CHALLENGES IN MANAGING THE LATE ADOLESCENT PATIENT ON PALFORZIA

• Published in: Annals of allergy, asthma, & immunology Vol. 129; no. 5; p. S148
• Main Authors: Ghoshhajra, M., Bishop, L., O'Brien, T., Clinch, K.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-11-2022
• ISSN: 1081-1206; 1534-4436
• DOI: 10.1016/j.anai.2022.08.933

Palforzia [Peanut Allergen Powder-dnfp] is the only FDA-approved therapy to minimize the potential for life-threatening anaphylactic reactions to peanut in children. Given the inherent risks, the dosing schedule must be followed exactly.
L.B. is a 17-year-old male with severe peanut anaphylaxis, tree nut allergy, and asthma. He began Palforzia in November 2021. All required parties completed the Risk Evaluation and Mitigation Strategy program. A detailed binder created by our nursing staff containing dosing procedures and a dose tracker was provided. Phone calls were made 3 days after each Up-dose. Various issues occurred during treatment. He once forgot to eat breakfast before an Up-dose and was given food in our clinic first. In December, he developed anaphylaxis from tree nut ingestion but only informed our office after 2 days. In January, he began having abdominal pain and diarrhea with each Up-dose. With questioning, he reported taking the doses late at night without parental supervision, on an empty stomach, or going to the gym within 3 hours of the dose. We frequently reviewed the proper dosing protocol and cautioned that treatment would stop if he was noncompliant. Famotidine helped the gastrointestinal symptoms. He achieved Maintenance in April but stopped Palforzia by June 2022.
We learned that the care of late adolescents on Palforzia poses particular challenges. Open communication and full engagement with the patient and family are critical throughout the process. Going forward, we must respect their lifestyle and growing autonomy so they can safely incorporate Palforzia into their daily routine.