Peanut allergies: Parents worry after Palforzia drug sales flop

Before Katie Turner's son Ian tried Palforzia - the world's only approved peanut allergy drug - exposure to even microscopic amounts of nuts could be life threatening for him.

Months after finishing the treatment, he accidentally took a big swig of a peanut butter smoothie and was "perfectly fine".

"The medication saved my child's life," said Ms Turner. "I can't tell you the weight that was lifted off our family's shoulders."

But the drug seems to have flopped commercially after lower-than-expected uptake among doctors, according to Nestlé.

Just two years after packaged-food giant Nestlé bought the manufacturer of Palforzia, Aimmune Therapeutics, for $2.6bn (£2.1bn) it's exploring "strategic options for the drug" - a move experts say indicates it will likely try to sell it.

Peanut allergies affect about one million children in the US, according to the Food and Drug Administration (FDA). Serious allergies can lead to anaphylactic shock and death, and there are no cures available.

Palforzia does not cure the allergy, but it does lessen the reaction.

Providers and families say the medication, which requires trips to the doctor every two weeks, is not a perfect fit for all patients. But the drug's disappointing sales have sparked concerns about future investment in the broader food allergy research and drug development space.

The allergies can have a host of other negative affects on patients, including mental, social and financial burdens for families, according to Kenneth Mendez, the president and chief executive officer of the Asthma and Allergy Foundation of America.

For some parents of children with peanut allergies, it's an emotional journey.

Food allergies can create the feeling of "not belonging", said Stacey Sturner, who has a child with a peanut allergy.

The condition can impede many daily activities, including sharing foods with friends, said Ms Sturner, who also runs a Facebook group "Food Allergy Treatment Talk", where experts and families can discuss the latest therapy options.

Palforzia was approved by the FDA in January 2020 as the first and only drug to help reduce allergic reactions to peanuts for children aged four to 17. It works by gradually exposing children who are allergic to peanuts to higher doses of the nut to help lower the risk of severe reactions, including anaphylaxis.

A spokesperson for Nestlé told the BBC that the company could not speculate on "next steps" for the medication or what the consequences of selling the drug to another company would be.

Selling Palforzia could actually make the treatment more widely available as a new company would seek to recruit as many patients as possible, said Tim van Biesen, managing partner of consulting firm Bain & Company's Global Healthcare practice.

But if the company is unable to find a buyer, that could be a cause for concern among patients, he said.

Though some patients have benefited from Palforzia, experts say several reasons have contributed to poor sales.

Complicated billing procedures have discouraged many providers from offering the treatment, making it difficult for some patients to access, while others are not able to commit to the biweekly visits required for several months of treatment, said Panida Sriaroon, the medical director of the Johns Hopkins All Children's Food Allergy Clinic.

The coronavirus brought another impediment. The pandemic began shortly after the medication was approved, preventing many from visiting the doctor, says Mr Van Biesen of Bain & Company.

Some worry that Palforzia's lacklustre performance could serve as a "cautionary tale" for manufacturers considering investing in food allergy therapeutics.

"There remains a massive disconnect between what investors want and what the food allergy community needs," said Ms Sturner.