Is Your Child Suitable?

There are a series of key questions to help decide if your child is suitable for peanut desensitisation (OIT) treatment with PALFORZIA. Please read and consider these and if you are still interested then we would ask that you complete the questionnaire that follows and return it to us.

Question 1: Is my child definitely allergic to peanut?

Usually this is not an issue – if there is a clear history of allergic reactions to peanut together with a recent, clearly positive allergy test (Skin prick test and/or Specific-IgE blood test), this is usually enough to be certain of the diagnosis. The diagnosis may however be uncertain for one of the following reasons:
• The diagnosis is only based on test results (that were not high enough to be confirmatory) and there is no history of an allergic reaction to peanut.
• The tests were taken some years ago and there has not been a reaction. More recent testing will be required to ensure the peanut allergy has not been outgrown, this happens in 10-20% of young children, and usually by 5 years of age.
Given the duration, cost and effort involved with peanut OIT, it is important to confirm that peanut allergy is present before progressing. If there is any uncertainty, we can arrange for the suitable allergy tests and if necessary, a supervised food challenge to confirm allergy.

Question 2: Is my child ‘too allergic’ to peanut?

Allergic reactions to peanut are unpredictable in nature but if there is a history of a reaction that has required intensive care or more than 2 injections of adrenaline, then it may be that peanut OIT is not suitable. This may also be the case if there have been significant reactions to trace exposures to peanut. Although very rare, some patients react to amounts of peanut that are less than the first dose of PALFORZIA and this would make the process very difficult. Please note that the size of an allergy test to peanut is not a reliable predictor of how successful desensitisation will be. Of note, the studies that underpin OIT as a treatment for peanut allergy included children with very high tests, children with a history of non-recent anaphylaxis to peanut and children who were allergic to multiple foods and other nuts.

Question 3: How old is my child?

PALFORZIA is licensed from 4–17 years of age. As long as your child is within the age group at the start of treatment, then there is not an issue. There are options to desensitise younger children by different OIT programs so please get in touch to find out more.

Question 4: Does my child have unstable asthma?

Asthma is common in children with food allergy and is usually not a problem as long as it is well controlled. However, if asthma is not well controlled then it can be a risk factor for severe allergic reactions and this needs to be addressed (regardless of whether you go ahead with peanut OIT). Oral immunotherapy is associated with occasional wheezing episodes after the treatment has been taken. It is not possible to consider food Desensitisation if asthma is not well controlled. Uncontrolled asthma means that there is a regular need for Ventolin more than twice a week, ongoing asthma related symptoms such as wheeze or cough or recent visits to hospital with asthma related symptoms.

Question 5: Does my child have a history of eosinophilic gastrointestinal disease?

It is possible that food desensitisation may aggravate symptoms of eosinophilic gastrointestinal disease such as Eosinophilic Oesophagitis (EoE) and if your child has this condition, then they would not be suitable for treatment. If your child has any problems with chronic abdominal pain, nausea and vomiting or any difficulty swallowing, then this would need careful assessment to rule out EoE before commencing desensitisation treatment.

Question 6: Does your child have a history of any other medical conditions?

Most other medical problems should not interfere with treatment but if they have severe eczema or another severe illness such as cancer, an immune deficiency, chronic urticaria, cardiovascular disease or active autoimmune disease, then they may not be suitable and a detailed discussion would be required before further consideration is given.

Question 7: Is my child on any medication that might be a problem?

If your child is on continuous oral steroid medication or another type or immune suppressant e.g. Azathioprine, ciclosporin or methotrexate, then these may impact on the effectiveness of the treatment. If they are taking beta blockers, these can reduce the efficacy of emergency medicines used for severe allergic reactions from working. It is important that you let us know full details of any medication your child is taking from the outset in order that we can discuss treatment options.

Question 8: Do you have a clear idea of what is involved in peanut OIT, including the risks?

Food desensitisation is not right for everybody and it is critical that you understand the risks and benefits of treatment before making a decision. These are discussed in detail in our other patient information material but in summary, the treatment carries a real risk of allergic reactions to PALFORZIA. Most of these adverse reactions will be mild but may on occasion be more severe and include anaphylaxis requiring an adrenaline autoinjector (AAI) e.g. Epipen. Anaphylaxis is more common in the early stages of treatment and may occur at home. We will supervise all ‘up-dosing’ visits to ensure this is safely tolerated. Anaphylaxis can be treated effectively by the early use of adrenaline and you will be trained in recognizing and treating allergic reactions with your AAI. Of course, these risks need to be balanced with the benefits of treatment, which is to reduce the risk of a severe reaction in an uncontrolled environment, due to an accidental exposure to the food allergen.

Question 9: Are you able to commit to regular dosing?

Food desensitisation will only work if you can make a regular commitment to treatment. This involves up-dosing visits inGreat Ormond Street Hospital for Children every 2 to 3 weeks as well as daily dosing at home. Approximately 12 visits will be required over a 5-6 month period. Dosing will be required on an ongoing basis in order to maintain the effect of successful desensitisation but over the longer term, this can be done with peanut in other forms such as peanut butter. If you are unable to commit to starting this potentially life-long journey, then it is better not to embark on the treatment in the first place.

Question 10: Are you able to pay for the treatment?

Details of the cost of treatment are outlined here. Payment for the first year of treatment is required up front at the start of treatment, although payment plans are available if required. If you are not able to complete the course of treatment for any reason, there is a detailed refund policy. Unfortunately, due to the high overhead costs involved in the treatment, we are unable to offer any discounts. Upon completion of the maintenance period, your care will revert back to the referring clinician.

What Happens Next?

1. Having read about the key questions above, if you are still interested and think that your child will be eligible, then please complete the suitability questionnaire here and email it to us at office@oit.clinic . This will be reviewed by one of our medical leads and then one of our team will feedback to you as to whether an assessment visit would be appropriate or not.

2. If you wish to progress treatment and believe you are suitable or if you are not sure and would like to discuss it in more detail, then please book an assessment appointment. This will be with one of our team of Professors and will enable us to make a firm decision with you as to whether treatment is suitable. An assessment visit is required even if you are a well-known patient of one of our Professors. This is because we will still need to sign a formal consent form, for which we need to ensure you and your child have a full understanding of what is involved and the possible risks.

Please call 0203 633 9851 or email us at office@oit.clinic to make the appointment.

This assessment appointment will be charged at £300 (including the cost of a skin prick test to peanut), which is non-refundable regardless of the final decision whether to progress to the treatment or not.

If further testing is required, such as blood tests, then there will be an additional charge for this from a third party provider. We will aim, as far as possible, not to offer an assessment appointment if it is apparent from the details provided on this form that treatment will not be suitable.

Download the suitability questionnaire here.