Information updates

The latest immunoglobulin (Ig) Program Update is now available on the National Blood Authority (NBA) website www.blood.gov.au/Ig-program-updates

Ig Program Updates provide a snapshot of the NBA's current work program and priorities in the immunoglobulin space.

Current topics include:

• Release of new educational and training resources.
• Updates to BloodSTAR.
• Updated data on Ig usage.
• Commencement of an Ig Program evaluation review.
• Ig health technology assessment (HTA) reviews by the Medical Services Advisory Committee (MSAC).
• Work on the Ig prioritisation framework.
• Reports on Ig committee and stakeholder meetings.

The ASCIA Action Plan for Anaphylaxis includes the following infographics that show the correct and incorrect positioning of a person having anaphylaxis.

When a person has anaphylaxis their blood pressure can drop rapidly, which reduces blood flow to the heart. Laying the person flat will help blood flow to the heart which improves blood pressure, whilst standing can make anaphylaxis worse by causing blood pressure to drop.

A new animation has been developed as part of the National Allergy Strategy, which explains:

• How to position a person having anaphylaxis, including when giving the adrenaline (epinephrine) injector.
• Why it is important that a person having anaphylaxis does not stand or walk.

The animation is available at www.allergy.org.au/hp/anaphylaxis/positioning

Oral immunotherapy (OIT) is a potential treatment for food allergy. There are currently several clinical research trials of food allergy OIT and other treatments for food allergy underway in Australia and other countries. At present there is no evidence that OIT it is a cure for food allergy and there are no food allergy OIT products approved or registered by the Therapeutic Goods Administration (TGA) in Australia or by Medsafe in New Zealand.

ASCIA has updated its information about Oral Immunotherapy (OIT) for Food Allergy and the following new information is available on the ASCIA website:

1. New ASCIA OIT for Food Allergy Position Paper for health professionals www.allergy.org.au/hp/papers/ascia-oral-immunotherapy-for-food-allergy
2. New ASCIA OIT for Food Allergy frequently Asked Questions (FAQ) for patients, consumers and carers www.allergy.org.au/patients/allergy-treatment/oral-immunotherapy-for-food-allergy

Whilst both of these documents are new, the Position Paper has been adapted from the previous document that was for patients, consumers and carers, but expanded and updated to provide more detailed information for health professionals. The FAQ is a summary of the most common questions about food allergy OIT.

The ASCIA COVID-19 FAQ, Position Statement and Guides have been updated to reference the following summary of the Australian Technical Advisory Group on Immunisation (ATAGI) statement, issued on 8 April 2021 about AstraZeneca COVID-19 vaccine safety concerns:

• ATAGI notes further evidence of a rare but serious side effect involving thrombosis (clotting) with thrombocytopenia (low blood platelet count) following receipt of AstraZeneca COVID-19 vaccine.
• ATAGI recommends that the Pfizer (Comirnaty) COVID-19 vaccine by is preferred over the AstraZeneca COVID-19 vaccine in adults aged under 50 years. This recommendation is based on the increasing risk of severe outcomes from COVID-19 in older adults (and hence a higher benefit from vaccination) and a potentially increased risk of thrombosis with thrombocytopenia following the AstraZeneca COVID-19 vaccine in people aged under 50 years.
• The AstraZeneca COVID-19 vaccine can be used in adults aged under 50 years where the benefits are likely to outweigh the risks for that individual, and the person has made an informed decision based on an understanding of the risks and benefits.
• People who have had the first dose of the AstraZeneca COVID-19 vaccine without any serious adverse effects can be given the second dose, including adults under 50 years.

Further information from ATAGI is available at www.health.gov.au/news/atagi-statement-on-astrazeneca-vaccine-in-response-to-new-vaccine-safety-concerns

The updated ASCIA COVID-19 resources are avaialble as follows:

ASCIA Allergy, Immunodeficiency, Autoimmunity and COVID-19 Vaccination Frequently Asked Questions (FAQ)

www.allergy.org.au/patients/ascia-covid-19-vaccination-faq

ASCIA Allergy, Immunodeficiency, Autoimmunity and COVID-19 Vaccination Position Statement

www.allergy.org.au/hp/papers/ascia-hp-position-statement-covid-19-vaccination

ASCIA Guide: Immunodeficiency, Autoimmunity and COVID-19 Vaccination

www.allergy.org.au/hp/papers/guide-immunodeficiency-autoimmunity-and-covid-19-vaccination

ASCIA Guide: Allergy and COVID-19 Vaccination

www.allergy.org.au/hp/papers/guide-allergy-and-covid-19-vaccination

A new animation showing how to safely remove ticks by freezing, not squeezing, is now available on the ASCIA website www.allergy.org.au/patients/insect-allergy-bites-and-stings  

To prevent allergic reactions to ticks it is important that ticks are NOT forcibly removed or touched. Disturbing a tick may cause more allergen-containing saliva to be injected by the tick. 

Allergic reactions to ticks range from mild, with swelling and inflammation (at the site of a tick bite), to severe (anaphylaxis). Published studies show that the safest way to remove a tick is to:

• Freeze the tick, using a product that rapidly freezes and kills the tick, and allow it to drop off; OR
• Leave the tick in place and seek medical assistance to remove the tick.

Development of this animation was funded by the National Allergy Strategy (NAS) and is a collaboration between the National Allergy Strategy, ASCIA, Allergy & Anaphylaxis Australia (A&AA) and TiARA.  

Dupixent (dupilumab) is now listed on the Pharmaceutical Benefits Scheme (PBS) in Australia for the treatment of patients aged 12 years and older with:

• Uncontrolled severe asthma from 1st April 2021; and

• Severe atopic dermatitis who have failed to respond to optimally prescribed topical treatments from 1st March 2021.

Dupixent is a fully human monoclonal antibody that inhibits the signaling of the interleukin-4 (IL-4) and interleukin-13 (IL-13) pathways. IL-4 and IL-13 are key and central drivers of type 2 inflammation that plays a central role in allergic and eosinophilic asthma, as well as atopic dermatitis. Dupixent is not an immunosuppressant.

Dupixent is jointly developed by Sanofi and Regeneron under a global collaboration agreement.

Full Product Information is available from Sanofi-Aventis Australia Pty Ltd at www.guildlink.com.au/gc/ws/sw/pi.cfm?product=swpdupix or by contacting 1800 818 806.

Consumer Medicine Information (CMI) is available at www.guildlink.com.au/gc/ws/sw/cmi.cfm?product=swcdupix

Further information is available here:

Consumer Media Release Dupixent Asthma PBS Listing152.05 KB

Medical Media Release Dupixent Asthma PBS Listing149.21 KB

Dupixent® PBS listed for severe atopic dermatitis145.4 KB

The following two online events are being hosted by the peak professional bodies for allergy and immunology in Australia, New Zealand and Asia and registration is free.  

ASI-ASCIA COVID-19 Vaccine Safety Online Fireside Chat on Wednesday 31st March 2021, 6.30-7.30pm AEST with Dr Paul Turner, who leads the COVID-19 vaccine allergy surveillance unit in the UK and Prof Michaela Lucas, who is a clinician-scientist and ASCIA President. Register here 

APAAACI COVID-19: Allergies and Vaccines, Understanding the Facts and Myths on Monday 12th April 2021, 7-8pm (GMT+8, Singapore Standard Time). Register here

In the meantime information is available in the ASCIA ASCIA Allergy, Immunodeficiency, Autoimmunity and COVID-19 Vaccination FAQ www.allergy.org.au/patients/ascia-covid-19-vaccination-faq which includes the following key statements:

• Vaccination is an important way to reduce the risk of developing infectious diseases which can easily spread. This includes COVID-19, which is caused by infection with the SARS-CoV-2 coronavirus. Immunity occurs after the vaccine stimulates a person’s immune system to make antibodies (immunoglobulins) to help protect the body from future infections. This means that if a person is vaccinated, they will be less likely to get COVID-19. Even if a person does get infected, it is likely to be a milder illness.

• Public health measures and restrictions that were implemented by the Australian and New Zealand governments since March 2020 have been successful in controlling the spread of COVID-19 in our countries. However, the COVID-19 pandemic has been a major cause of illness and deaths in other countries. This means that vaccination programs are required throughout the world, including Australia and New Zealand.  

• COVID-19 vaccines approved for use in Australia and New Zealand are not live-attenuated vaccines and are safe for people with immune system disorders, including allergy, immunodeficiency or autoimmune conditions.

• Allergic reactions to COVID-19 vaccines are rare. However, if there is a high risk of an allergic reaction to one of the vaccines, it may be possible to have another vaccine, subject to availability and medical advice.

Allergy is a science based medical speciality which relies on the use of ‘evidence-based’ allergy tests and treatments. This means that there needs to be published evidence that a test or treatment is reliable, based on studies of other patients with similar conditions.

Accurate diagnosis of allergic disorders requires an examination of the patient’s clinical history by a qualified medical practitioner, to determine whether allergy or another immune condition is likely to be the cause of symptoms, combined with reliable evidence-based allergy tests to confirm the diagnosis. Evidence-based treatments can then be prescribed and management strategies advised, based on the diagnosis.

ASCIA strongly recommends against the online allergy testing and non evidence-based, unproven allergy ‘tests’ and “treatments”, which can result in adverse outcomes, including:

• Major dietary restrictions that can impair growth and cause malnutrition, particularly in young children.

• Impact on employment and social functioning, due to unnecessary avoidance of foods. environmental allergens and chemicals.

• Delayed access to more effective diagnostic tests and treatments, with lost productivity from inadequately controlled allergic disease.

ASCIA has developed the following information about Evidence-Based Versus Non Evidence-Based Allergy Tests and Treatments, to assist patients, consumers, carers and health professionals to choose evidence-based, proven allergy tests and treatments:

• ASCIA Frequently Asked Questions (FAQ) - Evidence-Based Versus Non Evidence-Based Tests and Treatments for Allergic Disorders (for patients, consumers and carers) 
  www.allergy.org.au/patients/allergy-testing/evidence-based-versus-non-evidence-based-tests-and-treatments

• ASCIA Position Paper - Evidence-Based Versus Non Evidence-Based Tests and Treatments for Allergic Disorders (for health professionals) 
  www.allergy.org.au/hp/papers/position-paper-evidence-based-versus-non-evidence-based-allergy-tests-and-treatments

• ASCIA Reference List - Evidence-Based Versus Non Evidence-Based Tests and Treatments for Allergic Disorders 
  www.allergy.org.au/hp/papers/refs-evidence-based-versus-non-evidence-based-allergy-tests-and-treatments

These documents replace the old ASCIA documents about “unorthodox” allergy tests and treatments. The word “unorthodox” has been retained in the documents to describe “unorthodox/alternative practitioners”, but tests and treatments are now referred to as “non-evidence-based” instead of “unorthodox”.

Further information about allergy testing is available on the ASCIA website:

• Patients, Carers and Consumers - www.allergy.org.au/patients/allergy-testing

• Health Professionals - www.allergy.org.au/hp/papers#p11