Professor Adam Fox OBE, Professor of Paediatric Allergy at Allergy London, shares a personal perspective on the recent Palforzia discontinuation update. Stallergenes Greer, the US/French pharmaceutical company that manufactures Palforzia, has announced that it will no longer support the product from later this year. A similar announcement was made nearly two weeks ago regarding Palforzia provision in the United States, and this now confirms that the same decision will apply across the UK and Europe.
Prof. Adam Fox OBE shares:
In practice, Stallergenes Greer, a US/French pharmaceutical company, have recommended that patients do not start Palforzia treatment beyond the end of March 2026 or they may be supply issues although they have assured supply for at least a year beyond this.
Importantly, they point out that this doesn’t in any way relate to any safety issue or concern about the effectiveness of Palforzia, which is very much proven, but is in fact a purely commercial decision related to very poor US sales.
Palforzia is a product made from peanut powder in carefully measured capsules that forms a programme for Peanut Oral Immunotherapy, which is a treatment that reduces a patient’s risk of having accidental reactions to peanut. The product itself is simply made out of peanut powder and hence in the United States, doctors have the option of simply using regular peanut or this more expensive pharmaceutical product – so this treatment can also be done using regular peanuts as long as there’s a means to measure doses accurately.
In the United States there is no regulatory requirement to use a licensed product when it’s available, and hence US allergists have instead used the cheaper option of regular peanut to achieve the same effect.
As a result, Palforzia is no longer economically viable as a product for its manufacturer.
In the UK, the medical regulation is a little different and where there is a licensed product such as Palforzia, doctors have an obligation to use it without a very clear clinical reason (which cannot be simply cost).
As a result, for children between the ages of four and 17 where Palforzia was licensed, there was an obligation to use this product, and frustratingly this added significant cost which partly led to a limit to its accessibility on the NHS, despite its NICE approval and high costs to access it privately.
I have rather mixed emotions around this news – on the one hand the huge, randomised control trials conducted in order to get a license for Palforzia really advanced the science of oral immunotherapy in a way that was hugely helpful.
On the other hand, by licensing what was essentially just peanut protein, set a precedent around the commercialisation of food oral immunotherapy that risks markedly limiting its accessibility to patients.
So what does this mean in practice?
- For patients who are currently on Palforzia, they should, of course, discuss this with the allergist who is supervising their care but this shouldn’t be a problem given the timelines of the supply.
- If you’re in the UK and are about to start a course of Palforzia, it’s important to start before the end of March to be sure supply doesn’t become an issue. Again, this is something you should discuss directly with your provider.
The discontinuation of Palforzia also raises some important questions around NHS provision:
- Palforzia was a NICE-approved product and had been since 2022 when NHS England stated that they expected thousands of patients to be treated with this and as a result, having a real impact on the quality of life for patients with peanut allergy.
- However, despite the NICE approval, which technically should mandate NHS commissioners to offer the treatment, we saw very little traction and numerous specialist allergy services that tried their best to try and offer the treatment were simply not given the resources to be able to do so.
There are some very important lessons to be learned about the ability to translate NICE-approved medications into actual patient benefit and had NHSE delivered on their promise, the product may well have remained commercially viable. I very much hope in the near future, we see a very different story when it comes to availability of sublingual immunotherapy for respiratory allergens, which have also recently received NICE approval.
I also very much hope that the withdrawal of this product and the implication about the commercial viability of oral immunotherapy doesn’t put off further investment into this area. I’m very excited to see the outcome of the many other ongoing clinical trials, both industry-sponsored and otherwise, relating not just to oral immunotherapy, but also other forms of immunotherapy such as Epicutanoeus and Sublingual immunotherapy for food, as clinical trials are in advanced stages.
Prof. Fox is dedicated to sharing helpful updates on his Instagram account, (DrAdamFox) on the topic of children’s allergies, creating a trusted resource for parents/anyone involved in the care of children with allergies – follow him on Instagram.
A comment from Allergy London
We are pleased to offer treatments for a growing number of allergens, including peanut. To find out more, please contact our team on 020 3758 9160 or email info@allergylondon.com.
