Oral allergen immunotherapy (peanut)

Peanut protein

Brand names: Palforzia

Adult dose

Dose: Children 4–17 years: dose-escalation protocol up to 300mg/day maintenance, supervised in specialist centre

Route: Oral

Frequency: OD daily — long-term

Clinical pearls

NICE TA769: option for IgE-mediated peanut allergy in children 4–17 years
Initial dose escalation in specialist allergy centre with anaphylaxis facilities
Adrenaline auto-injector throughout — prescribed and patient/carer trained
BSACI guidelines on food allergy management

Contraindications

Uncontrolled asthma
Active eosinophilic oesophagitis or other eosinophilic GI disease
Severe systemic mastocytosis
Hypersensitivity to excipients
Recent severe anaphylaxis

Side effects

Abdominal pain
Vomiting
Throat irritation
Itching/urticaria
Anaphylaxis (during initial and updosing)
Eosinophilic oesophagitis

Interactions

Beta-blockers and ACE inhibitors (impair anaphylaxis treatment)

Monitoring

Anaphylaxis observation 60 min post-dose during escalation
Asthma control
Eosinophilic oesophagitis symptoms

Reference: BNF; NICE TA769; BSACI food allergy guidelines; SmPC; https://bnf.nice.org.uk/drugs/peanut-protein/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways