April 7, 2021

Peanut OIT rolling out at U-M Food Allergy Clinic

Implementing the first-ever federally approved “treatment” for peanut allergy is well under way at the Michigan Medicine Food Allergy Clinic.

There are about 100 patients on the wait list for Palforzia, the desensitization therapy that the U.S. Food and Drug Administration approved last year for people age 4-17, said Malika Gupta, MD, an allergist at the clinic, assistant professor at the U-M medical school and member of the MHWFAC faculty.

“It’s taken off and been very well accepted,” said Dr. Gupta, who noted that given COVID-related delays, Michigan Medicine didn’t start offering the treatment until December.  “We’re administering it to about four new patients a week.”  

Palforzia is not a cure for peanut allergy, she emphasized.  It helps the patient’s body adapt to a small amount of peanut protein – about the amount in one nut, at the strongest dosage – to avert reactions due to cross-contamination and inadvertent exposure.

“It is not a license to eat a peanut-butter sandwich,” she said. “We are training your system to tolerate an unintentional ingestion of peanut protein.”

The starting dose for this oral immunotherapy (OIT) is 3 milligrams -- less than 1/100th of a peanut.  Patients visit the clinic to consume the dose in applesauce or some other treat, then are observed for one to three hours to make sure no adverse reaction occurs. 

If all goes well, the patient takes home a supply of capsules and repeats the process each day.  At two-week intervals, the individual returns to the clinic for the initial dose of a higher amount of protein powder.  Eventually, after about six months, the patient has worked up to the maintenance dose of 300 milligrams of powder, and stays on that indefinitely. 

Children and teens use the same protocol, said Dr. Gupta, and the tolerance is not sustained without daily maintenance of the OIT.  She finds so far that younger patients are more apt to adopt the regimen; the frequent clinic visits and adherence to the daily protocol are more than some busy teenagers want to take on. 

Insurance typically covers the cost of the therapy, Dr. Gupta said. 

“Palforzia has standardized the process of desensitization, so there is less room for error,” she said. “It can be life-changing.”