3.2 Allergic conditions
First line drugs | Second line drugs | Specialist drugs | Secondary care drugs |
Traffic light status (TLS) explained:
- Green: Routine prescribing within licensed indication
- Amber 1: specialist recommendation followed by GP initiation and continuation
- Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
- Amber 3: specialist initiation and stabilisation followed by GP continuation
- Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
- Red: Hospital or specialist prescribing only
Antihistamines
Non-sedating antihistamines
Cetirizine hydrochloride
-
Tablets 10mg
-
Oral solution 5mg/5mL
Notes:
- Sugar-free versions are available and can be ordered by specifying sugar-free on the prescription
- Should not be prescribed in Primary Care or at Discharge
- Advise patient to purchase, unless prescription is for long-term regular use
Fexofenadine hydrochloride
- Tablets 120mg, 180mg
Loratadine
- Tablets 10mg
- Oral solution 5mg in 5mL
Notes:
- Should not be prescribed in Primary Care or at Discharge
- Advise patient to purchase, unless prescription is for long-term regular use
Sedating antihistamines
Chlorphenamine maleate
- Tablets 4mg
- Oral solution sugar-free 2mg in 5mL
- Injection 10mg/mL
Notes:
- Patients aged over 6 should not be prescribed in Primary Care or at Discharge
- Advise patient to purchase, unless prescription is for long-term regular use
Hydroxyzine hydrochloride
- Tablets 10mg, 25mg
Note:
- Hydroxyzine is favoured by the dermatologists for its anti-itch and sedating effects.
- MHRA/CHM advice: Hydroxyzine - risk of QT-interval prolongation and Torsade de Pointes (April 2015)
Promethazine hydrochloride
- Tablets 10mg, 25mg
- Elixir 5mg/5mL
- Injection 25mg/mL
Vaccines (Allergen-type)
Pharmalgen® Bee Venom or Wasp Venom extract; Subcutaneous Injection
Notes:
- Use as per NICE TA246: Pharmalgen for the treatment of systemic reactions to bee and wasp venom allergy (February 2012)
Grazax allergy vaccine
- Sublingual tablets for severe grass pollen allergy
- Considered a LOW PRIORITY treatment due to lack of evidence of incremental clinical and cost effeectiveness when compared to existing therapies.
- Our policy statement
Allergen Immunotherapy
Benralizumab
Fasenra® Injection, 30mg/ml pre-filled syringe
Notes:
- Use as per NICE TA565: Benralizumab for treating severe eosinophilic asthma (March 2019)
Mepolizumab
- Nucala® Injection, 100mg powder for reconstitution
Notes:
- Use as per NICE: TA431 Mepolizumab for treating severe refractory eosinophilic asthma (January 2017)
Reslizumab
- Cinqaero® Injection, 10mg/mL concentrate for solution for infusion vials
Notes:
- Use as per NICE TA479: Reslizumab for treating severe eosinophilic asthma (October 2017)
Anaphylaxis
Adrenaline / Epinephrine
- Injection 1 in 1000; 1mL amp; IM or SC (1mg/mL)
- Injection 1 in 10,000; 10mL amp; IV use (100mcg/mL)
- Minijet 1 in 1000; 1mL IM, 1mL SC disposable syringe (1mg/mL)
- Minijet 1 in 10,000; 10mL IV disposable syringe (100mcg/mL)
(Subcutaneous injection not generally recommended).
Dose of intramuscular injection of adrenaline (epinephrine) for the emergency treatment of anaphylaxis by healthcare professionals
Age |
Dose |
Volume of adrenaline 1 in 1000 (1mg/mL) |
Child under 6 years |
150 microgram |
0.15mL |
6-12 years |
300 microgram |
0.3mL |
Adult & and child 12-18 years |
500 microgram |
0.5mL |
Self-administration of adrenaline (epinephrine)
Guidance
- Drug Safety Update. Adrenaline auto-injector advice for patients (August 2017)
- People who have been prescribed an adrenaline auto-injector because of the risk of anaphylaxis should carry two with them at all times for emergency, on-the-spot use.
- After every use of an adrenaline auto-injector, an ambulance should be called (even if symptoms are improving), the individual should lie down with their legs raised and, if at all possible, should not be left alone.
Emerade®
- 150 micrograms solution for injection in pre-filled pen
- 300 micrograms solution for injection in pre-filled pen
- 500 micrograms solution for injection in pre-filled pen
Epipen®
- Auto-injector 300 microgram dose
- Junior Auto-injector 150 microgram dose
Note:
- It is advisable to prescribe adrenaline auto-injector by brand (Epipen) to avoid confusion.
Jext® (Amber 1)
- 150 micrograms solution for injection in pre-filled pens
- 300 micrograms solution for injection in pre-filled pens
Traffic light status (TLS) explained:
- Green: Routine prescribing within licensed indication
- Amber 1: specialist recommendation followed by GP initiation and continuation
- Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
- Amber 3: specialist initiation and stabilisation followed by GP continuation
- Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
- Red: Hospital or specialist prescribing only
Return to Chapter: 3. Respiratory System
Last updated by: Dupe Fagbenro on 27-03-2019 17:05