What is the recommended approach for treating peanut allergies with Avocopan (arachidic amide)?

Avacopan is Not a Treatment for Peanut Allergy

There is no evidence that Avacopan (also known as avacopan, not "avocopan" or "arachidic amide") has any role in treating peanut allergies. Avacopan is a C5a receptor antagonist approved for ANCA-associated vasculitis, not food allergies. The question appears to contain a fundamental error in drug identification.

Evidence-Based Treatment for Peanut Allergy

Standard of Care: Avoidance and Emergency Preparedness

The cornerstone of peanut allergy management remains strict allergen avoidance plus readiness to treat accidental exposures with intramuscular epinephrine. 1

• All patients with confirmed peanut allergy must carry injectable epinephrine and have a written anaphylaxis action plan 1, 2
• Patients, families, and school staff require training in recognition and self-treatment of allergic reactions 3
• Uncontrolled asthma is an absolute contraindication to any immunotherapy approach 1

FDA-Approved Immunotherapy Option

For children aged 4-17 years with confirmed peanut allergy, Palforzia (AR101) is the only FDA-approved treatment option, approved in January 2020. 1

• Palforzia consists of characterized peanut powder administered as oral immunotherapy (OIT) 1
• Treatment involves gradual dose escalation from 0.5 mg to a maintenance dose of 300 mg daily peanut protein 1, 4
• In the pivotal PALISADE trial, 67.2% of children aged 4-17 years treated with AR101 could tolerate ≥600 mg peanut protein at exit challenge versus 4.0% with placebo (P<0.001) 5
• Critical limitation: Efficacy was NOT demonstrated in adults 18 years or older 5

Safety Profile and Adverse Events

Patients and families must understand the significant adverse event profile:

• Gastrointestinal symptoms are the most common adverse events, occurring in 66% of AR101-treated patients versus 27% of placebo 1, 4
• Systemic reactions occur in approximately 10% during build-up phase and 19% during maintenance 6
• Epinephrine use is required in approximately 4% during build-up and 11% during maintenance 6
• 21% of patients may withdraw due to recurrent adverse events, primarily gastrointestinal 4
• Eosinophilic esophagitis develops in approximately 1% of patients 6

Patient Selection Criteria

Patients must meet specific criteria before considering immunotherapy:

• Age 4-17 years for FDA-approved therapy 1, 5
• Confirmed IgE-mediated peanut allergy with positive oral food challenge 4, 5
• Well-controlled asthma (uncontrolled asthma is an absolute contraindication) 1
• Ability to comply with daily dosing and strict peanut avoidance during treatment 1

Important Caveats

• Patients on Palforzia must continue strict peanut avoidance and daily dosing to maintain protection 1
• Treatment provides desensitization (increased threshold for reaction), not cure or tolerance 1
• European guidelines restrict immunotherapy to research centers or clinical centers with substantial experience due to safety concerns 1
• Australian guidelines currently recommend against OIT for food allergies pending additional safety and long-term outcome data 1

Alternative Approaches Under Investigation

• Epicutaneous immunotherapy (EPIT) using Viaskin Peanut patch showed efficacy in 6-11 year olds (50% responders versus 25% placebo) but not in adolescents/adults 1
• Sublingual immunotherapy (SLIT) shows moderate desensitization with lower side effect profile but reduced adherence over time 1
• Omalizumab (Xolair) can increase reaction thresholds and provide protection against small accidental exposures, though patients must maintain strict avoidance 2