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BNSSG Adult Joint Formulary

3.2 Allergic conditions

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Last edited: 09-05-2024

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

Link to BNSSG Allergic Rhinitis Pathway for Adults

Antihistamines

Non-sedating antihistamines

Although drowsiness is rare, patients should be advised that it can occur and may affect performance of skilled tasks.

Loratadine (TLS Green)

Cetirizine (TLS Green)

Specific Indication:

Fexofenadine (TLS Blue)

Fexofenadine is for the treatment of chronic idiopathic urticaria and seasonal allergic rhinitis in patients who have not adequately responded to cetirizine and loratadine. Fexofenadine is more expensive than loratadine and cetirizine

Sedating antihistamines

Drowsiness may affect performance of skilled tasks; sedating effects enhanced by alcohol.

Chlorphenamine (TLS Green)

Specific indications: (TLS Blue)

Hydroxyzine

Dermatology and renal use

Promethazine

Dermatology use

Vaccines (Allergen-type)

Bee venom extract

Alutard^® (TLS Red)

Hypersensitivity to wasp or bee venom only

Grass pollen extract

Pollinex^® (TLS Red)

Immunology only

Grazax^® (TLS Red)

Immunology only

Grass, Tree Pollen and House Dust mite Extracts

OralVac^® (TLS Red)

Immunology only

Acarizax (oral) (TLS Red)

For adolescents and adults with severe rhinitis or house dust mite allergic asthma

Birch pollen extract

Itulazax (Standardised allergen extract of pollen from white birch [Betula verrucosa]) (TLS Red)

For treatment of moderate-to-severe allergic rhinitis and/or conjunctivitis induced by pollen from the birch homologous group for use by the specialist allergy team.

Anaphylaxis

Link to BNSSG Remedy Immunology and Allergy page

Adrenaline (epinephrine) 1 in 1000 (1mg/mL) (TLS Green)

Intramuscular
For self-administration using pre-filled adrenaline auto-injectors (pens) - brands include Epipen^®, Jext^® and Emerade^® (note: in May 2023 a National Patient Safety Alert (NatPSA) Class 1 Medicines Recall Notification was published recalling Emerade 500 micrograms and Emerade 300 micrograms auto-injectors, due to the potential for device failure, NatPSA/2023/004/MHRA)
Training will be required if changing brand of adrenaline for self-administration

Adrenaline (epinephrine) 1 in 10,000 (100micrograms/mL) (TLS Green)

Intravenous

Chlorphenamine (parenteral) (TLS Green)

Hydrocortisone sodium succinate (parenteral) (TLS Green)

3.2.1 Angioedema

C1-esterase inhibitor (Berinert^®, Cinryze^®) (TLS Red)

Conestat alfa (Ruconest^®) (TLS Red)

Icatibant (Firazyr^®) (TLS Red)

All the above should be prescribed in accordance with the NHS England Clinical Commissioning Policy on Treatment of Acute Attacks in Hereditary Angioedema (B09/P/b)

Or in accordance with NHS England Clinical Commissioning Policy on Plasma-derived C1-esterase inhibitor for prophylactic treatment of hereditary angioedema (HAE) types I and II (16045/P)

Berotralstat (TLS Red)

NICE TA738 Berotralstat for preventing recurrent attacks of hereditary angioedema

Allergen immunotherapy

Lanadelumab (TLS Red)

NICE TA606 For preventing recurrent attacks of hereditary angioedema

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