Information updates

ATAGI COVID-19 Vaccine Recommendations - December 2023

Monovalent COVID-19 Omicron XBB.1.5 vaccines are now available in Australia, following the Therapeutic Goods Administration of Australia (TGA) approval of the following XBB 1.5 vaccines for use as primary and additional doses:

Pfizer monovalent Omicron XBB.1.5 vaccine 5 - <12 years formulation (light blue cap)
Pfizer monovalent Omicron XBB.1.5 vaccine ≥12 years formulation (dark grey cap)
Moderna monovalent Omicron XBB.1.5 vaccine, registered for use in people aged 12 years and older.

The Australian Technical Advisory Group on Immunisation (ATAGI) advises the following:

All currently available COVID-19 vaccines are anticipated to provide benefit to eligible people, however the monovalent Omicron XBB.1.5 vaccines are preferred over other vaccines for use in children aged 5 years or older and adults who are currently recommended primary or additional doses of COVID-19 vaccine according to the Australian Immunisation Handbook
For those who have had the recommended 2023 dose/s of COVID-19 vaccine, ATAGI is not recommending further doses or re-vaccination with an XBB.1.5-containing vaccine at this time
ATAGI notes the recent increase in COVID-19 cases across Australia since November 2023. ATAGI encourages all people who have not yet had their recommended 2023 dose/s to receive them as soon as possible (see table below).

There are no monovalent XBB.1.5-containing vaccines registered for use in children aged 6 months to 4 years. Currently, Pfizer original (maroon cap) is the only formulation available for use in this age group. Providers can refer to the Australian Immunisation Handbook to check which vaccines are recommended by age group.

ATAGI updated the recommendations for doses of COVID-19 in February and September 2023. These recommendations have not changed at this time. As published in the September statement, the current recommendations for further doses are summarised below:

Table: Current recommendations for further COVID-19 vaccine doses (unchanged from September 2023)

first 2023 dose (February 2023 guidance)*

second 2023 dose (September 2023 guidance)*

Age

At risk^#

No risk factors

At risk^#

No risk factors

<5 years

Not recommended

5-17 years

Consider

Not recommended

18-64 years

Recommended

Consider

Consider if severe immunocompromise^{^}

Not recommended

65-74 years

Recommended

Consider

≥ 75 years

Recommended

*XBB.1.5-containing vaccine preferred for all doses. For eligible children aged 6 months to 4 years, use Pfizer Original 6 month - <5 year formulation (maroon cap) as the only available formulation for this age group. Timing: 2023 vaccine doses should be given from 6 months after a person’s last dose and can be given in early 2024, pending updated advice from ATAGI.
^#Includes those with a medical condition that increases the risk of severe COVID-19 illness (refer to the Australian Immunisation Handbook) or those with disability with significant or complex health needs or multiple comorbidities which increase the risk of poor outcomes from COVID-19.
^{^} For details, refer to the ATAGI recommendations on the use of a third primary dose of COVID-19 vaccine in individuals who are severely immunocompromised.

Further information is available at https://www.health.gov.au/news/atagi-recommendations-on-use-of-the-moderna-and-pfizer-monovalent-omicron-xbb15-covid-19-vaccines

ASCIA Update – Shared Care Project - November 2023

ASCIA’s involvement in the National Allergy Council Shared Care project includes:

Advocacy to increase access to care, including food and drug challenges, to improve diagnosis and management of allergic conditions.
Education, training and mentorship of health professionals, to improve knowledge and experience in managing allergic conditions.

Current areas of focus for ASCIA are:

ASCIA workforce surveys for Full and Associate Medical ASCIA members will be conducted from mid December 2023 to February 2024. The data from these surveys will be used to advocate for improved access to allergy/immunology education, training and services, include in ASCIA submissions for MBS item numbers for food and drug challenges, and identify regions with significant waiting times for patient appointments.

An ASCIA education and training survey https://www.allergy.org.au/hp is currently being conducting that is directed towards institutions and results will be used to make recommendations about what anaphylaxis and training should be included in health professional courses and ways to deliver the training.

ASCIA e-training courses for health professionals https://etraininghp.ascia.org.au/ continue to be well utilised, and reports from mandated 2023 feedback surveys will guide course updates in 2024. A report from 2022 surveys has already been developed and is available at https://www.allergy.org.au/ascia-reports

ASCIA website resources https://www.allergy.org.au/ are highly utilised by health professionals, patients and carers, attracting more than 3 million pageviews and 2 million visits from 1.5 million users (unique visitors) each year. ASCIA is constantly updating its website and online resources, to improve content, access and the user experience, and this will be a major focus in 2024.

ASCIA communications include monthly e-newsletters https://www.allergy.org.au/about-ascia/updates/archive/listing, regular website information updates https://www.allergy.org.au/about-ascia/info-updates and social media posts based on the newsletter content. In 2024 ASCIA will be developing a communications plan to increase the reach of its communications to health professionals.

ASCIA online meetings https://www.allergy.org.au/conferences/online-meetings have expanded in 2023, and will continue to expand in 2024, to improve case based learning, which has the potential to be expanded for other health professionals.

The ASCIA Food Allergy and Adverse Food Reactions Courses for Dietitians https://www.allergy.org.au/members/dietitians has been held twice in 2023, in March (Melbourne) and November (Sydney). The next course is scheduled for May 2024 in Adelaide, South Australia.

The ASCIA 2023 Conference https://www.allergy.org.au/conferences/ascia-annual-conference was held in early September in Sydney, and included significantly more content that is targeted to improve knowledge in managing allergic disease for a range of health professionals. The ASCIA 2024 Conference will continue to include more sessions for a range of health professionals.

ASCIA members and staff also participated in the National Allergy Council Shared Care meetings on Friday 10 November 2023 and Saturday 11 November 2023 in Sydney.

The previous ASCIA Update for the Shared Care project is available at https://www.allergy.org.au/about-ascia/info-updates/ascia-progress-report-nac-shared-care-for-allergy-project

Changes to PBS Criteria - Jorveza EoE treatment - November 2023

Jorveza® (budesonide) is an orally disintegrating tablet for the treatment of eosinophilic oesophagitis (EoE) in adults, that was first listed on the Pharmaceutical Benefits Scheme (PBS) on 1 May 2022. Several changes have been made to PBS prescribing criteria (from 1 November 2023) that should enable easier access to Jorveza for all patients with EoE, particularly those being treated in the public health system, but also in regional or remote areas where access to a Gastroenterologist may be limited. These changes have now been recommended by the Pharmaceutical Benefits Advisory Committee (PBAC) and implemented by PBS, with prescribing criteria changes to be implemented on 1 November 2023.

ASCIA made a submission in January 2023 to support the main changes requested:

For ‘other specialists experienced in the management of EoE’ to be able to prescribe Jorveza (whilst respecting the need for histological confirmation of the condition prior to initiating treatment - through endoscopic tissue sample collection and analysis.
The requirement for re-examination by endoscopy at 8 -10 weeks to confirm remission was considered too rigid (particularly within the public health system) meaning that some patients were unable to access treatment simply due to these scheduling of endoscopy limitations.

In summary these changes affect three treatment ‘phases’ as listed below. The new ‘First Continuing Treatment’ phase allows patients to stay on treatment (if it is providing a benefit) whilst waiting for the 2^nd histology for confirmation of remission, and should ensure doctors feel confident to commence treatment without being concerned by when they can schedule the 2^nd endoscopy.

Treatment Phase 1: Initial treatment - Induction of remission

Clinical criteria:

Patient must have a history of symptoms of oesophageal dysfunction,

AND

Patient must have eosinophilic infiltration of the oesophagus, demonstrated by oesophageal biopsy specimens obtained by endoscopy confirming the presence of at least 15 eosinophils in at least one high power field (hpf); corresponding to approximately 60 eosinophils per mm² hpf,

AND

Patient must not receive more than 90 days of treatment under this restriction.

Treatment criteria:

Must be treated by a prescriber who is either: (i) gastroenterologist, (ii) surgeon experienced in the management of patients with eosinophilic oesophagitis, (iii) physician experienced in the management of patients with eosinophilic oesophagitis

**NEW** Treatment Phase 2: First continuing treatment - until remission is confirmed

Clinical criteria:

Patient must have previously received PBS-subsidised initial treatment with this drug for this condition,

AND

Patient must have demonstrated an adequate response to treatment with this drug for this condition,

AND

Patient must not receive more than 36 weeks of treatment under this restriction.

Treatment criteria:

Treatment Phase 3: Subsequent continuing treatment - Maintenance of remission

Clinical criteria:

Patient must have previously received PBS-subsidised treatment with this drug for this condition under the First continuing treatment restriction,

AND

Patient must have documented evidence of having achieved histologic remission while receiving Initial and First continuing PBS-subsidised treatment with this drug for this condition, defined as a peak eosinophil count of less than 5 eosinophils per high power field (hpf), corresponding to less than 16 eosinophils per mm² hpf on oesophageal biopsy,

AND

The condition must not have progressed while being treated with this drug.

Treatment criteria:

These changes should provide benefits to patients with EoE by improving ease of access to Jorveza as the only TGA registered and PBS reimbursed treatment for EoE.

ASCIA Food Allergy and Adverse Food Reactions Course for Dietitians in Sydney 23rd-24th November 2023

Thank you to the the faculty and delegates who participated in the ASCIA Food Allergy and Adverse Food Reactions Course in Sydney, in Sydney 23rd-24th November 2023

The next course is scheduled for early May 2024 in Adelaide, South Australia.

For information about this course go to https://www.allergy.org.au/members/dietitians

Undergraduate Allergy Training for Health Professionals Survey - Closing date 17 February 2024

People who are involved in the development and/or delivery of tertiary healthcare degrees in Australia are invited to complete a survey about allergy training. ASCIA is conducting this survey as part of the National Allergy Council Shared Care for Allergy Project.

The survey is available here from 17 October to 17 February 2024 and will take approximately 10 minutes to complete.

The purpose of this survey is to:

Find out what allergy training is currently being provided in tertiary healthcare degrees.
Collect information to make recommendations to government about including evidence-based, best-practice allergy education as part of education and training for all relevant health professionals entering the workforce in Australia.

Why is collecting this information important?

Allergy is a significant public health issue with over 4 million Australians living with allergies.
We currently do not know what allergy training is being provided to students undertaking tertiary study in healthcare.
Your feedback will help ASCIA to improve allergy training in tertiary degrees for future health professionals by standardising training for undergraduate health professionals, which will improve how people with allergic disease are managed in the community.

Participation in the survey is voluntary and your responses will be securely stored by Qualtrics and only accessed by approved employees of ASCIA. Any identifiable information received will not be stored with your responses. If you have any questions about the survey, please contact Emily Mamo (ASCIA Senior Project Officer) at This email address is being protected from spambots. You need JavaScript enabled to view it.

ACECQA approved ASCIA anaphylaxis e-training for children's education and care services - October 2023

ASCIA anaphylaxis e-training for children's education and care services has been approved by the Australian Children's Education and Care Quality Authority (ACECQA) until October 2026.

The ASCIA course is now published on ACECQA’s approved anaphylaxis management course list https://www.acecqa.gov.au/qualifications/nqf-approved (Section 3. Search the NQF approved qualifications list - under general search enter "ASCIA October 2026"):

Anaphylaxis Management only	Australasian Society of Clinical Immunology and Allergy (ASCIA)	ASCIA Anaphylaxis Training for Children's Education/Care	Any date before October 2026	National	Australia	ACECQA assessed and approved this qualification on 6 October 2023.

ACECQA is an independent statutory authority that assists governments in implementing the National Quality Framework for early childhood education and care throughout Australia. The content of the previous version of the ASCIA course was ACECQA approved until the end of September 2023.

ASCIA anaphylaxis e-training for children's education and care services will remain on ACECQA’s approved list until the end of September 2026 unless it undergoes significant changes.

Feedback reports on ASCIA anaphylaxis e-training courses are available at https://www.allergy.org.au/ascia-reports

AusPollen partnership impact case study published by NHMRC - September 2023

An Impact Case Study on the AusPollen Partnership and associated research projects has recently been published by the NHMRC, the peak national body supporting health and medical research in Australia. Read more here

The AusPollen partnership is an important research collaboration for ASCIA and was one of the first research projects supported by an AIFA research grant in 2014, when AIFA was first established. Since then, a total of 27 projects have been awarded AIFA research grants. Read more here

New ASCIA Management Plan for Delayed Allergic Reactions to Foods - September 2023

A new ASCIA Management Plan for Delayed Allergic Reactions to Foods has been developed by the ASCIA Dietitians committee, in response to requests from children's education/care services. This plan is to be used for delayed non-IgE mediated allergic reactions to foods:

Food Protein Induced Allergic Proctocolitis (FPIAP) - a delayed non-IgE mediated food allergy, associated with blood and mucus in stool, and diarrhoea in an otherwise thriving infant.
Food Protein Enterocolitis (FPE) - a delayed non-IgE mediated food allergy associated with diarrhoea, abdominal pain, vomiting, and sometimes faltering growth.

The plan is available on the ASCIA website https://www.allergy.org.au/patients/food-other-adverse-reactions/delayed-reactions-management-plan

ASCIA resources are living documents, and feedback on this plan is welcome, which will inform future updates.

The format of ASCIA Plans for Food Protein-Induced Enterocolitis Syndrome (FPIES) and Eosinophilic Oesophagitis (EoE) has been updated to be consistent with other ASCIA Plans, but the content is unchanged.

To access these plans go to https://www.allergy.org.au/patients/food-other-adverse-reactions