Palforzia Shortage: What Providers and Prescribers Need to Know in 2026

For allergists and immunologists who built peanut OIT programs around Palforzia, or who referred patients to REMS-certified practices for this treatment, the January 2026 announcement of Palforzia's voluntary discontinuation demands immediate clinical attention. Stallergenes Greer will cease commercialization of Palforzia [Peanut (Arachis hypogaea) Allergen Powder-dnfp] as of July 31, 2026. This guide outlines the clinical and operational implications for prescribers managing current Palforzia patients.

Clinical Background: Why Palforzia Is Exiting the Market

Stallergenes Greer cited "complex administrative and dosing requirements" as the primary contributor to limited clinical adoption. The REMS program — mandatory due to anaphylaxis risk — required healthcare setting enrollment, provider certification, and patient-by-patient REMS agreements, creating substantial administrative overhead for prescribing allergists. Combined with competition from off-label, office-based peanut OIT protocols using non-pharmaceutical peanut flour, Palforzia's commercial uptake never reached projected levels. The decision to discontinue is purely commercial; Palforzia's clinical efficacy is not in question.

Discontinuation Timeline for Providers

January 2026: Public discontinuation announcement; patient communication initiated by Stallergenes Greer.

March-April 2026: Healthcare providers advised not to initiate new patients. Initial Dose Escalation packs restricted or no longer available.

July 31, 2026: Full commercialization ends. No new batches. Remaining inventory for patients in active therapy only.

Immediate Clinical Priorities: Your Current Palforzia Patients

Providers with patients currently in Up-Dosing or Maintenance phases face the most urgent decisions. Key clinical priorities include:

Inventory assessment: Determine how much remaining Palforzia supply exists for each patient at each dose level. Contact the Palforzia Pathway Patient Hub (1-844-PALFORZ) and your specialty pharmacy contacts.

Do not abruptly discontinue: Abrupt cessation of OIT reverses desensitization and restores full peanut sensitivity. All transitions must be medically supervised.

Document baseline status: Record each patient's current Palforzia dose level before transitioning, so that any alternative OIT protocol can be calibrated appropriately.

Initiate patient communication: Proactively contact all current Palforzia patients to explain the situation, answer questions, and schedule transition planning visits.

Transition Option 1: Office-Based Peanut OIT

The most clinically seamless transition for Palforzia patients is to office-based peanut OIT using measured peanut flour. Patients who have reached a specific Palforzia dose level — such as the 3 mg Up-Dosing level — can theoretically continue at an equivalent peanut protein dose using a standardized peanut flour protocol. Key considerations:

Off-label, not FDA-approved — insurance coverage is inconsistent; document medical necessity carefully.

Standardization requires a documented in-office protocol, appropriate weighing equipment, and patient/caregiver training on home dose preparation.

Informed consent forms should outline the differences from the FDA-approved Palforzia protocol.

Academic OIT programs (e.g., Latitude Food Allergy Care, university allergy departments) may have established protocols that could support patient transfers.

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Transition Option 2: Omalizumab (Xolair) for Food Allergy

Omalizumab (Xolair; Genentech/Novartis) received FDA approval in February 2024 for the reduction of allergic reactions from accidental food exposure in patients ages 1 and older. For Palforzia patients who cannot or will not transition to office-based OIT, Xolair may be an appropriate alternative, particularly for:

Patients who experienced frequent adverse events on Palforzia (abdominal pain, urticaria, anaphylaxis)

Patients allergic to multiple foods who would benefit from omalizumab's broader coverage

Patients with asthma or urticaria who are already appropriate candidates for anti-IgE therapy

Note: Xolair works differently from OIT. It blocks IgE-mediated reactions but does not induce durable immune tolerance. Benefits are maintained only while the patient is on therapy. This distinction is important in shared decision-making conversations with families.

REMS Obligations During Wind-Down

Providers enrolled in the Palforzia REMS program should be aware that REMS obligations — including adverse event reporting, monitoring, and documentation — remain in effect until Stallergenes Greer holds the marketing authorization. Stallergenes Greer has stated it will fulfill all regulatory obligations through the wind-down period. Continue reporting any adverse events via the established REMS channels (1-844-PALFORZ) and to the FDA MedWatch program as required.

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How medfinder Supports Provider Transitions

For providers whose patients are still seeking remaining Palforzia supply during the wind-down, medfinder for providers helps efficiently locate specialty pharmacies that still carry Palforzia at specific dose levels. Rather than spending staff time calling pharmacies one by one, medfinder does the calling and delivers results directly. This is particularly useful when managing multiple patients at different Palforzia dose stages simultaneously.

Key Takeaways for Providers

Palforzia commercialization ends July 31, 2026 — a commercial, not safety, decision.

No new patients should be started on Palforzia; Initial Dose Escalation packs are restricted.

Transition current patients to office-based OIT (peanut flour) or evaluate for omalizumab.

Never abruptly discontinue OIT without a supervised transition protocol.

Maintain REMS documentation and adverse event reporting obligations through July 2026.

Use medfinder to locate remaining specialty pharmacy supply for patients mid-treatment.