Food allergies can be deadly but also costly for those concerned

This article is part of SWI swissinfo.ch's Food Digest series. Helen James / SWI swissinfo.ch

The latest treatment for peanut allergy can cost around $10,000 a year and was supposed to be a pharma blockbuster. What went wrong?

As the mother of a daughter with peanut allergy and a board member of the Swiss Association for Peanut Allergy and Anaphylaxis (VEaA), Isabelle Seger-Sauli knows only too well the challenges that come with living with the condition.

“To ensure safety of school-age children, parents often need to train involved personnel such as teachers or cooks in canteens on the allergy and its symptoms as well as the correct use of the emergency medication,” she told SWI swissinfo.ch.

Those with a peanut allergy either must completely avoid coming into contact with any peanut product or risk anaphylactic shock that could be life-threatening without a rapidly administered epinephrine injection. Doctors can help desensitisation by administering small amounts of peanut protein orally or by injection regularly, but this will only help prevent death not alleviate symptoms. Living with the condition can be isolating. 

“The psychological suffering from a food allergy should not be underestimated, as affected children may get singled out by their dietary restrictions. This may be an issue for example in case of birthday parties or school events involving food,” says Seger-Sauli. 

Wonder cure

A new drug approved by the United States Food and Drug Administration (FDA) could have been a game changer for her daughter. In January 2020, the American company Aimmune made a big announcement that attracted the attention of financial markets and peanut allergy sufferers around the world. It’s new drug Palforzia had won the approval of the United States to become the world’s first oral drug that would reduce peanut allergy symptoms. The treatment was approved for users from four through 17 years with a confirmed diagnosis of peanut allergy.

Food Digest: A bite-sized view of the food industry from Switzerland

This article is part of our dedicated coverage of developments in the food industry from a consumer’s point of view. Despite its small size, Switzerland occupies a substantial place in the global food basket. It is home to food and agriculture giants like Nestlé and Syngenta, as well a major players in chocolate and dairy. The country is also positioning itself as a food tech hub with many startups and a dedicated incubator in the form of the Swiss Food and Nutrition Valley. The Alpine nation is also the European hub for many commodity firms dealing with food products like soy, cocoa, coffee and palm oil. 

Studies measuring its effectiveness showed that almost 70% of Palforzia recipients were able to tolerate a 600mg dose of peanut protein compared to just 4% who were given a placebo. Those who had taken six months of treatment were likely to show only mild allergic symptoms when exposed to peanuts in their environment. 

Just a few months after FDA approval of Palforzia, Nestlé Health Science announced that it had acquired the company for $2.6 billion.

“Aimmune’s Palforzia, the first medication approved for treating peanut allergy, is a game-changer and it’s only the beginning. Aimmune’s pharmaceutical expertise and infrastructure will complement our existing research and development to further drive growth globally,” stated Nestlé Health Science CEO Greg Behar in an October 2020 press release. 

Price point

Nestlé’s optimism was well founded given that various studies estimate peanut allergy prevalence to be between 1% to 2% of the population of western nations. In the US alone it is estimated that one million children are affected with only one in five outgrowing the allergy. However, the list price for Palforzia is $890 per month in the US or £10.12 per day in the UK which adds up to $10,680 or £3,694 a year. 

“The price and levels of coverage by health insurance varies by country, working with local regulatory authorities,” says Jacquelyn Campo, a spokesperson of Nestlé Health Sciences when questioned about affordability. 

Currently, Palforzia is only available in the US, UK, Austria, Germany and Switzerland.  In Switzerland, where it was approved in May 2021, it is not on the list of medicines covered by mandatory basic health insurance.

“Palforzia is authorised by Swissmedic [the Swiss medicines regulator] for peanut allergies. However, as it is not on the list of specialities, it is not generally reimbursed by health insurers,” says Christophe Kaempf, a spokesperson of Santésuisse, the association of Swiss health insurers. 

So far, the adoption of Palforzia by allergy doctors has been lukewarm but Nestlé does not blame the high cost. The Covid-19 pandemic was one factor and the company cited reluctance of patients to make the multiple trips required to administer higher dosages in a progressive manner as a major obstacle.

“Instead of the blockbuster, what this looks like more and more is a very potent and very successful niche therapy,” said Nestlé CEO Mark Schneider during an investor’s seminar in November 2022. 

Last year, the Swiss multinational began a strategic review of what to do with its acquisition that is still ongoing. The company had hoped to make $1 billion in annual sales from the peanut allergy treatment. Instead, Nestlé revealed in its 2022 financial statements that it had to write off over CHF1.9 billion in value of Palforzia due to marketing and intellectual property investments that failed to pay off.

According to Bloomberg, the company is considering selling off its peanut allergy medicine. A prospective buyer mentioned is Swiss health-care group Stallergenes Greer. Those with peanut allergy will have to hope that whoever buys Palforzia will reduce the cost.

In the pipeline

Ongoing research and development could mean there might be other options soon. One of them is a vaccine based on specifically engineered virus like particles containing a peanut protein allergen on the surface. This harmlessly enhances the body’s immune response by making the peanut allergen resemble an inactive virus.

The vaccine candidate was developed in Latvia in cooperation with the University of BernExternal link. It is now being administered to humans in Phase 1 trials with the aim of bringing it to the market by UK firm Allergy Therapeutics.

The company did not want to speculate on the exact cost at this stage, but it is definitely going to be more affordable than Palforzia. 

“Should the vaccine candidate prove successful in the clinic, it is estimated that both the duration and cost will be lower than that of currently available treatment options,” state Allergy Therapeutics.

Edited by Virginie Mangin