Oral immunotherapy (OIT) is a procedure where patients are given tiny increasing doses of the allergic food over time to increase their tolerance so that they will no longer have an allergic reaction to small amounts of the food. It is administered in an Allergy specialist’s office in a carefully controlled setting, so patients are closely monitored for any reactions, treated with necessary medication, and their doses adjusted as needed.
Aside from the potential life threatening risks of peanut allergy, it also has a significant effect on the quality of life of the child and the family. Studies show increased anxiety and social isolation resulting in decreased quality of life in food allergic children and their families. OIT has been shown to improve quality of life in these patients.
A new treatment option to treat peanut allergies called Palforzia (AR1010), a form of peanut oral immunotherapy (OIT), was approved by the FDA in September 2019. Palforzia is FDA approved to reduce the incidence and severity of allergic reactions after accidental exposure to peanut in children aged 4 to 17 years of age with confirmed diagnosis of peanut allergy. Palforzia is classified as a drug but is a standardized dose of peanut flour in a capsule, which makes it safer than other forms of non-FDA approved Oral Immunotherapy.
With Palforzia, the initial visit usually takes 4 hours where the patient is given multiple doses of the drug to determine how much they can tolerate without a reaction. They then return the next day for another visit which usually takes 1-2 hours where they are “updosed” or given a dose higher than the previous day’s dose. They are then sent home with this same dose which they are supposed to take at the same time every day for 2 weeks. After 2 weeks, they return to their doctor’s office for another updose and this goes on for 5-6 months until the patient is able to tolerate 300 mg of peanut protein which roughly correlates to 1-2 peanuts. The patient then continues to take this dose of Palforzia daily to maintain desensitization and protect them from accidental peanut exposures.
Most common side effects from peanut OIT have been abdominal pain, vomiting, and mild allergic reactions. Rarely a condition called eosinophilic esophagitis can occur, which causes bad Gastric reflux and difficulty swallowing. This condition usually resolves after stopping the drug. Anaphylaxis is also a risk, as with any form of desensitization. However, OIT dose increase is gradual and carefully monitored, so the risk is minimized.
We also offer Peanut OIT to patients older than 17 years old at risk for anaphylaxis to peanuts.