Reducing some of the anxiety around eating out in cases of severe peanut allergy, can be life-changing.
However, the treatment is not without its risks. Adverse reactions can occur, and the necessity for a long-term commitment to the maintenance phase can be daunting (and expensive) for some patients and families.
For patients in the UK, Palforzia can be obtained on the NHS as well. You would first need a GP referral to an allergist for skin prick testing and establishing of the allergy diagnosis. The waiting lists will vary throughout the country, so it’s a good idea to check with your local hospital.
If you do decide to have it privately, Palforzia would cost about £3,000 per year for the medication cost alone. This usually excludes any follow ups or visits to your allergist.
In other countries, such as USA, the cover for Palforzia will vary depending on the insurance provider.
What happens once you turn 18?
Initiation of Palforzia is only licensed in those between 4 to 17 year old.
However, if you are over 17 and established on the maintenance dose, the medication information leaflet advises that you should continue taking it unless told otherwise.
Conclusion
Whilst there are other immunotherapy agents for nut allergy in various clinical trials, the wide approval of Palforzia has been welcomed by the medical community.
Although we don’t currently do immunotherapy for nut allergies at Holistic Allergies, we would be happy to help you with allergy testing. If you think you may have any kind of nut or other food allergy, get in touch with us to book a consultation and skin prick testing. Note that we currently only see new patients 16 or over.
