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
Higher baseline peanut-specific IgE levels predict increased risk of systemic reactions during both build-up and maintenance phases. 6
- Patients must have documented IgE-mediated peanut allergy confirmed by oral food challenge 4, 5
- Screening typically requires dose-limiting symptoms at ≤143 mg peanut protein 4
- Older patients and those with higher peanut-specific IgE have increased odds of adverse reactions 6
Geographic Variations in Guidelines
European and Australasian guidelines are more restrictive than U.S. practice:
- European Academy of Allergy and Clinical Immunology (EAACI) restricts OIT to research centers or clinical centers with substantial experience 1
- Australasian Society of Clinical Immunology and Allergy (ASCIA) currently recommends against OIT use outside clinical trials due to safety concerns 1
- Canadian Society for Allergy and Clinical Immunology recommends OIT with off-the-shelf foods for adults, but pregnancy is an absolute contraindication 1
Alternative Investigational Approaches
For patients who cannot tolerate or are not candidates for Palforzia:
- Epicutaneous immunotherapy (EPIT) using Viaskin Peanut patch showed 50% response rate in children aged 6-11 years versus 25% placebo, but was not effective in adolescents/adults 1
- Sublingual immunotherapy (SLIT) demonstrates moderate desensitization with predominantly oral mucosal symptoms, but adherence is problematic 1
- Omalizumab (Xolair) can increase reaction thresholds and provide protection against small accidental exposures, though patients must maintain strict avoidance 2
Critical Management Points
Patients on any form of peanut immunotherapy must: