Oral immunotherapy is not a new idea and is done in various clinics in the UK, and is much more easily available in European countries and in North America.
Introducing oral immunotherapy as a treatment on the NHS requires 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.
In England and Wales, the NHS was expected to offer peanut immunotherapy, following a NICE appraisal in 2022 of the commercial peanut immunotherapy product, Palforzia. But there was little money to support this and a lack of trained staff, so only a few clinics were set up. Since Palforzia has now been withdrawn globally (January 2026), these services are likely to close.
In Scotland, the Scottish Medicines Consortium (SMC) refused approval for Palforzia to be used on the NHS.
The reason given was 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. There was no question that 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?
There will probably be more evidence about peanut oral immunotherapy over the coming year or two (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/