STEPS

New Drug Reviews

Peanut Allergen Powder (Palforzia) for Peanut Allergy

 

Am Fam Physician. 2022 Jan ;105(1):20-21.

Peanut allergen powder (Palforzia) is an allergen extract for oral immunotherapy. It is labeled for the mitigation of allergic and anaphylactic reactions to accidental exposure to small amounts of peanuts in patients with a confirmed diagnosis of peanut allergy. Use of peanut allergen powder may be initiated in children four to 17 years of age and maintained in adults 18 years and older.1

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DrugDosageDose formCost of full course*

Peanut allergen powder (Palforzia)

Three phases of dosing: initial escalation, up-dosing, and maintenance

0.5-mg to 100-mg capsules; 300-mg sachets

$3,000


*—Estimated lowest GoodRx price for one year of treatment. Actual cost will vary with insurance and by region. Information obtained at https://www.goodrx.com (accessed November 5, 2021; zip code: 66211).

DrugDosageDose formCost of full course*

Peanut allergen powder (Palforzia)

Three phases of dosing: initial escalation, up-dosing, and maintenance

0.5-mg to 100-mg capsules; 300-mg sachets

$3,000


*—Estimated lowest GoodRx price for one year of treatment. Actual cost will vary with insurance and by region. Information obtained at https://www.goodrx.com (accessed November 5, 2021; zip code: 66211).

Safety

In clinical studies, life-threatening anaphylaxis occurred in 8.7% to 9.4% of patients taking peanut allergen powder vs. 1.7% to 3.8% of patients taking placebo (number needed to harm = 14 to 18).2 The need for epinephrine was 10.4% in the peanut allergen group and 4.8% in the placebo group.1 Peanut allergen powder is contraindicated in patients with severe asthma, eosinophilic gastrointestinal disease, or anaphylaxis for any reason in the previous 60 days. It should not be prescribed concurrently with medications that could interfere with the effectiveness of, or result in harm by, epinephrine administration (e.g., epinephrine can cause hypertensive crisis in patients taking beta blockers). Although peanut allergen powder has not been studied in pregnant patients, anaphylaxis may cause hypotension and corresponding placental hypoperfusion, which can adversely affect a fetus. A registry to collect health information on exposure during pregnancy is available.3 There are no data on the effects of peanut allergen powder on lactation. Use of peanut allergen powder has not been studied in children younger than four years or for the initiation of treatment in adults older than 55 years. Most data include patients four to 17 years of age.2

Tolerability

Abdominal pain affects about one in four patients taking peanut allergen powder (26% vs. 8% in those taking placebo). Other common adverse effects of peanut allergen powder compared with placebo include allergic symptoms such as throat irritation (9.3% vs. 5.1%)

Address correspondence to Deborah Erlich, MD, MMedEd, FAAFP, at Deborah.erlich@tufts.edu. Reprints are not available from the author.

Author disclosure: No relevant financial relationships.

References

show all references

1. Hise K. U.S. Food and Drug Administration. BLA clinical review memorandum. Peanut (Arachis hypogaea) allergen powder. Accessed March 10, 2021. https://www.fda.gov/media/135488/download...

2. DailyMed. Drug label information. Palforzia–peanut kit. Palforzia–peanut powder. Accessed March 10, 2021. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=17f5be03-6705-4ac9-b8f3-bc4993ebc0eb#footnote-4

3. U.S. Food and Drug Administration. List of pregnancy exposure registries. Accessed November 16, 2021. https://www.fda.gov/science-research/womens-health-research/list-pregnancy-exposure-registries

4. Vickery BP, Vereda A, Casale TB, et al.; PALISADE Group of Clinical Investigators. AR101 oral immunotherapy for peanut allergy. N Engl J Med. 2018;379(21):1991–2001.

STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.

The series coordinator for AFP is Allen F. Shaughnessy, PharmD, MMedEd, assistant medical editor.

A collection of STEPS published in AFP is available at https://www.aafp.org/afp/steps.

 

 

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