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The Process
Important Notice: Just because your child is suitable for desensitisation, does not mean it is the right treatment for them. It is critical that there is a process of shared decision making, discussing the benefits, risks, alternatives and implications of not doing the treatment. This process will be supported by lots of written information to help you make the right decision for your family, which may well be to continue to avoid peanut.
Oral Desensitisation (OD), also known as Oral Tolerance Induction (OTI or OIT) or Food Desensitisation, is a treatment that involves giving very small, but gradually increasing, amounts of the food that the child is allergic to. The intention of OIT is to increase the tolerance to the food so that larger amounts of it can be consumed without causing any symptoms and, as a result, accidental exposures to small amounts of the food should not cause reactions.
This treatment has been most studied for milk, egg and peanut.
In 2020, PALFORZIA became the first licensed food immunotherapy treatment initially in the US and then in Europe. This was the result of large, international studies to show its effectiveness and safety.
Each PALFORZIA dose contains consistent, precise amounts of peanut protein in the form of a peanut flour. The flour will be sprinkled from a capsule, or sachet at higher doses, and mixed with preferred soft foods that can be eaten cold e.g., yogurt (milk or Soy, allergies depending) or applesauce. The PALFORZIA doses are accurately measured which is important when the OIT journey is to start at very low doses e.g. 3mg of peanut protein which equates to 100th of a peanut kernel containing 300mg of peanut protein.
It is important to recognise that this treatment leads to a state of desensitisation (a temporary state, where greater amounts of peanut can be tolerated without symptoms) and not necessarily true ‘tolerance’ (a permanent state where any amount of peanut can be consumed without any risk of reaction). In practice, this means that the regular doses of peanut must be continued regularly in the long term for the treatment effect to remain. If it isn’t, the risk of reaction returns.
It is also important to realise that the treatment is ‘allergen specific’ i.e. the improved tolerance will only be to peanut and not to any other food allergens that your child may be allergic to.
The Palisade and Artemis trials have also demonstrated that the reaction severity that occurs to very high amounts of peanut decreases on therapy, and levels of tolerated peanut (and immune changes that support such changes) improve over time.