page216
Pharmalgen
c
(ALK-Abello
´
) A
Bee venom extract (
Apis mellifera
) or wasp venom
extract (
Vespula
spp.), net price initial treatment set =
£54.81 (bee), £67.20 (wasp);
maintenance treatment
set = £63.76 (bee), £82.03 (wasp)
GRASS AND TREE POLLEN
EXTRACTS
Indications
treatment of seasonal allergic hay fever
due to grass or tree pollen in patients who have failed
to respond to anti-allergy drugs (see notes above)
Cautions
see notes above and consult product litera-
ture
Contra-indications
see notes above and consult pro-
duct literature
Pregnancy
avoid
Side-effects
see notes above and consult product
literature
Dose
. See under preparations below
Pollinex
c
(Allergy) A
Grasses and rye or tree pollen extract, net price initial
treatment set (3 vials) and extension course treatment
(1 vial) = £450.00
Dose
By subcutaneous injection,
consult product literature
Grass pollen extract
Grazax
c
(ALK-Abello
´
) T A
Oral lyophilisates (= freeze-dried tablets)
,
grass
pollen extract 75 000 units,
net price 30-tab pack =
£66.56.
Counselling,
administration
Dose
ADULT and CHILD over 5 years, 1 tablet daily;
start treat-
ment at least 4 months before start of pollen season and continue
for up to 3 years
Counselling
Tablets
should be placed under
the tongue and
allowed to disperse. Advise patient not to swallow for 1 minute,
or eat or drink for 5 minutes after taking the tablet
Omalizumab
Omalizumab is a monoclonal
antibody that
binds to
immunoglobulin E (IgE). It is used as additional therapy
in individuals with proven IgE-mediated sensitivity to
inhaled
allergens,
whose
severe
persistent
allergic
asthma cannot
be controlled adequately with high-
dose inhaled corticosteroid together with a long-acting
beta
2
agonist.
Omalizumab should be initiated by phy-
sicians in specialist centres experienced in the treatment
of severe persistent asthma.
Churg-Strauss syndrome has occurred rarely in patients
given omalizumab;
the reaction is usually associated
with
the
reduction
of
oral
corticosteroid
therapy.
Churg-Strauss syndrome can present
as eosinophilia,
vasculitic rash, cardiac complications, worsening pulm-
onary symptoms, or peripheral neuropathy. Hypersensi-
tivity reactions can also occur
immediately following
treatment with omalizumab or sometimes more than 24
hours after the first injection.
For
details
on the management
of
anaphylaxis,
see
section 3.4.3.
The
Scottish Medicines Consortium
p.
4 has advised
(September 2007 and March 2010) that omalizumab is
accepted for restricted use within NHS Scotland as add-
on therapy to improve asthma control
in children (6 to
12 years), adolescents, and adults with severe persistent
allergic asthma.
Omalizumab is restricted to patients
who are prescribed chronic systemic corticosteroids
and in whom all
other
treatments
have failed.
The
response should be assessed at 16 weeks and omalizu-
mab treatment discontinued in patients who have not
shown a marked improvement in overall
asthma con-
trol.
NICE guidance
Omalizumab for severe persistent allergic
asthma (November 2007)
Omalizumab is recommended as additional therapy
for
the
prophylaxis
of
severe
persistent
allergic
asthma in adults and children over 12 years,
who
cannot
be
controlled adequately with high-dose
inhaled corticosteroids and long-acting beta
2
ago-
nists in addition to leukotriene receptor antagonists,
theophylline,
oral
corticosteroids,
oral
beta
2
ago-
nists, and smoking cessation where clinically appro-
priate.
The following conditions apply:
.
confirmation of
IgE-mediated allergy to a per-
ennial
allergen by clinical
history and allergy
skin testing;
.
either 2 or more severe exacerbations of asthma
requiring hospital admission within the previous
year,
or
3 or
more severe exacerbations
of
asthma within the previous year,
at
least
one
of
which required hospital
admission,
and a
further 2 which required treatment or monitor-
ing in excess of the patient’s usual regimen, in an
accident and emergency unit.
Omalizumab should be initiated and monitored by a
physician experienced in both allergy and respir-
atory medicine in a specialist centre, and discontin-
ued at 16 weeks in patients who have not shown an
adequate response to therapy.
NICE guidance
Omalizumab for the treatment of severe
persistent allergic asthma in children aged 6
to 11 years (October 2010)
Omalizumab is not recommended for the treatment
of severe persistent allergic asthma in children aged
6 to 11 years.
OMALIZUMAB
Indications
prophylaxis of allergic asthma (see notes
above)
Cautions
autoimmune disease;
susceptibility to hel-
minth infection—discontinue if infection does not
respond to anthelmintic
Hepatic impairment
manufacturer advises caution—
no information available
Renal impairment
manufacturer advises caution—no
information available
Pregnancy
manufacturer advises avoid unless essen-
tial
Breast-feeding
manufacturer advises avoid—present
in milk in
animal
studies
196
3.4.2 Allergen Immunotherapy
BNF 61
3
Respiratory system