Paediatric allergy · London
Palforzia peanut oral immunotherapy - London.
A structured 18-month programme for children aged 4 to 17 with confirmed peanut allergy - run by a consultant paediatric allergist in an anaphylaxis-ready London unit, so your child is protected from an accidental crumb.
Why parents choose us
- 01
A paediatric allergist with a Palforzia programme
Not a general allergy clinic. A named consultant paediatric allergist running a structured Palforzia service, in a unit with anaphylaxis-ready facilities.
- 02
Honest about who benefits, and who does not
Palforzia is not a cure and not for everyone. If your child has uncontrolled asthma or a very recent severe reaction, we will say so before you commit.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
What Palforzia is
The first licensed peanut oral immunotherapy in the UK.
Palforzia is defatted peanut flour, precisely measured into graduated dose sachets by Aimmune Therapeutics. It was the first oral peanut immunotherapy licensed by the EMA and MHRA, and it was approved by NICE in October 2022 (TA765) for children and young people aged 4 to 17 with confirmed peanut allergy.
Palforzia is not a supplement, not a homemade dose of ground peanuts, and not a substitute for adrenaline. It is a licensed medicine, prescribed and supervised by a specialist paediatric allergy team, taken every single day.
In one line
A daily, controlled dose of peanut protein that retrains the immune system to tolerate an accidental crumb.
How it works
Tiny, daily doses - gradually increased over six months.
A slow, structured retraining of your child's immune response, rather than a one-off cure.
Start with a fraction of a peanut
The first dose is 0.5 mg peanut protein - about 1/600th of a single peanut kernel. The immune system is exposed to an amount too small to cause a big reaction, but enough to start desensitisation.
Increase every two weeks
Every 2 weeks, in clinic, the dose is stepped up. If tolerated after 60-minute observation, the new dose is taken daily at home until the next visit. 11 steps in total, over roughly 6 months.
Maintain 300 mg every day
Once at 300 mg (about one peanut kernel of protection), your child takes one full sachet a day, indefinitely, mixed into a spoon of soft food. Missed doses lose protection quickly.
Indicative pricing
What a private Palforzia programme costs in London.
Indicative ranges across our partner units. Send us your child's allergy summary and we quote firm figures across two or three options.
In short
A full Palforzia programme in our London network: £14,000-£22,000 for 6-month up-dosing plus year-one maintenance.
| Stage | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Initial allergy assessment and eligibility review | £450-£850 | 60-90 min | Same visit |
| Initial Dose Escalation (IDE) day in clinic | £1,800-£2,800 | 4-5 hours | Same day |
| Up-dosing phase (6 months, 11 clinic visits) | £8,500-£12,000 | 2-3 hrs/visit | 6 months |
| First year maintenance (monthly review, drug supply) | £3,500-£6,500 | 30-45 min/visit | 12 months |
| Full 6-month up-dosing + Year 1 maintenance (bundle) | £14,000-£22,000 | 18 months | Programme |
| Annual maintenance follow-up (Year 2 onwards) | £1,500-£3,500 | Quarterly | Per year |
Prices vary by unit, by which consultant runs the programme, by whether drug supply is bundled, and by how many clinic visits your child needs during up-dosing. We come back with a firm quote within one working day.
The journey
From first enquiry to maintenance - what happens, in order.
One team from first message to long-term follow-up - including monthly reviews and annual auto-injector training.
Phase 1 · Before starting
Assessment and planning
Phase 2 · IDE day
One clinic day
Phase 3 · Up-dosing and beyond
6 months then lifelong
- 01
Before
You send us your child's allergy history
A short, confidential form. Age, peanut allergy diagnosis, asthma control, recent reactions, current medicines, and any prior food challenge results.
- 02
Before
We come back with a recommendation
Within one working day: whether Palforzia fits your child, or whether a food challenge or watchful waiting is the better call. Indicative price. An honest read either way.
- 03
Before
We arrange the first appointment
Usually within two to three weeks. A full allergy review with the consultant, baseline bloods and skin prick testing if needed, and a written care plan sent before day one.
- 04
In clinic
Initial Dose Escalation in clinic
A single day, 5 doses from 0.5 mg to 6 mg over about 3 hours, with observation after each dose. Anaphylaxis-ready room, adrenaline drawn up, one parent stays with your child.
- 05
In clinic
Up-dosing every 2 weeks
11 dose levels from 3 mg to 300 mg over roughly 6 months. Each new dose is given in clinic with 60-minute observation; the same dose is then taken daily at home until the next visit.
- 06
After
Daily maintenance at home
300 mg (one full sachet) mixed into a spoon of soft food every single day, indefinitely. Missed doses need clinic advice before restarting.
- 07
After
Monthly review and annual training
Monthly nurse check for the first year, then quarterly. Adrenaline auto-injector technique refreshed every year. MedicAlert bracelet recommended.
Typical end-to-end: 2-3 weeks to first appointment. Up-dosing: 6 months. Maintenance: indefinite.
Who benefits
The right child, the right family, the right moment.
Palforzia rewards families who can commit to daily dosing and 2-weekly clinic visits for six months. It rules out children with uncontrolled asthma or a very recent severe reaction.
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Confirmed IgE-mediated peanut allergy
Positive skin prick test or specific IgE plus a convincing clinical history, or a prior positive oral food challenge. Not for oral allergy syndrome alone.
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Children aged 4 to 17
NICE-approved and licensed for ages 4-17. Under 4s are not eligible; 18 and over can continue if started as a child but new adult starts are off-licence.
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Well-controlled asthma
Any asthma must be stable, on a written action plan, with no A&E visits or oral steroid courses in the last 3 months. Uncontrolled asthma is a firm no.
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Parents ready for daily dosing
A dose every single day, at roughly the same time, for years. Missed doses of more than a few days need clinic advice. Family buy-in matters more than money.
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No severe reaction in the last 60 days
A recent anaphylaxis to peanut means the immune system is too primed to start. We wait, stabilise, and reassess at 60-90 days.
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Fear of accidental exposure is limiting life
School trips, birthday parties, restaurants, travel. Palforzia is about protection from accidental crumbs, not about eating a peanut butter sandwich.
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Multi-food allergic children (selected)
Palforzia can run alongside other allergies. Multi-food OIT is a different programme; we can advise on sequencing.
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Not suitable: uncontrolled asthma, EoE
Severe eosinophilic oesophagitis, systemic mastocytosis, uncontrolled asthma, or poor expected adherence all rule Palforzia out.
The programme
Palforzia in stages - and the alternatives that sit alongside it.
What each stage actually involves, and where Palforzia sits next to multi-food OIT, SLIT, omalizumab-assisted OIT and strict avoidance.
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Initial Dose Escalation (IDE)
One clinic day: 0.5, 1, 1.5, 3 and 6 mg peanut protein given 20-30 minutes apart, with observation. Establishes whether your child can tolerate the very first exposures at all.
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Up-dosing phase (6 months)
11 dose levels from 3 mg to 300 mg. Each step is given first in clinic under observation; if tolerated, the same dose is taken daily at home for 2 weeks before the next step.
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Daily maintenance (300 mg)
One 300 mg sachet emptied onto a spoon of yoghurt, apple sauce or pudding, every day, indefinitely. Roughly equivalent to one peanut kernel of protection.
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Dose adjustment for illness or exercise
Doses are held or reduced during febrile illness, uncontrolled asthma, poorly managed hay fever, or around vigorous exercise, hot baths and menstruation.
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Multi-food OIT (separate programme)
For children allergic to peanut plus tree nuts, milk, egg or sesame. Longer, more complex, and only in specialist paediatric allergy centres.
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Sublingual immunotherapy (SLIT)
Drops under the tongue rather than swallowed. Lower systemic reaction rate but weaker efficacy than oral immunotherapy; not currently NICE-approved for peanut.
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Omalizumab-assisted OIT
A monoclonal antibody used off-licence to blunt reactions during up-dosing in very reactive children. Adds cost and complexity; only in tertiary centres.
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Strict avoidance plus adrenaline
The traditional path. No daily dose, no clinic visits, but no protection from accidental exposure either. Still a valid choice for many families.
Outcomes
What the trials show - honestly.
The two landmark studies behind the NICE approval, and what real-world data says about how long protection lasts.
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67%
PALISADE - tolerated 600 mg peanut protein
In the pivotal PALISADE trial, 67% of Palforzia children tolerated 600 mg peanut protein at exit food challenge, compared with 4% on placebo. 600 mg is roughly two peanut kernels - well above an accidental crumb.
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Similar
ARTEMIS - European real-world data
The ARTEMIS European trial confirmed comparable results: most fully up-dosed children could tolerate 1000 mg peanut protein, with a side-effect profile that matched PALISADE.
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~13%
Sustained unresponsiveness at 1 year
Only about 13% of children showed sustained unresponsiveness after a year of maintenance and a short off-drug period. Most children lose protection quickly if they stop dosing - which is why maintenance is indefinite.
Our vetted London network
A small panel of paediatric allergy units, we picked them.
Consultant paediatric allergists running structured Palforzia services in anaphylaxis-ready London units. Introductions are made privately, once we understand your child's case.
Where we place children
Paediatric allergy centres in London we work with.
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Great Ormond Street Hospital International & Private Care
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The Portland Hospital - Paediatric Allergy
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HCA The Wellington Hospital - Paediatric Allergy
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Chelsea and Westminster Hospital - Paediatric Private
Selection criteria
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Consultant paediatric allergists running a structured, NICE-aligned Palforzia service
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Anaphylaxis-ready day units with paediatric nursing and resuscitation cover
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Written up-dosing schedule, dose-hold rules and a 24/7 clinical contact
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Clear route back to NHS or tertiary allergy referral if your child needs it
Safety and side effects
What to expect during the programme - honestly.
Side effects are common. Most are mild and settle. A minority need adrenaline. Around 15-25% of children stop the programme, and that is a valid choice.
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Mouth and throat itching, most days
Mild oral tingling or throat itch 30-60 minutes after the dose is the commonest side effect. Usually settles within weeks and rarely stops the programme.
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Abdominal pain and vomiting
Reported by 10-30% of children, mostly in the first weeks. A short antihistamine course, dose-timing changes and eating with the dose usually help.
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Systemic reactions needing adrenaline
Around 5-15% of children need at least one adrenaline injection during the programme, most often during up-dosing. This is why the auto-injector stays close to hand.
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Eosinophilic oesophagitis (EoE)
New-onset EoE occurs in around 5-10% of Palforzia patients, often with persistent reflux, food sticking or vomiting. Symptoms warrant endoscopy and biopsy.
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Discontinuation is common
15-25% of children stop Palforzia, most often for gut side effects or family fatigue with daily dosing. Stopping is a valid choice, not a failure.
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Dose-hold days for illness or exercise
Doses are held for fever, uncontrolled asthma, vomiting bugs, or immediately before vigorous exercise. A written rule sheet goes home on day one.
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Adrenaline auto-injector, lifelong
Two in-date auto-injectors carried at all times, forever. Palforzia reduces the risk of a severe reaction to a crumb; it does not remove the need for adrenaline.
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Missed doses need clinic advice
Missing 3+ consecutive daily doses usually means the next dose has to be given back in clinic, not at home, because tolerance is lost quickly.
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Red flags after a dose
Widespread hives, breathing difficulty, throat tightness, drowsiness or collapse - give adrenaline, call 999, and inform the clinic the next working day.
Adrenaline stays with you, for life
Palforzia does not replace the adrenaline auto-injector. Two in-date devices, carried everywhere, annual technique training, and a MedicAlert bracelet - forever.
Your written plan
Your Palforzia plan in four parts. Read the last one first.
Whichever London unit runs the programme, the written plan follows the same shape.
A quiet reminder
Allergy plans can read densely - we will talk you through yours.
If you would like us to walk through the up-dosing calendar and dose-hold rules before day one, just ask.
- 01 Header
Allergy diagnosis and baseline testing
Confirmed peanut allergy on skin prick and specific IgE (Ara h 2 in particular). Asthma control, exercise triggers and any other food allergies noted.
- 02 Plan
Up-dosing schedule and dose-hold rules
The 11-step up-dosing calendar, home dosing routine, dose-hold rules for illness or exercise, and the plan for missed doses.
- 03 Emergency
Anaphylaxis action plan
Written BSACI-style action plan with adrenaline auto-injector doses, when to use it, when to call 999, and school and grandparent copies.
- 04 Review
Follow-up and long-term maintenance
Read this first: your next clinic date, monthly nurse review number, annual training booking, and when it is safe to stop dosing (usually not).
Recognised by major UK insurers
Cover for Palforzia varies by insurer. Some fund the full programme with a consultant recommendation; others exclude oral immunotherapy. We confirm cover before booking.
Frequently asked
Everything parents ask about Palforzia.
Quick answers on whether it is a cure, whether the auto-injector stays, insurance, age, side effects and stopping.
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Is Palforzia a cure for peanut allergy?
No. Palforzia is a protective treatment, not a cure. The goal is to reduce the risk of a severe reaction if your child eats a small amount of peanut by accident - a crumb, a bite of a mislabelled biscuit, cross-contamination in a restaurant. It does not mean your child can eat peanut butter sandwiches or roasted peanuts, and daily dosing must continue indefinitely to keep the protection.
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Do we still need an adrenaline auto-injector?
Yes, for life. Two in-date auto-injectors need to be carried at all times, and roughly 5-15% of children on Palforzia need at least one adrenaline injection during the programme. Annual training is part of every follow-up visit, and we recommend a MedicAlert bracelet.
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Will private health insurance cover Palforzia?
Cover varies. Some UK insurers reimburse the up-dosing programme and drug supply for children with a clear specialist recommendation and documented severe peanut allergy; others exclude oral immunotherapy as a newer treatment. We check your policy before you book, and we can quote self-pay bundles if cover is declined.
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From what age can my child start?
Palforzia is licensed and NICE-approved for children aged 4 to 17. Under-4s are not eligible on licence, though clinical trials in younger children are ongoing. Adolescents who turn 18 during the programme can continue maintenance without issue.
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Are the side effects manageable in real life?
For most families, yes. Mild mouth or throat itching after the daily dose is very common and usually settles. Abdominal pain and vomiting affect 10-30% of children, mostly early on, and often respond to timing changes, eating with the dose, or a short antihistamine course. Systemic reactions are less common but need adrenaline, which is why the plan and the auto-injector matter.
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What happens if we decide to stop Palforzia?
15-25% of children stop the programme, most often because of gut side effects or the weight of daily dosing. Stopping is a valid, safe choice - your child returns to strict avoidance plus adrenaline, the same position as before Palforzia. If your child was fully up-dosed, protection is usually lost within a few weeks off treatment.
Related tests and treatments
Looking for something else?
-
Multi-food oral immunotherapy
For children allergic to peanut plus tree nuts, milk, egg or sesame.
Learn more -
Oral food challenge
The gold-standard test to confirm or exclude a food allergy.
Learn more -
Component-resolved allergy testing (ISAC/ALEX)
Precise molecular allergy profiling for complex cases.
Learn more -
Paediatric skin prick testing
Fast, safe first-line allergy testing for children.
Learn more -
Anaphylaxis management and EpiPen training
Auto-injector technique and written action plan for the whole family.
Learn more -
Baby and toddler allergy assessment
Structured allergy review for under-4s and early weaning.
Learn more -
Egg ladder reintroduction
Structured, staged reintroduction of egg after early allergy.
Learn more -
Send Enquiry
Tell us about your child and we come back within a working day.
Learn more
Ready to talk it through?
Send us your child's allergy history. We reply within one working day.
A short, confidential form - age, peanut history, asthma control, current medicines. We match your child to the right London consultant and quote a firm price. No cost. No pressure.