Palforzia treatment has been available for some years now in various European countries and in North America.
In England, the NHS are starting to arrange some peanut immunotherapy clinics, following a NICE appraisal in 2022, but there is little money to support this and a lack of trained staff.
In Scotland, on the other hand, the Scottish Medicines Consortium (SMC) have refused approval for Palforzia to be used on the NHS.
The reason given is that the company who make Palforzia did not present a “sufficiently robust economic analysis” – in other words, there was no clear cost saving or clear clinical benefit to justify the cost, although the treatment works.
There are a couple of different considerations here:
• How much would it mean to you, if your child could eat peanuts without reacting? How much would it mean to them, and the the wider family? Would it change anything, or not?
• At the end of treatment, how many children will continue to take their regular dose of peanut, and in those who do not take it regularly, how often and how quickly will the peanut allergy come back?
• Introducing Palforzia as a treatment on the NHS will require additional staff, training and clinic facilities – most allergy services in Scotland are struggling to deal with the existing demand for allergy diagnosis and advice, in the face of financial cuts, and are not in a position just now to develop a new service or recruit new staff.
This isn’t a final decision – there will probably be more evidence about Palforzia and other forms of peanut immunotherapy over the coming year (the Natasha Trial, for example).
The full report into the SMC decision is here – https://www.scottishmedicines.org.uk/medicines-advice/defatted-powder-of-arachis-hypogaea-l-semen-peanuts-palforzia-full-smc2487/