**This Tool Was Taken and Adapted from the ACAAI**
Should My Child Try Peanut Allergy Treatment?
Use this tool to help decide if the treatment is right for your child
If your 4-17-year-old has a peanut allergy, a new treatment may offer additional protection. Oral peanut immunotherapy slowly exposes an allergic child to peanuts so their immune system is less likely to react after an accidental ingestion of peanut product. That means if your child accidentally eats something containing peanuts, the treatment may protect them from a severe reaction. Even with this treatment, your child MUST continue to avoid peanuts and carry two epinephrine auto-injectors.
It’s important to understand:
- The new treatment is not a cure – your child will still be allergic to peanuts and must avoid them.
- It will not enable your child to eat peanuts or peanut products anytime they wish.
- It works only while your child is taking it on a daily basis.
- Your child will need to continue to carry two epinephrine auto-injectors and you and your child will still need to read food labels.
- Reactions can occur due to the treatment itself.
For many children with peanut allergy and their parents, the benefits may be worth the drawbacks.
This tool helps you talk with your child’s allergist to decide if this treatment might be a good option for your child.
The tool is easy to use:
- Read about peanut allergy and the therapy.
- Respond to a few simple statements based on your child’s temperament and preferences.
- Bring your answers to the general information session held by Dr. Chipps or Dr. Parikh.
About Peanut Allergy
Peanut allergy, is one of the most common food allergies, occurring in one in 50 children. Peanuts or peanut protein can be found in many different types of foods and the consequences of exposure can be life-threatening.
To prevent allergic reactions, children with peanut allergies are taught to avoid peanuts, ask what’s in food before eating it, check nutrition labels and always carry two epinephrine autoinjectors. That works well for many children and their parents. Some parents may seek additional protection for their child, which may be provided by a new treatment called Palforzia™. However, the treatment has its risks and is not a cure. Whether or not they are taking the new treatment, if a child with a peanut allergy has a reaction, they should inject their epinephrine to reverse the allergic reaction and call 911 to be taken to the nearest emergency room.
About the New Treatment
A new treatment called Palforzia™ has been approved by the Food and Drug Administration (FDA) as an option for peanut allergy in children 4-17 years of age. It is known as oral immunotherapy and works by exposing the child to a small amount of the allergen so they become less likely to have an allergic reaction if they accidentally eat a peanut product. The treatment involves putting a tiny bit of peanut powder into food every day – the amount is slowly increased over time – so that the child is less likely to react after an accidental ingestion of a peanut product. It is not a cure.
There are several limitations to the treatment. The child should take the treatment with a meal and should delay taking it after strenuous exercise until they are no longer flushing, sweating, breathing rapidly and their heart is no longer beating fast. They also should avoid taking a hot shower or bath right before or three hours after the treatment. This means it’s important to consider meal times, sports practice, competitions and activities when determining the timing of treatment in the daily schedule.
For many parents, the potential benefit of decreasing reactions to an accidental ingestion outweighs the negatives and limitations of the treatment. For their child, it may mean feeling more comfortable in social situations such as during lunch at school, parties, overnight camp, playdates and eating in restaurants.
Read on to learn more about the treatment.
Peanut Allergy Treatment
There are two options to avoid a reaction in children and adolescents ages 4 to 17 who have a peanut allergy. One is to continue to avoid peanuts and carry two autoinjectors of epinephrine. The other is to continue to do those things, as well as daily peanut allergy treatment.
This chart explains more about the two options.
| Option | Peanut allergy treatment
|
Avoidance
|
| How does it work? | Palforzia™ peanut powder is sprinkled on food once a day. (It should be taken with food or after eating.)
The child visits the doctor every two weeks for at least the first six months to be given a higher dose of peanut powder and is observed for 60 minutes for a reaction. During the first visit, the child will receive several increased doses will be in the allergist’s office for a few hours. Once the maintenance dose is reached, the child will take the treatment daily with a meal and follow up with their allergist regularly
The caregiver/child reads labels and avoids ingestion of peanuts, and carries two epinephrine autoinjectors at all times.
|
The caregiver/child reads labels and avoids ingestion of peanuts, and carries two epinephrine autoinjectors at all times. |
| What are the advantages? | The child is less likely to react to accidental peanut exposure.
May help the child feel more comfortable in social situations.
|
Current standard of care.
No need to take daily treatment and no risk of reaction from that treatment. No need to adjust activities based on peanut dosing. |
| What are the possible side effects or limitations? | Most common: Stomach ache and itchy mouth or throat, which likely will decrease over time.
Risk of hives and swelling, congestion and runny nose, wheezing, asthma developing or worsening and anaphylaxis
Risk of anaphylaxis, during buildup and maintenance is higher than avoidance.
Very small risk of eosinophilic esophagitis, an inflammatory reaction of the tube that connects the mouth and stomach.
The child should delay taking the treatment after exercising until they have stopped flushing, sweating and breathing rapidly and no longer have a rapid heart rate. Also, the child should not take a hot bath or shower immediately before the treatment or within three hours afterward.
A lower dose or no dose should be taken if the child has a fever, infection or is feeling ill.
|
None |
| What are the possible disadvantages? |
Risk of reactions to the therapy including possible anaphylaxis.
Risk of development of eosinophilic esophagitis.
There is a greater risk of allergic reaction due to: - Exercise - Hot water exposure - Fastingn Menstruation - Sleep deprivation - Use of nonsteroidal anti-inflammatory medication (such as Advil® and Aleve®) - Uncontrolled asthma
Many children and adolescents with peanut allergies do not like the taste of peanuts, making the therapy challenging, especially in younger children.
Must be taken every day indefinitely or it stops working.
|
Reactions can occur at lower levels of peanut exposure. |
| What is the cost of treatment? | $$$
Includes two epinephrine autoinjectors, the treatment and seeing the allergist every two weeks for at least six months.
Financial assistance may be available – ask your allergist. Work with your allergist to determine what it will cost based on your insurance.
|
$
Includes two epinephrine autoinjectors. |
| What else should I know? | The treatment is not a cure and does not enable the child to eat peanuts or peanut products.
The treatment only reduces the risk of reaction to peanuts, not other food allergens.
The treatment must be refrigerated and taken with a meal.
This treatment is approved for use only in children and adolescents ages 4 to 17 years old.
|
Most children do not outgrow peanut allergy. |
Your Turn
The next step is to talk about the treatment with Dr. Parikh or Dr. Chipps. To help you figure out if the treatment might be an option for your child, note whether you agree or disagree with the following statements.
- I worry constantly that my child will be exposed to peanuts and have a serious allergic reaction.
- My child avoids peanuts and carries an epinephrine autoinjector but still doesn’t feel protected from a reaction.
- I would be able to take my child to the allergist every two weeks for six months.
- My child is not able to fully enjoy participating in activities such as parties and overnight camp due to their peanut allergy.
- It would not be difficult to plan daily activities such as showering and exercise around the treatment.
- My child would be willing to try this treatment.
- My child would be able to adhere to a daily treatment.
Even though Palforzia has been approved by the FDA, it is currently not able to be prescribed for treatment at this time. Additional steps by Aimmune as well as us here at CARDC must be completed before it will be available to be prescribed for patient use.
Please take the time to read the information above and discuss with your child all of these important details. Additional information is also available on palforzia.com. At the top of the website is a link “Medication Guide”. This is a useful 5 page handout describing additional details about the treatment.
If after review of this document, discussion with your child, and review of the information available on palforzia.com you are interested in pursuing this treatment – you are encouraged to proceed with a peanut OIT office consultation.
Due to the current COVID-19 crisis, this office consultation will be done via telemedicine. If you’d like to schedule a telemedicine peanut OIT consultation, please call our main office at (916) 453-8696 and ask to be connected to J St Front Desk for Scheduling Peanut OIT consultation. During this consultation we will review your peanut diagnosis, discuss the treatment, and answer additional questions regarding peanut OIT. Due to the current COVID-19 crisis, we do not anticipate being able to start the treatment until July (this is an estimate).
