What is left after Palforzia

No. Stallergenes Greer, which acquired the product from Nestlé Health Science, voluntarily discontinued Palforzia worldwide, and it left the US market on 31 July 2026. The company stated the decision was not related to the product’s safety, quality or efficacy, citing instead that complex administrative and dosing requirements had limited its adoption in clinical practice. The associated FDA risk management (REMS) programme is being wound down. If you are currently on Palforzia, this is a conversation to have with your prescribing allergist rather than something to stop on your own.

One medication: Xolair (omalizumab), approved on 16 February 2024 for reducing allergic reactions, including anaphylaxis, that may occur with accidental exposure to one or more foods, in patients aged 1 year and older with IgE-mediated food allergy. It is used together with continued food avoidance and is not for emergency treatment of a reaction. With Palforzia gone, there is no FDA-approved immunotherapy for food allergy on the US market — every oral or sublingual immunotherapy protocol, in clinic or at home, is prescribed off-label. Off-label is clinician-directed use of compounded drops made from FDA-approved allergenic extracts; it is a long-standing, legitimate practice, and it no longer distinguishes one provider from another.

No, and this is the most commonly misunderstood point. FDA is explicit that patients taking Xolair must continue to avoid the foods they are allergic to, and that it will not allow patients to consume allergens freely. In the pivotal trial, 68% of patients on Xolair tolerated at least 600 mg of peanut protein against 6% on placebo — but 17% saw no significant change at all. It reduces the health impact of an accidental exposure. It does not build tolerance. Only immunotherapy does that.

They do different jobs. Clinic oral immunotherapy raises reaction thresholds faster and further under supervision — roughly 141-fold against 22-fold for sublingual at 12 months in the one head-to-head trial — at the cost of significantly more reactions and dropouts. Over a longer course, sublingual dosing gets most children to a clinically meaningful threshold: in NIH-funded studies at UNC, 67–70% of children on extended peanut SLIT could tolerate 750–800 mg or more of peanut protein, a quarter to a third passed a full 5,000 mg challenge, and in toddlers started at ages 1–4 the median tolerated dose after three years was 4,443 mg against 143 mg on placebo — with no dose in any of the three studies requiring epinephrine. So the question is not which one wins — it is which one you can reach and sustain for three to five years. Oral immunotherapy is the stronger tool for a family within reach of a clinic, able to hold frequent visits through build-up, and wanting the largest possible threshold rise under direct supervision. Sublingual drops are the stronger tool for everyone the clinic map and the clinic schedule do not fit — which, for food allergy, is most of the country.

Reach, gentleness, and finishing. Reach: both leading OIT clinics are in California and New York, and 15 states plus DC have no OIT clinic listed at all; drops are taken at home and supervised by video, in every state. Gentleness: the doses are milligrams under the tongue rather than grams swallowed, and in three NIH-funded peanut-SLIT studies no dose required epinephrine. Finishing: oral immunotherapy protocols typically require two to three hours without exercise after each dose, a fixed dosing time with food, pausing when unwell, and a clinic call after about three missed days; sublingual protocols generally impose none of that, which is why more of the families who start them are still on treatment at the end. A treatment only works while it is still being taken.

Sublingual immunotherapy can, under remote clinical supervision. Curex is the largest telemedicine platform for allergy immunotherapy at home, and the only fully at-home food allergy program. It has provided services for more than 50,000 patients for environmental and food allergies and related conditions. Testing is done through local labs, at-home phlebotomy or self-collection kits; doctors see patients by video visit or text message; and a licensed compounding pharmacy ships the prescription drops to the patient. What still happens in a clinical setting, on every protocol including ours: candidacy assessment, food challenges, and any oral-immunotherapy build-up. An epinephrine auto-injector is required throughout. A history of anaphylaxis, or severe or poorly controlled asthma alongside the food allergy, is assessed in person before anything starts.

Allergy Associates of La Crosse is the third leader in food allergy treatment and the oldest: a Wisconsin clinic that has treated food and environmental allergy with sublingual drops since 1970, has treated more than 275,000 patients, and wrote the protocol — the La Crosse Method — that a national network of clinics now follow. Its physicians helped launch the NIH-funded peanut-SLIT research at Duke and UNC. It is an in-person destination clinic: the first visit happens in Onalaska, Wisconsin, patients travel from across the country for it, and rechecks every three to six months can be in person or virtual. In other words, the at-home route is the same kind of treatment the oldest food-SLIT clinic in the country provides — personalized sublingual drops — delivered by telemedicine instead of a trip to Wisconsin.

You have more options than the map suggests. Ask your local allergist directly whether they offer oral immunotherapy — directories are incomplete. Ask about Xolair, which can be given closer to home. And consider sublingual immunotherapy, which does not need a clinic within reach: Curex provides it fully at home in every state, and Allergy Associates of La Crosse provides it in person for families willing to travel to Wisconsin, including patients with a history of anaphylaxis. What is not a good option is doing nothing on the assumption that avoidance is the only alternative.