Information updates

ASCIA welcomes the speech that was delivered today in the Australian Parliament House by Dr Katie Allen MP, in support of government investment into allergy and anaphylaxis, by creating a new National Allergy Council (NAC) and a new National Allergy Centre of Excellence (NACE).

Implementing these recommendations from the Report on the Parliamentary Inquiry into Allergies and Anaphylaxis ‘Walking the allergy tightrope - Addressing the rise of allergies and anaphylaxis in Australia’ will result in significant improvements to the health of more than 5 million Australians with allergic disease, their families and the community, with immediate and long term impact. 

The new NAC and NACE would enable continued expansion of the National Allergy Strategy, a partnership between the Australasian Society of Clinical Immunology and Allergy (ASCIA) and Allergy & Anaphylaxis Australia (A&AA), and expansion of the Centre for Food & Allergy Research (CFAR). 

The Parliamentary Inquiry Report was tabled on Monday 15 June 2020 in the Parliament of the Commonwealth of Australia.  

Walking the allergy tightrope - Allergies and Anaphylaxis Report

ASCIA welcomed the recommendations in the Report and the recognition of ASCIA’s pivotal and leading role in improving the care of Australians with allergic disease. ASCIA has thanked the Minister for Health, Hon Greg Hunt MP, the Committee Chair, Trent Zimmerman MP, Deputy Chair, Dr Mike Freelander MP, panel members including Dr Katie Allen MP, and the committee Secretariat for their excellent work in initiating and conducting the Parliamentary Inquiry.  

Stallergenes Greer, a biopharmaceutical company specializing in treatments for respiratory allergies has announced that it has received approval in Australia for a new indication for ACTAIR®, a 300 IR sublingual allergen immunotherapy (SLIT) tablet for the treatment of house dust mite allergic rhinitis, for patients aged 5 years and over.

This new approval by the TGA extends an existing indication for use of ACTAIR® in patients aged 12 years and over in Australia, which was approved in April 2016. 

ACTAIR® is now the first and only house dust mite SLIT treatment approved for use in Australia for paediatric patients under the age of 12 years.

ORALAIR®, a 300 IR SLIT tablet for the treatment of grass pollen allergic rhinitis, is already approved in Australia and New Zealand for patients under the age of 12 years.

Approval of ACTAIR® for patients under the age of 12 was supported by data from a multi-centre, randomized, double-blind, placebo-controlled study, which evaluated the efficacy of ACTAIR® at a daily maintenance dose of 300 IR administered for 12 months to children between 5 and 16 years old with house dust mite-associated allergic rhinitis. A total of 438 patients were randomized to receive 12 months of treatment with ACTAIR® or placebo. The active group demonstrated a statistically significant difference (p=0.0005) versus placebo on the Average Adjusted Symptom Score after 12 months of treatment, achieving the primary efficacy endpoint. An onset of action vs placebo was demonstrated as early as 2 months. Local adverse reactions were observed, with most of them mild in nature. The safety profile of ACTAIR® in this paediatric population was consistent with that of adults, with no new safety concerns.

ASCIA Allergy, Immunodeficiency, Autoimmunity and COVID-19 Vaccination Frequently Asked Questions (FAQ) has been updated to include approval of a new vaccine (Novavax) in Australia and updated advice from the Australian Technical Advisory Group on Immunisation (ATAGI) regarding co-administration of influenza vaccines:

• Novavax/Biocelect Nuvaxovid spike protein based COVID-19 vaccine was approved in Australia in January 2022, for adults 18 years and over. It is expected to be available from late February 2022.

• ATAGI now recommends that influenza vaccines can be co-administered with COVID-19 vaccines. Subject to availability of influenza vaccines, an ideal time to vaccinate could be on the same day as a COVID-19 booster vaccine. This updated advice was issued by ATAGI in December 2021, to coincide with borders reopening and greater population movement and an expected resurgence of influenza activity in 2022, outside of the usual influenza season. 

  Previously the preferred minimum interval between a dose of seasonal flu vaccine and a dose of a COVID-19 vaccine was seven days. This was to avoid confusion about the cause of side effects or allergic reactions, if they occur in response to the COVID-19 vaccine or the influenza vaccine. 

Futher information:

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

https://www.health.gov.au/news/atagi-statement-on-the-use-of-novavax-covid-19-vaccine-nuvaxovid

https://www.health.gov.au/news/updated-atagi-advice-on-the-administration-of-seasonal-influenza-vaccines-in-2021-december-2021 

This news item was issued on 9 February 2022 by the Australasian Society of Clinical Immunology and Allergy (ASCIA), the peak professional body for clinical immunology and allergy in Australia and New Zealand.

With widespread cases of COVID-19 in Australia and New Zealand, treating allergic rhinitis (hay fever) and/or asthma regularly and correctly is important for the following reasons:

• To avoid hay fever and/or asthma symptoms being mistaken for symptoms due to respiratory infections, including COVID-19. 

• To maintain good health by ensuring that hay fever and/or asthma are well controlled, using nasal sprays, inhalers and other medications as prescribed and directed by the treating doctor.  

• To reduce coughing and sneezing, which can spread respiratory infections (such as COVID-19, colds and influenza).

If a person's hay fever and/or asthma symptoms occur, despite treatments being used regularly and correctly, and their most recent COVID-19 rapid antigen test result is negative (based on testing at least 1-2 times each week, in regions where tests are readily available), they should:

• Be allowed to attend their school, early children's education/care centre, other institution or workplace; and 

• See their doctor as soon as possible to check if their hay fever and/or asthma treatments need to be modified. 

Further information:

www.allergy.org.au/patients/allergic-rhinitis-hay-fever-and-sinusitis

www.allergy.org.au/members/covid-19

AbbVie announced on 22 January 2022 that RINVOQ® (upadacitinib), a Janus Kinase 1 (JAK1) inhibitor, has been listed on the Pharmaceutical Benefits Scheme (PBS) for Australian patients living with severe atopic dermatitis (eczema), which can affect their whole body, face or hands.

Atopic dermatitis is a chronic inflammatory skin condition caused by an overactive immune system and is one of the most common and severe forms of eczema. Approximately 1.6 million Australians are thought to be living with atopic dermatitis, with around one in five of these suffering from a moderate to severe form of the condition.

Atopic dermatitis has a significant impact on quality of life.  As there is no cure for atopic dermatitis, the main goals in managing the disease are to reduce itch, minimise rash, and limit the impact on quality of life. Access to targeted therapies such as RINVOQ® (upadacitinib) provides additional treatment options to help alleviate the burden of this chronic condition. 

More information: 

www.abbvie.com.au/media/rinvoq-eczema-atop-derm-pbs-listed.html

www.pbs.gov.au

www.allergy.org.au/patients/skin-allergy

www.allergy.org.au/about-ascia/info-updates/pbs-listing-of-dupixent-dupilumab-for-severe-atopic-dermatitis

The ASCIA Hereditary Angioedema (HAE) Position Paper and Management Plan have been updated and are now available on the ASCIA website: www.allergy.org.au/hp/papers/hereditary-angioedema

The urgent updating of these documents is due to Takhzyro® (lanadelumab) being PBS listed for HAE from 1^st December 2021.

We have also taken this opportunity to make other product related changes, including:

• Removal of the product name ‘Firazyr’ as the current product is generic ‘Icatibant’.
• A statement regarding Danazol (Azol) being discontinued in January 2020 in Australia.
• Replacing the Berinert® order form with an updated version on page 25.  
• Updating of the ASCIA HAE Management Plan on page 23 to include Takhzyro® (lanadelumab) and remove the product name ‘Firazyr’.

A new ASCIA HAE Frequently Asked Questions (FAQ) for patients, consumers and carers has been developed in October 2021 and is available on the ASCIA website www.allergy.org.au/patients/immunodeficiencies/hae

This news item was issued on 13 January 2022 by ASCIA, the peak professional body for clinical immunology and allergy in Australia and New Zealand.

ASCIA Adrenaline (Epinephrine) Injector Prescribing Guidelines and Frequently Asked Questions (FAQ) have been updated, and are now available on the ASCIA website:

Adrenaline Injectors FAQ Updated Februry 2022

ASCIA Guidelines - Adrenaline (Epinephrine) Injector Prescription Updated February 2022

ASCIA Guidelines Summary - Adrenaline (Epinephrine) Injector Prescription New February 2022 

The main updates include links to several publications (see below) that support ASCIA adrenaline injector dose recommendations for EpiPen^® and Anapen^® and the use of a 500 microgram device (Anapen^® 500), which:

• Provides doctors with  choice of dose for doctors, as some may prefer to prescribe a higher dose (500 microgram device) for people over 50kg.
• May potentially reduce the need for further doses of adrenaline in older adolescents and adults weighing over 50kg. 

The Guidelines and FAQ also include other reasons why it is important to have more than one brand of adrenaline injector available.

Publications 

ASCIA adrenaline injector dose recommendations are based on expert consensus and standard practice by ASCIA members, which vary to the product information. These doses are consistent with the Acute Anaphylaxis Clinical Care Standard for Australia, Australian Prescriber Anaphylaxis wallchart, Australian Immunisation Handbook and international recommendations from the World Allergy Organisation (WAO), Canada and the UK.

https://www.safetyandquality.gov.au/standards/clinical-care-standards/acute-anaphylaxis-clinical-care-standard

https://www.nps.org.au/australian-prescriber/articles/anaphylaxis-emergency-management-for-health-professionals

https://immunisationhandbook.health.gov.au/resources/handbook-tables/doses-of-intramuscular-11000-adrenaline-for-anaphylaxis 

https://www.worldallergyorganizationjournal.org/article/S1939-4551(20)30375-6/fulltext

https://www.resuscitationjournal.com/article/S0300-9572(21)00150-7/fulltext

https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-2-vaccine-safety/page-4-early-vaccine-reactions-including-anaphylaxis.html#shr-pg0

https://onlinelibrary.wiley.com/doi/full/10.1111/cea.14055

Other changes in the ASCIA Adrenaline Injectors FAQ are as follows:

• Some of the FAQs have been reordered and expanded, to address the most common questions that we have received, including FAQs 1 and 2.
• FAQ 8 includes ‘Students and children may be prescribed EpiPen^® or Anapen^® devices, and schools and CEC services need to accept both devices. Therefore, staff in schools and CEC services should be trained on both device brands.’
• FAQs 9 and 10 clarify that there are three steps to give EpiPen^® and four steps to give Anapen^®.
• FAQ 13 includes ‘There is no evidence that injecting the second dose of adrenaline into the same thigh is a problem. The most important thing is to give another dose of adrenaline (after 5 minutes) if symptoms persist, and phone an ambulance.’

Other changes in the ASCIA Adrenaline Injector Prescription Guidelines are as follows:

• Addition of ‘These guidelines should be used in conjunction with clinical judgement, with consideration of issues that include training on a new device and preference of device from the patient or their carer.’
• Inclusion of ‘It is important to specify brand and tick box on PBS prescription to ensure that brand is not substituted’ on the first and last page and ‘Ensure correct ASCIA Action Plan is provided for the brand of prescribed device’.
• A reordering of the dose recommendations to be on page 2, in a more prominent location than in the previous version.
• Colour coding of the prescription guide recommendations to make them easier to follow.
• Replacement of the definitions with a link to clinical definitions in the ASCIA Guidelines for Acute Management of Anaphylaxis.

This news item was issued on 13 January 2022 and updated on 28 February 2022 by ASCIA, the peak professional body for clinical immunology and allergy in Australia and New Zealand.

From 10 January 2022 in Australia, and from 17 January 2022 in New Zealand, all children from five years of age are eligible for COVID-19 vaccination. The approval of mRNA COVID-19 vaccines in children aged from 5 to 16 years has been made following careful evaluation of the available data supporting safety and efficacy.

COVID-19 vaccines available in Australia and New Zealand are safe for people with allergies, including children:

• There is no evidence that people with allergic conditions such as asthma, hay fever (allergic rhinitis), food allergy or insect sting allergy are at any greater risk of vaccine allergy compared to the general population.
• Unlike some other vaccines, there is no food, gelatin or latex in the COVID-19 vaccines that are currently available, and they are not grown in eggs.
• If a person has had an allergic reaction to another vaccine, this does not mean that they will also be allergic to the COVID-19 vaccine.

Further information is available at https://www.allergy.org.au/patients/ascia-covid-19-vaccination-faq 

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) and COVID-19 specific T cells, 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.

This news item was issued on 12 January 2022 by the Australasian Society of Clinical Immunology and Allergy (ASCIA), the peak professional body for clinical immunology and allergy in Australia and New Zealand.