The U.S. Food and Drug Administration has approved the first oral immunotherapy treatment for peanut allergy in children and teens ages 4-17. The treatment gives children who are allergic to peanuts a new option to protect them against accidental exposure, says Dr. MaLourdes de Asis, Section Chief of Allergy and Immunology at Montefiore Nyack Hospital.
Peanuts are among the most common food allergies, affecting an estimated 1.6 million children in the United States. The new treatment, called Palforzia, consists of peanut protein. It should significantly reduce the severity of allergic reactions, including anaphylaxis, after accidental peanut exposure, Dr. de Asis said. “Palforzia will only be prescribed by allergy specialists, and the child must be enrolled in a special program to have access to the medication,” Dr. de Asis said.
The treatment involves ingesting small measured and standardized doses of peanut protein, increased gradually over months, to build the child’s tolerance to peanuts.
Before a child is prescribed the medicine, the allergist will perform testing to make sure the child is actually allergic to peanuts, Dr. de Asis said. If the child does indeed have a peanut allergy, they will be given a small amount of the medication, and monitored carefully over several hours to make sure they don’t have an adverse reaction. The dose is gradually increased, with the doctor carefully monitoring the child. Once a certain level is reached without an adverse reaction, the child will go home and continue to take that dose every day. The child will return every two weeks to get a higher dose during a monitored office visit, for up to six months. “The highest dose is equivalent to two peanuts,” Dr. de Asis said.
To stay desensitized to peanuts, the child will have to take the maintenance daily dose of peanut indefinitely. “The treatment won’t allow you to eat a peanut butter sandwich, and you will still have to carry an EpiPen to treat an acute allergic reaction,” she noted.
The drug, in powder form, is emptied into semisolid food such as applesauce, yogurt or pudding, and mixed. Palforzia can cause stomach upset or vomiting. “You have to take it after eating a full meal,” Dr. de Asis said. “For some families, peanut allergy has a huge impact on their quality of life,” she said. “For them, it’s worth it to do this so they don’t have to be anxious about the child having a dangerous reaction to peanuts.”
Another new peanut allergy treatment may be approved by the FDA later this year. The treatment will be administered through a skin patch. “It provides a lower level of peanut protein, so it may provide less protection, but it could be a good alternative for kids who can’t tolerate the oral treatment,” Dr. de Asis said.
Preventing Peanut Allergy
Guidelines issued several years ago by the American Academy of Pediatrics suggest that parents should introduce most babies to peanut-containing foods around the time they begin eating other solid foods, typically 4 to 6 months of age. The guidelines recommend that infants eat about 2 grams of peanut protein (the amount in 2 teaspoons of peanut butter) 3 times a week. Recent studies have shown that the early introduction of peanut to infants at 4-11 months of age significantly reduces the risk of development of peanut allergy, especially in high-risk infants.
Don’t give infants whole peanuts, which are a choking hazard. Infants should get their peanuts in prepared peanut-containing foods such as peanut butter spread on bread or crackers.
“If a child has mild to moderate eczema, parents can try giving their child peanut butter at home, but if they’re worried about a reaction, they can do it in a pediatrician’s or allergist’s office,” Dr. de Asis said. “If your child has asthma, you may also want to introduce peanut in an allergist’s office, or at least talk to your pediatrician before trying it at home.”
It is recommended that high-risk infants—those with a history of severe eczema and/or egg allergy—undergo a blood or skin-prick test before being given foods containing peanuts. The test results can help to determine how, or even if, peanuts should be introduced in the child’s diet.