BSACI Palforzia guidelines
A Delphi consensus study, by the British Society of Allergy and Clinical Immunology, involving a panel of clinicians but also parents.
The guidelines state that “clinical capacity should not constrain access to this treatment” – this is not one of the consensus statements, however. In supplement, advises on how to approach local commissioners for additional funding, saying that Palforzia may now be considered an “essential part of paediatric allergy service delivery”.
Palforzia treatment should be seen as one aspect of overall allergy management, and that individual needs may justify its use, even when resources are limited.
This fits with the Canadian (CSACI) 2020 guidelines which say “Individuals vary with respect to their level of comfort with risk as well as their perception of the extent of benefit derived from a treatment. Thus, the decision to pursue [treatment] should be left to the well-informed patient as much as clinically possible, rather than based on external criteria.” And the inability of clinicians to reliably predict risk and severity of future reactions means “[Palforzia] should be available to all patients who wish to receive it”.
One of the consensus statements states “Parents of children with peanut allergy who are aged at least 4 years of age should be informed that peanut oral immunotherapy (OIT) is an option for management and be offered a discussion with a HCP who understands the child and their family’s context.”
In other words, it shouldn’t be up to the whim of a doctor/nurse to decide whether to talk about it, or whether to offer it.
It is also clearly stated that families/children with multiple food allergies (not just peanut) were keen to undertake OIT – which highlights that avoidance of peanut is a particular burden on families.
Another consensus statement was around converting to “real world” peanut rather than continuing with the commercial product – all the focus group participants were in favour of real world peanut, as it highlights the sense of progress, and it feels “normal” rather than medical.
With regards to follow up, the guidance recommends that each patient should be reviewed on at least one occasion around 12 months after achieving stability on either real world peanut or Palforzia maintenance before considering discharge – since it takes at least 6 months to achieve stability, this emphasizes that even where tolerance is successfully achieved, further support and review is essential.