Information updates

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

The following two new ASCIA COVID-19 Vaccination FAQs have been added to www.allergy.org.au/patients/ascia-covid-19-vaccination-faq, in response to questions about the Pfizer and AstraZeneca COVID-19 vaccines.

FAQ 3: Does mRNA which is used in the Pfizer vaccine integrate into our own DNA? 

No. The mRNA (messenger ribonucleic acid) in the Pfizer COVID-19 vaccine is only taken up in the body of our cells, known as the cytoplasm, and is then quickly destroyed. The mRNA is not taken up in the nucleus of our cells, which contains our DNA (deoxyribonucleic acid). The mRNA is coded to instruct our cells to produce the non-infectious SARS-CoV-2 coronavirus spike protein, which triggers an immune response to the spike protein, ready to protect you if you encounter the SARS-CoV-2 coronavirus. 

FAQ 4: Will we become infected with the chimpanzee adenovirus that is used in the AstraZeneca vaccine?

No. The adenovirus in the AstraZeneca COVID-19 vaccine is the vehicle (like a taxi or uber) that carries the genetic material of the non-infectious SARS-CoV-2 coronavirus spike protein into the body of our cells, known as the cytoplasm. This causes our cells to produce the spike protein, which triggers an immune response to the spike protein, ready to protect you if you encounter the SARS-CoV-2 coronavirus. The adenovirus cannot reproduce in humans and is destroyed.

Another recent addition to the ASCIA COVID-19 FAQ (17) and Position Statement is the addition a link to the following publication: 

COVID-19 vaccination decision guide for women who are pregnant, breastfeeding, or planning pregnancy has been developed by the Australian Government and is available at https://www.health.gov.au/resources/publications/covid-19-vaccination-covid-19-vaccination-decision-guide-for-women-who-are-pregnant-breastfeeding-or-planning-pregnancy

The following information is unchanged, but has been highlighted in bold in the FAQ (2) and Position Statement:

This is in response to recent media reports about a very small number of possible allergic reactions to COVID-19 vaccines, which may have caused unwarranted alarm for some people:

COVID-19 vaccines approved and available 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.  

As stated in the ASCIA Position statement about Allergy and COVID-19, vaccinations in the community should have a post-vaccination observation period of 15 minutes.  A post-vaccination observation period of 30 minutes should only be required in people who have: 

• Immediate (within four hours) and generalised symptoms of a possible allergic reaction without anaphylaxis to a previous dose of a COVID-19 vaccine.
• Generalised allergic reaction (without anaphylaxis) to one of the ingredients in the COVID-19 vaccine to be administered (Pfizer-PEG or AstraZeneca-Polysorbate 80).
• Prior history of anaphylaxis to previous vaccines and/or multiple drugs (injectable and/or oral) where ingredients such as PEG or polysorbate 80 may conceivably be the cause.
• A known systemic mast cell activation disorder with raised mast cell tryptase, that requires treatment.

Further information

ASCA Frequently Asked Questions (FAQ) COVID-19 Vaccination (patients, consumers, carers) www.allergy.org.au/patients/ascia-covid-19-vaccination-faq

ASCA Position Statement COVID-19 Vaccination (health professionals)www.allergy.org.au/hp/papers/ascia-hp-position-statement-covid-19-vaccination

ASCIA Guide Allergy and COVID-19 Vaccination (health professionals)www.allergy.org.au/hp/papers/guide-allergy-and-covid-19-vaccination

ASCIA Guide Immunodeficiency, Autoimmunity and COVID-19 Vaccination (health professionals) www.allergy.org.au/hp/papers/guide-immunodeficiency-autoimmunity-and-covid-19-vaccination

ASCIA COVID-19 webpage www.allergy.org.au/members/covid-19  

8 March 2021: 

On International Women's Day we celebrate ASCIA's female leadership and members.

Pictured left to right: ASCIA Past Presidents Prof Connie Katelaris AM, Prof Jo Douglass and Dr Melanie Wong (now Chair of the Allergy and Immunology Foundation of Australasia) with current ASCIA President Prof Michaela Lucas.

More than 60% of ASCIA's members are women, who are professionals working to improve health outcomes for people with allergy and other immune diseases across Australia and New Zealand. Our members include clinical immunology/allergy specialists, immunology/allergy trainees, other medical practitioners, pharmacists, nurses, dietitians and  scientists. 

The ASCIA team manage the ASCIA Conference and develops world-leading online educational resources under the leadership of our CEO Jill Smith. We work together with ASCIA committees and working parties, as well as our webmasters (Impagination), conference organisers (ICMSA) and graphic designer (Rachael Hopkins).

www.allergy.org.au/about-ascia

www.allergy.org.au/members/committees 

We are also proud of the National Allergy Strategy partnership with Allergy & Anaphylaxis Australia (A&AA). Dr Preeti Joshi represents ASCIA as co-chair of this initiative.  https://nationalallergystrategy.org.au

Anapen 300®, Anapen 500® and Anapen 150 Junior® (Anapen Junior) adrenaline (epinephrine) autoinjectors have been approved by the Therapeutic Goods Administration (TGA) for the treatment of anaphylaxis (severe allergic reactions). 

The Pharmaceutical Benefits Advisory Committee (PBAC) has recommended the General Schedule Authority Required Pharmaceutical Benefits Scheme (PBS) listing of Anapen 300®, Anapen 500® and Anapen 150 Junior®. The Public Summary Documents from the November 2020 PBAC meeting are now available.

It is expected that Anapen 300®, Anapen 500® and Anapen 150 Junior® will be available in Australia on the PBS in September 2021. 

In preparation for the updating of ASCIA resources and e-training courses by July 2021, ASCIA has developed:

• ASCIA Action Plan for Anaphylaxis - Anapen version www.allergy.org.au/hp/anaphylaxis/ascia-action-plan-for-anaphylaxis
• How to give Anapen www.allergy.org.au/hp/anaphylaxis#aj2