Oral immunotherapy (OIT) “retrains” the immune system to be less reactive to allergenic food proteins. In the case of peanut allergy, for example, OIT is performed by feeding the patient increasing doses of peanut protein slowly over time, starting with an extremely small dose. Eventually the patient will eat a larger, daily dose of peanut protein that they can tolerate without a reaction. This dose is eaten every day in hopes that it will provide a protective benefit to cross-contact or accidental ingestion of peanut. This is not a guarantee of future tolerance, meaning that the patient will not necessarily be able to eat peanut freely without reaction. The need for diligence and immediate access to injectable epinephrine persists.
What is OIT with Palforzia?
The Aimmune website states that Palforzia is a “proprietary, pharmaceutical-grade peanut protein formulation containing all allergenic proteins in peanut in a fixed ratio”. In other words, Palforzia is treatment that consists of capsules filled with precisely measured amounts of peanut protein.
While OIT has promise to provide your child with the ability to have less serious reactions if exposed to their allergen, it is a time-consuming process that requires real dedication and willingness to participate in the treatment.
Here are some questions to ask yourself and/or your child to see if OIT may be right for you.
Palforzia may be right for your child.
OIT may be right for your child. Palforzia indicates that children with severe, uncontrolled asthma are not good candidates for treatment.
OIT with Palforzia may not be right for your child because it requires a patient to have minimal activity for at least 3 hours after a daily dose.
OIT may be right for your child. OIT with Palforzia is a long-term, potentially life-long commitment requiring ingestion of a daily dose peanut protein.
OIT with Palforzia may or may not be right for your child. The most common side effect seen in studies with Palforzia was GI related and some cases of eosinophilic esophagitis were found after treatment with Palforzia.
Because a patient needs to take increasing doses of Palforzia over time, there is a chance for anaphylaxis at each up-dosing. There are also risk factors like exercise, increases body temperature, illness and changes in hormones that may affect your child’s response to the daily dose of Palforzia making anaphylaxis possible. If your child has significant anxiety regarding anaphylaxis or the use of injectable epinephrine, Palforzia may not be right for your child.
OIT with Palforzia may be right for your child. Because we don’t know how long this treatment needs to be taken for, a child who decides to take Palforzia needs to be highly motivated.
OIT with Palforzia may not be right for your child. It is more difficult to treat anaphylaxis in individuals on beta-blockers.
OIT with Palforzia requires significant family support, cooperation and coordination. This treatment may be right for your child is everyone agrees that Palforzia is an important treatment and understands that consistency in dosing is necessary to the success of the treatment.
OIT with Palforzia may not be right for your child. Children with history of significant anaphylaxis are not recommended for this treatment.
No, Palforzia is a peanut-specific treatment.
While the cost of OIT with Palforzia will vary greatly depending on your insurance coverage, treatment may still require out-of-pocket expenses and will likely be a significant financial committment.