Peanut Oral Immunotherapy (OIT)

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Peanut Oral Immunotherapy (OIT)

Peanut oral immunotherapy (OIT) with peanut allergen powder-dnfp (Palforzia®) is an FDA-approved treatment for children ages 4 to 17 years that can help reduce the risk and severity of allergic reactions to peanuts, including anaphylaxis. 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 is not a cure for peanut 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 child must still avoid eating peanuts and carry two epinephrine auto-injectors in case of an accidental exposure. If the therapy is stopped, the benefits will gradually wear off. Who Peanut OIT Is For Children 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 uncontrolled asthma or certain stomach conditions, including eosinophilic esophagitis (inflammation of 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 our Peanut Allergy Treatment Shared Decision-Making Tool and 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 – nonsteroidal 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)

Peanut OIT can cause anaphylaxis, a severe 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
  • Vomiting
  • Regurgitation of undigested food

The following conditions and activities can increase your child’s risk of an allergic reaction while receiving peanut OIT.

  • Strenuous physical activity
  • Hot showers or baths
  • Illness (viral infection)
  • Fasting
  • Menstruation
  • 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.