Information updates

A new ASCIA Fast Facts about adrenaline injectors is now available on the ASCIA website, following review by the ASCIA Anaphylaxis committee, as well as a new one page ‘How to give adrenaline injectors’ guide:

• Adrenaline Injectors Fast Facts New March 2022

In response to recent feedback, questions 11 and 12 in the ASCIA Action Plans FAQ have been reworded slightly to make the information clearer, with the main updates highlighted in blue below.

• ASCIA Action Plan FAQs Updated April 2022

Q 11: Who should have a green ASCIA Action Plan?

• The green ASCIA Action Plan for Allergic Reactions has been developed for children or adults with a confirmed allergy to foods or insects, who have not been prescribed an adrenaline injector, as they are considered to be at low risk of anaphylaxis.
• The dark green ASCIA Action Plan for drug (medication) allergy has been developed for children or adults with a confirmed allergy to drugs (medications). Adrenaline injectors are not usually prescribed for people with a drug allergy.
• Allergies to foods, insects or drugs have the potential to result in anaphylaxis, and the green ASCIA Action Plans provide guidance on how to manage anaphylaxis if it occurs. 

Q 12: Should a person with allergic rhinitis (hay fever) have an ASCIA Action Plan for Allergic Reactions completed by their doctor or nurse practitioner?

No. ASCIA Action Plans are not required for people with allergy to environmental inhalant allergens such as grass pollen, dust mite, or mould, resulting in allergic rhinitis (hay fever). Whilst allergic rhinitis can cause uncomfortable symptoms, they are not potentially life-threatening allergic reactions and hence an ASCIA Action Plan is not required. However, if the allergic rhinitis affects an individual's asthma, their Asthma Action Plan should be followed. People with allergic rhinitis can be given an ASCIA Treatment Plan for Allergic Rhinitis for personal/home use.

The ASCIA Treatment Plan for Allergic Rhinitis is completed by a doctor, nurse practitioner or pharmacist, and is meant for the person or the parent, not for schools. Most schools do not play a role in the treatment and management of allergic rhinitis. However, when medication administration is required at school, parents should liaise with the school.

We hope that this new and updated information is useful.

ASCIA is intending to apply for a Medicare Benefits Schedule (MBS) item number for antibiotic allergy challenges in 2022. In preparation for this application, a new ASCIA FAQ for patients and carers, as well as a new Consent Form, have been developed, following review by the ASCIA Drug Allergy committee. These resources are now available open access on the ASCIA website:

ASCIA Antibiotic Allergy Challenge New March 2022

ASCIA Consent Form - Antibiotic Allergy Challenges New March 2022

The new resources complement the ASCIA antibiotic allergy information for health professionals, which is also available on the ASCIA website www.allergy.org.au/hp/papers#p2 

We note that in the Federal Budget announcement on Tuesday 29 March 2022, it was stated that the Australian Government’s investment would include support to improve access to allergy diagnostics and to gather evidence to support MBS items for food and drug challenge testing. Our aim is for the new resources listed above to assist in this process.

To read more about the Federal Budget announcement go to www.allergy.org.au/about-ascia/info-updates/allergic-diseases-and-anaphylaxis-funding-announced-in-federal-budget

ASCIA is intending to re-apply for a Medicare Benefits Schedule (MBS) item number for food allergen challenges in 2022. In preparation for this application, a new ASCIA Position Paper has been developed, following review by the ASCIA Paediatric committee, as well as a new Consent Form and Reference List. These resources are now available open access on the ASCIA website:

• ASCIA Position Paper - Food Allergen Challenges New March 2022
• ASCIA Consent Form - Food Allergen Challenges New March 2022
• References - Food Allergen Challenges New March 2022

The new resources complement the ASCIA food allergen challenges FAQ for patients and carers, which is also available on the ASCIA website:

• ASCIA Food Allergen Challenges 

We note that in the Federal Budget announcement on Tuesday 29 March 2022, it was stated that the Australian Government’s investment would include support to improve access to allergy diagnostics and to gather evidence to support MBS items for food and drug challenge testing. Our aim is for the new resources listed above to assist in this process.

To read more about the Federal Budget announcement go to www.allergy.org.au/about-ascia/info-updates/allergic-diseases-and-anaphylaxis-funding-announced-in-federal-budget

This news item was issued on 4 April 2022 by Jill Smith, CEO of ASCIA, the peak professional body for clinical immunology and allergy in Australia and New Zealand.  

The National (Australian) COVID-19 Clinical Evidence Taskforce (the Taskforce), has issued recommendations on the use of monoclonal antibodies tixagevimab plus cilgavimab (Evusheld), for COVID-19 prevention (prophylaxis). Evusheld is supplied by Astra Zeneca and has provisional approval in Australia from the Therapeutic Goods Administration (TGA) since January 2022:

www.tga.gov.au/media-release/tga-grants-provisional-determination-astrazeneca-pty-ltd-covid-19-prophylaxis-and-treatment-tixagevimab-and-cilgavimab-evusheld

Product information is available at www.tga.gov.au/sites/default/files/evusheld-pi.pdf which includes the following details:

• Evusheld is administered by intramuscular (IM) injection, and should be given with caution to patients with thrombocytopenia or any coagulation disorder.
• Serious adverse events are rare, as listed in table 5.
• Efficacy and safety of Evusheld in children (less than 18 years) has not been established.
• Evusheld is not recommended as a substitute for vaccination.
• The trial of Evusheld included particpants who had moderate to severe immune compromise due to a medical condition or immunosuppressive medications/treatments, that made it likely that they will not mount an adequate immune response to COVID‐19 vaccination.

Supply of Evusheld is currently limited, and is only available in Australia from the National Stockpile. Therefore Evusheld can only be considered for pre-exposure prophylaxis in exceptional circumstances, in people who are severely immunocompromised and at high risk of progression to severe COVID-19. This includes people who are expected to have an inadequate response to vaccination, who have:

• Solid organ transplant, blood or bone marrow transplant.
• Primary immune deficiencies, also known as inborn errors of immunity.
• Secondary immune deficiencies, including patients on significant immunosuppressive medications and some people with HIV.

ASCIA recommends that allocation of Evusheld should be based on the severity of the underlying immune deficiency, the risk of acquiring coronavirus infection, and the risk of severe COVID, supported by the patient’s specialist recommendation.

It is noted that there is currently no clinical data regarding effectiveness of Evusheld specific to SARS-CoV-2 variants of concern. 

The Taskforce recommendations on Evusheld for prophylaxis are available at: https://app.magicapp.org/#/guideline/L4Q5An/section/j7Amwz 

This information is also available at https://www.allergy.org.au/hp/papers/ascia-covid-19-prophylaxis-in-people-with-immune-deficiencies

This news item was issued on 28 March 2022 and updated on 6 May 2022 by Jill Smith, CEO of the Australasian Society of Clinical Immunology and Allergy (ASCIA), the peak professional body for clinical immunology and allergy in Australia and New Zealand.   

Aspen Pharmacare Australia Pty Ltd took over the distribution of the Novalac infant formula range from Bayer Pharmaceuticals on 1^st June 2022. 

As the distributor of Novalac Allergy, Aspen Pharmacare Australia Pty Ltd www.aspenpharma.com.au is working with the global manufacturer to ensure supply, particularly as babies who are fed Novalac Allergy Infant Formula are vulnerable patients with specialised nutrition requirements.

In recent months, global supply chains have come under strain from the impact of COVID-19 and geopolitical events such as the conflict zones in Europe. With the higher-than-average demand, stock levels of Novalac Allergy Infant Formula continue to be depleted at an accelerated pace.  

While limited availability continues, parents and carers should contact their local pharmacy to check stock levels prior to going in-store and, if the product cannot be found in-store, try online options: chemistwarehouse.com.au or priceline.com.au.

Some minor improvements to the Novalac Allergy formulation

Novalac  is constantly looking to improve the formulations to better meet the needs of babies with common feeding problems. Novalac Allergy has made improvements to some of the ingredients. The fish oil has now been replaced with 100% plant source which is rich in DHA and ARA, we have replaced glucose syrup with maltodextrin, as a result the volume per scoop and Nutrition Information Panel (NIP) has been adjusted accordingly. Please be assured that these improvements in Novalac Allergy continue to meet the nutrient requirements according to the FSANZ guidelines 2.9.5.

It is recommended that parents/carers speak to their healthcare professional who can provide medical advice about milk-substuiute products specifically for their baby if they have cow's milk (dairy) allergy, which are listed on the ASCIA website www.allergy.org.au/hp/papers/guide-for-milk-substitutes-cows-milk-allergy

With the recent listing of Rinvoq® on the PBS, the following ASCIA resources have been updated to include Dupixent® (dupilumab) and Rinvoq® (upadacitinib) treatments for severe eczema:

• ASCIA Eczema FAQ www.allergy.org.au/patients/skin-allergy/eczema

• ASCIA Action Plan for Eczema https://www.allergy.org.au/patients/skin-allergy/eczema-action-plan

• ASCIA Stepwise Management Plan for Eczema https://www.allergy.org.au/hp/papers/ascia-stepwise-management-plan-for-eczema

Both plans are also available at https://www.allergy.org.au/hp/ascia-plans-action-and-treatment#r4a

The FAQ has been updated with the following information under ‘Q 9: How should eczema flares and severe eczema be treated?.’

If prescribed, use a recently listed treatment for severe eczema. There are now two treatments for severe eczema that are listed on the Pharmaceutical Benefits Scheme (PBS) in Australia for people aged 12 years or older with severe eczema which has not responded to other prescribed topical treatments:

• Dupixent® (dupilumab) is an immune modulating treatment given by injection that is self-administered. Dupilumab works by modifying the body’s immune response to prevent inflammation that plays a central role in eczema, but it is not an immunosuppressant.
• Rinvoq® (upadacitinib) is a Janus Kinase 1 (JAK1) inhibitor, that is taken as an oral tablet. JAK enzymes create signals in the body's immune system that result in inflammation, so JAK inhibitors work by blocking these signals. This reduces inflammation and the production of immune cells within the body.

It is important to ask your clinical immunology/allergy specialist or dermatologist to see if you are eligible for one of these treatments for severe eczema, which target different parts of the immune system.

Upcoming webinar for ASCIA members: Uploading allergy information to My Health Record

Uploading information about a patient’s allergies and adverse reactions is important for their safety because it becomes available to other healthcare providers that treat them. Documents uploaded to My Health Record by specialists and viewed by other healthcare providers increased by 23% in January 2022.

Upcoming webinar: Uploading allergy information to My Health Record

Find out how to upload allergy information in a 30-minute webinar specifically for ASCIA members. Dr William Smith (Clinical immunology/allergy specialist) and Dr Kathy Rainbird (Australian Digital Health Agency) will explain how you can do this directly from your clinical software. The webinar will include a step-through demonstration using Genie software and time for questions.

Date and time: 8pm AEDT (5pm WST) Thursday 31 March 2022

Register: https://attendee.gotowebinar.com/register/3760776590315362830

Suitable for: Specialists using a range of conformant clinical software.

The National Allergy Strategy has developed a new series of short videos to help parents feed their babies the common allergy causing foods, as part of the Nip allergies in the Bub allergy prevention program.

Four videos have been developed (one for each stage of feeding development), which demonstrate how to prepare recipes taken from the Nip allergies in the Bub recipe booklet. One of the key recipes included in the first foods video is how to prepare a nut and seed mix, making sure the nuts and seeds are finely ground to prevent choking.

Click here to view the videos.

The Nip allergies in the Bub recipe booklet has also been updated. We have also updated to include photos of the recipes that are featured in the videos.

Click here to view the recipe booklet.

The Nip allergies in the Bub website www.preventallergies.org.au  has undergone a major review to make sure the content is consistent with the latest food allergy prevention evidence-base and best-practice. ReadSpeaker has also been added to the website to allow for content to be read aloud and/or translated into more than 20 languages.

The Nip allergies in the Bub allergy prevention program is based on ASCIA Guidelines for Infant Feeding and Allergy Prevention. A new Australian allergy prevention study shows that prevention measures, as outlined in the ASCIA Guidelines, are having a measurable impact on the population prevalence of food-related anaphylaxis presentations to hospital. To read more go to www.allergy.org.au/about-ascia/info-updates/new-allergy-prevention-study