Peanut allergen powder

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Peanut allergen powder, sold under the brand name Palforzia, is an oral medicine to help children with peanut allergy tolerate peanuts better. It is made from peanuts and comes as powder in capsules for dose increases and a sachet for ongoing maintenance. The dosing is carefully measured so people with severe allergies can take it safely.

Who can use it
- In the United States, it is approved to reduce allergic reactions, including anaphylaxis, that could occur if a peanut is accidentally eaten.
- In the European Union, it is approved for children aged 4 to 17 years with a confirmed peanut allergy to help desensitize them.

How it is used
- Taken by mouth.
- Treatment starts with gradually increasing doses (up-titration) and then continues with regular maintenance dosing.

Common side effects
- Abdominal pain, vomiting, nausea, tingling in the mouth, itching in the mouth or ears, cough, runny nose, throat irritation, hives, wheezing, shortness of breath, and in some cases anaphylaxis.
- It should not be used in people with uncontrolled asthma.

Effectiveness
- In a large study across the US, Canada, and Europe with about 500 participants, about 67% of those taking peanut allergen powder could tolerate a 600 mg peanut protein dose after six months of maintenance, compared with 4% of those given a placebo.

Safety and regulation
- Palforzia was approved by the U.S. FDA in January 2020 and in the EU in December 2020.
- In the US, access is controlled through a risk management program (REMS) requiring certified providers and enrolled patients.
- Reviews have noted that while the treatment can desensitize some patients, there may be an increased risk of allergic reactions during treatment, and some analyses have questioned the strength of the supporting evidence.