It’s peanuts. Food allergies, gastronomic concerns and Palforzia: a narrative review.

: Peanut allergy is usually framed as a clinical problem of diagnosis, avoidance and emergency management, but their consequences extend into everyday eating, restaurants, events, travel, commensality and culinary promotion. This thematic narrative review uses Palforzia, an oral immunotherapy based on peanut allergen powder-dnfp, as an analytical case to examine the intersection between peanut allergy, public health, food regulation, gastronomy and allergen-aware food environments. It synthesises literature and regulatory sources across six domains: 1) peanut allergy as a public health and gastronomic problem; 2) food allergy in restaurants, events and commensality; 3) Palforzia as peanut oral immunotherapy; 4) evidence, safety and adverse drug reactions; 5) regulatory and commercial fragility; and 6) implications for gastronomic and international promotion of national cuisines through gastrodiplomacy. Peanut occupies a boundary position as food ingredient, mandatory declarable allergen, source of severe reactions, medicinal substance and gastronomic identitarian element. Palforzia may increase tolerance thresholds in selected patients, but it does not resolve peanut allergy, remove avoidance or replace emergency preparedness. Its commercial discontinuation also shows that pharmaceutical inclusion may remain fragile despite regulatory approval. The review argues that transforming peanuts into a medicinal product does not remove the need to transform food environments. Peanut allergy requires a combined approach including clinical tools that may reduce vulnerability to reactions after accidental exposure and gastronomic infrastructures that support safer and more inclusive gastronomic participation.