New Product to Treat Peanut Allergy
The Allergenic Products Advisory Committee of the Food and Drug Administration (FDA) recently voted to recommend approval of a new treatment for peanut allergy to the FDA. The treatment was previously referred to as AR101 but it is expected to go by the brand name Palforzia, If as expected, the FDA gives the go ahead, it will be the first treatment for food allergy approved by the FDA.
A few important points about Palforzia
1. It is not a medicine.
Palforzia is a capsule filled with a precise amount of peanut powder. Thats it.
2. Palforzia is a form of oral immunotherapy
Oral immunotherapy is a process of feeding an allergic individual an increasing amount of the food they are allergic to with the goal of increasing the threshold that triggers a reaction. Immunotherapy for airborne allergens such as pollen, mold, and animal dander has been available by subcutaneous injection (allergy shots) for many years and is an effective treatment for seasonal allergies, allergy to pet dander, asthma, and eczema. Recently, a sublingual (under the tonge) immunotherapy tablet has been approved by the FDA for the treatment of grass and ragweed pollen allergy. Unfortunately, the grass tablet does not contain Bermuda grass and so is of limited value in Phoenix and other desert communities in Arizona. This will be the first oral form of immunotherapy to be approved for the treatment of a food allergy.
3. It is not a cure
By increasing the threshold dose of food required to cause a reaction, it is hoped that treatment with Paforzia will decrease the risk of a life threatening allergic reaction in the event that peanut is eaten by mistake. It will not allow peanut allergic patients to enjoy a Snickers bar or PBJ sandwich. With this treatment, a child who was at risk of a trip to the hospital if he ate half of a peanut, may be able to tolerate 3-4 peanuts before a severe reaction occurs.
4. It is for life
Patients must take the peanut capsule every day… forever!
5. There are risks
Patients receiving treatment with Paforzia frequently have allergic reactions to the peanut powder. These reactions range from a stomach ache to anaphylaxis. For this reason patients on Paforzia must carry self injectable epinephrine at all times.
Weighing the Risks versus Benefits
The challenge for doctors, patients and parents considering this new treatment will be in evaluating the benefits versus the risks: Does the benefit of having some protection against a life-threatening reaction to an unexpected exposure to peanut outweigh the risk of frequent allergic reactions with the daily treatment?