Palforzia Is Gone: What Peanut Allergy Families Can Do Next

The only FDA-approved oral immunotherapy for peanut allergy is off the U.S. market. Stallergenes Greer, which acquired Palforzia from Nestlé in 2023, announced in January that it would discontinue the product, and Allergic Living reports that sales ended in July. Patients who were still building up their doses had until the end of that month to finish up-dosing. The company also said it will not sell or transfer the product to another manufacturer, so there is no replacement version waiting in the wings.

For the families who relied on Palforzia, or who were planning to start it, the news raises a practical question: what happens now?

Why Palforzia Ended

The company says the decision was not tied to safety, quality, or efficacy. Instead, the treatment was hard to deliver, and that limited how many patients ever started it.

• Heavy paperwork. Prescribers, offices, pharmacies, and patients all had to go through an FDA-required safety certification program, known as a REMS, before treatment could begin.
• Frequent office visits. Dosing involved regular in-office appointments, especially during the up-dosing phase, which is a lot to ask of busy families and working parents.
• Bad timing. The 2020 launch landed in the middle of COVID-19 shutdowns, when in-person visits were hard to schedule.

Allergists have been open about their disappointment. Dr. Kelly O’Shea of the University of Michigan said she was “disheartened by the decision to discontinue Palforzia,” and a medical consultant for Stallergenes Greer acknowledged that its commercial failure and withdrawal have left many patients without access to a standardized treatment option.

What Current Patients Should Do

Anyone who is already on Palforzia should not change their routine on their own. The guidance from allergists is to keep following the plan your prescribing allergist set up and to ask them whether, when, and how to continue or finish treatment. Some patients who tolerate the 300 mg maintenance dose after their first year have discussed continuing with peanut in everyday foods instead, but that is a decision that belongs with a physician, not a parent working it out alone.

What Families Are Hearing About

Several alternatives are now part of the conversation:

• Xolair (omalizumab): an injection approved in 2024 to help reduce reactions after accidental food exposure. It is given monthly or every two weeks. It is designed to lower the risk from accidental exposures, not to build tolerance the way immunotherapy does.
• Omlyclo: a Xolair biosimilar expected to launch this fall.
• Ozureprubart: an anti-IgE therapy from RAPT Therapeutics, which GSK acquired in January. It is dosed every 12 weeks and is still in early trials.
• Newer immunotherapy candidates: Aravax recently received FDA Fast Track designation for PVX108, a peptide-based peanut immunotherapy. It is in phase 2 studies, with key data expected later this year, and it is not available to patients.
• Sublingual immunotherapy (SLIT): small doses placed under the tongue, which has shown promise for peanut allergy in some studies.

Some of these are medications that reduce the risk of reactions. Others are immunotherapies that aim to change how the immune system responds. Knowing the difference matters when you sit down with an allergist.

Where SLIT Fits

Oral immunotherapy (OIT) and SLIT work differently, and it is worth being precise about it. OIT uses higher doses that are eaten or swallowed, so it requires in-person physician observation, and anaphylaxis or GI side effects can be frequent. It can desensitize faster, but the trade-off is more risk along the way.

Food SLIT uses much smaller, precise doses placed under the tongue. Swallowed, those doses would be ineffective, because the effect comes through the tissue under the tongue. Because the doses are smaller, food SLIT is generally safer, with fewer side effects. It tends to be more gradual and gentle than OIT and may take longer, but fewer side effects can make it easier for patients to stay on treatment and reach desensitization.

That makes it an option some families look at when Palforzia’s heavy in-office routine was the obstacle. Both approaches are forms of allergy immunotherapy, the only treatment that changes the underlying allergic disease rather than just managing it. Immunotherapy has been used for more than 100 years, and it works by retraining the immune system to tolerate an allergen.

It is not a quick fix. A full course typically takes 3 to 5 years, it takes commitment, and whether someone may be a candidate is a clinical decision that starts with testing and a physician’s review. Treatment is built around the individual patient’s history, test results, and goals, and it needs clinical supervision.

Questions to Ask Your Allergist

If you are weighing next steps after Palforzia, these questions can help:

• Which of my child’s or my own allergies were confirmed by testing, and how do the results line up with symptoms?
• Is the goal to reduce the risk of accidental reactions, or to build lasting tolerance?
• How often are in-person visits needed, and which options can be supervised remotely?
• What are the side effects, and what is the plan if a reaction happens?
• What will it cost over a year, and what is covered by insurance?

Finding Food Allergy Treatment Options

Curex, the largest telemedicine platform for allergy immunotherapy at home, has provided services for over 50,000 patients with environmental and food allergies and related conditions. Families comparing food allergy treatment options can see how supervised at-home SLIT works, from testing to clinician review to ongoing check-ins. Personalized allergy drops are compounded by a pharmacy and prescribed off-label, a long-standing practice, and they are made from FDA-approved allergenic extracts, the same as those used in allergy shots. Off-label does not mean unsafe or experimental.

People specifically researching peanut allergy treatment can use the same resource to see whether a telemedicine approach might fit their situation.

Costs are a real factor. Food allergy immunotherapy can exceed $10,000 per year, and compounded drops are generally not reimbursed by insurance, so ask about financing, which starts as low as $79 per month on some treatment plans.

What Stays the Same

Whatever treatment path a family chooses, the basics of daily safety do not change. Strict avoidance of the allergen, careful label reading, an up-to-date emergency action plan, and epinephrine on hand remain the foundation of food allergy care. Immunotherapy, where appropriate, is added to those protections, not substituted for them.

The Takeaway

Palforzia’s exit leaves a gap, but it does not end treatment for food allergy. The options now include injectable medications, new candidates moving through trials, and sublingual immunotherapy that can be supervised from home. The best next step is a conversation with an allergist or telemedicine clinician about which goal and which approach make sense for your family.