Peanut OralImmunotherapy is a form of preventive and anti-inflammatory treatment of allergy to substances such as pollens, house dust mites, fungi, and stinging insect venom. Immunotherapy involves giving gradually increasing doses of the substance, or allergen, to which the person is allergic. The incremental increases of the allergen cause the immune system to become less sensitive to the substance, perhaps by causing production of a particular "blocking" antibody, which reduces the symptoms of allergy when the substance is encountered in the future." rel="tooltip">Immunotherapy(OIT)Peanut oral immunotherapy (OIT) with peanut allergen powder-dnfp (Palforzia®) is an FDA-approved treatment for childrenages 4 to 17 years可以帮助降低风险和severity of allergic reactions to peanuts, includinganaphylaxis. The therapy consists of daily exposure to peanut protein powder in increasingly larger doses over a six-month period to help your child develop tolerance, followed by daily maintenance doses to maintain effectiveness.Please note:Peanut OIT isnot a curefor peanutAllergies are inappropriate or exaggerated reactions of the immune system to substances that, in the majority of people, cause no symptoms. Symptoms of the allergic diseases may be caused by exposure of the skin to a chemical, of the respiratory system to particles of dust or pollen (or other substances), or of the stomach and intestines to a particular food." rel="tooltip">allergy. Treatment requires a commitment to a daily therapy that has likely side effects – such as allergic reactions – that can become less severe over time. Your childmuststill avoid eating peanuts and carry twoEpinephrine is a naturally occurring hormone, also called adrenaline. It is one of two chemicals (the other is norepinephrine) released by the adrenal gland. Epinephrine increases the speed and force of heart beats and thereby the work that can be done by the heart. It dilates the airways to improve breathing and narrows blood vessels in the skin and intestine so that an increased flow of blood reaches the muscles and allows them to cope with the demands of exercise. Epinephrine has been produced synthetically as a drug since 1900. It remains the drug of choice for treatment of anaphylaxis." rel="tooltip">肾上腺素auto-injectors in case of an accidental exposure.If the therapy is stopped, the benefits will gradually wear off.Who Peanut OIT Is ForChildren ages 4 to 17 years with a confirmed diagnosis of peanut allergy are good candidates for peanut OIT.Who Peanut OIT Isn’t For
- Children with uncontrolledAsthma is a chronic, inflammatory lung disease characterized by recurrent breathing problems. People with asthma have acute episodes where the air passages in their lungs get narrower, and breathing becomes more difficult. Sometimes episodes of asthma are triggered by allergens, although infection, exercise, cold air and other factors are also important triggers." rel="tooltip">asthmaor certain stomach conditions, including eosinophilic esophagitis (Inflammation is the redness, swelling, heat and pain in a tissue due to chemical or physical injury, or to infection. It is a characteristic of allergic reactions in the nose, lungs, and skin." rel="tooltip">inflammationof the esophagus) or other eosinophilic gastrointestinal diseases
- Children who are unwilling or unable to receive injectable epinephrine
- Children with a medical or physical condition, or who are taking a medication, that reduces their ability to survive a severe allergic reaction
- Children who cannot commit to taking daily treatments for the rest of their lives or whose caregivers cannot commit to administering daily treatments
To find out if peanut OIT is right for your child, please see ourPeanut Allergy Treatment Shared Decision-Making Tooland consult your allergist. The cost of peanut OIT is often covered or partially covered by health insurance. Work with your allergist to determine the cost based on your insurance coverage.
Note that there are also non-FDA-approved peanut OIT products that your allergist might use for treatment. You can discuss those options with your allergist to get more details.
Peanut OIT Treatment Process
After confirming that your child is a good candidate for this treatment, your allergist will work with the product manufacturer, your insurance, and a specialty pharmacy to get your child started on the three-phase treatment process.
During this four-hour first visit at your allergist’s office, your child will receive five increasingly larger doses of the peanut OIT: 0.5 mg, 1 mg, 1.5 mg, 3 mg, and 6 mg. After each dose, your allergist will wait 20 to 30 minutes and monitor your child for a severe reaction before administering the next dose.
After successfully completing the initial dosing phase, your child will start the up-dosing phase. This phase consists of 11 visits to your allergist’s office, roughly every two weeks for six months, with the first visit occurring within four days of the initial dosing appointment.
During each visit, your child will receive a progressively larger dose of the peanut OIT. The dose for the first visit will be 3 mg, and the doses for the following 10 visits will be 6 mg, 12 mg, 20 mg, 40 mg, 80 mg, 120 mg, 160 mg, 200 mg, 240 mg, and 300 mg, respectively. Your allergist will administer the initial dose and wait 20 to 30 minutes while monitoring your child for a severe reaction before giving you two weeks’ worth of the oral peanut powder to administer to your child at home.
It’s important to store each dose in the refrigerator and give the dose to your child at approximately the same time each day, with a meal. The doses of peanut powder should be mixed with cold or room-temperature soft foods like applesauce, pudding, or yogurt. They should not be given in hot foods or drinks.
After your child has successfully completed the up-dosing phase, they must continue to take 300 mg of peanut OIT every day at home. This helps your child continue to tolerate small amounts of peanut protein and is necessary for your child’s treatment to remain effective.
ACAAI has created child-friendly videos that explain the peanut OIT process in detail. Please select the appropriate video below to watch with your child.
Peanut OIT info: Children 4 to 8 years
Peanut OIT info: Children 9-17 years
Important Things To Note
- Doses should be taken with food at about the same time each day.
- Your child should avoid taking hot showers or baths and engaging in strenuous physical activity immediately before and up to three hours after a dose. These activities increase your child’s likelihood of having a severe allergic reaction. If your child is overheated or has an elevated heart rate, wait for them to cool down or for their heart rate to return to normal before giving them their next dose.
- If your child misses a dose, contact your allergist. Do not resume dosing without your allergist’s knowledge.
- Avoid NSAIDs – nonsteroidalAnti-inflammatory drugs reduce the symptoms and signs of inflammation. Although not a drug, immunotherapy ("allergy shots") reduces inflammation in both allergic rhinitis and allergic asthma." rel="tooltip">anti-inflammatory drugs– and other over-the-counter pain medications, except for acetaminophen (Tylenol).
Possible Side Effects
The following are commonly reported side effects of peanut OIT.
- Stomach pain or vomiting
- Itching or burning in the mouth
- Throat irritation or tightness
- Cough, runny nose, or sneezing
- Wheezing or shortness of breath
- Itchy skin or ears
- Hives (itchy, raised bumps on the skin)
花生OIT可以引起过敏反应,严重的allergic reaction that may be life-threatening.If your child has any of the following symptoms, they should stop taking the therapy, use their epinephrine auto-injector, and seek emergency medical treatment right away.
- Wheezing or trouble breathing
- Chest discomfort or tightness
- Throat tightness
- Trouble swallowing or speaking
- Swelling of the face, lips, eyes, or tongue
- Dizziness or fainting
- Severe stomach cramps or pain, vomiting, or diarrhea
- Hives (itchy, raised bumps on the skin)
- Severe flushing of the skin
Peanut OIT can also cause stomach or gut symptoms, including eosinophilic esophagitis (EoE).The following are common symptoms of EoE.
- Trouble swallowing
- Food stuck in the throat
- Burning sensation in the chest, mouth, or throat
- Regurgitation of undigested food
The following conditions and activitiescan increase your child’s risk of an allergic reaction while receiving peanut OIT.
- Strenuous physical activity
- Illness (viral infection)
- Sleep deprivation
- NSAIDs – nonsteroidal anti-inflammatory drugs – and other over-the-counter pain medications, except for acetaminophen (Tylenol)
- Uncontrolled asthma
For additional information on the possible side effects of peanut OIT, talk with your allergist.