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3.4 Antihistamines, hyposensitisation and allergic emergencies

3.4 Antihistamines, hyposensitisation and allergic emergencies

3.4.1 Antihistamines

Of some value in treatment of nasal allergies, urticarial rashes, pruritus, insect bites and drug allergies.  Non-sedating preparations are usually longer acting. 

Non-sedating antihistamines 
Although drowsiness is rare, nevertheless patients should be advised that it can occur and may affect performance of skilled tasks (e.g. driving); excess alcohol should be avoided. 
 
Non-sedating antihistamines should be offered first line to all patients, especially children and adolescents.
GREEN       Cetirizine tablets 10mg [Consider OTC/Self care] 
                    Cetirizine oral solution 5mg/5mL [Consider OTC/Self care] 
GREEN       Fexofenadine tablets 120mg, 180mg  
GREEN       Loratadine tablets 10mg, syrup 5mg/5mL [Consider OTC/Self care] 
                    
Sedating antihistamines
GREEN       Chlorphenamine (chlorpheniramine) tablets 4mg,  syrup 2mg/5mL [Consider OTC/Self care] 
                    Chlorphenamine (chlorpheniramine) injection 10mg/mL
                       
GREEN       Hydroxyzine tablets 10mg, 25mg
                    
GREEN       Promethazine tablets 10mg, 25mg   [Consider OTC/Self care]                             
                   Promethazine  liquid 5mg/5mL
 

3.4.2 Allergen Immunotherapy

Treatment of severe persistent allergic asthma (NICE TAG278)  
 (recommended as an option by NICE in people aged 6 years and older)
RED           Omalizumab injection 150mg/mL 
 
For previously treated chronic spontaneous urticaria - recommended as an option by NICE TAG 339
RED           Omalizumab injection 150mg/mL
 

3.4.3 Allergic emergencies

In anaphylactic shock adrenaline 1 in 1000 should be give by intramuscular injection at the doses below.
NOTE:   1. When administering adrenaline in an emergency the Health Care Professional should base the dose on age.  
 
 
By intramuscular injection
Child under 6 years     150 micrograms (0.15 mL), repeated every 5 minutes if necessary
Child 6–12 years           300 micrograms (0.3 mL), repeated every 5 minutes if necessary
Child 12–18 years          500 micrograms (0.5 mL), repeated every 5 minutes if necessary      
Adult                               500 micrograms (0.5 mL), repeated every 5 minutes if necessary
 

GREEN       Adrenaline injection 1 in 1000, 1mL    

Adrenaline pre-filled syringes

When prescribing for a patient 'just in case' then the prescription should be based on weight.
 Any child over 30kg should be prescribed  the 300mcg strength pen
 
Note the expiry of Jext ® has been reduced by the manufacturers from 24 months to 18 months.
Jext® - [Note 18 month expiry]
GREEN       Adrenaline (epinephrine) (Jext®) single dose pre-loaded syringe   

                     150micrograms (body weight up to 15 Kg for self administration)                                                                                                       300micrograms (body weight 30Kg and above for self administration)                                                         

                   Jext Website - information for Patients includes the 'How to use' videos
                   Jext Patient Information Leaflet view here
                   The following link provide training materials for the Jext devices:
                   Jext® devices
                   Jext® 150 Training Video
                   Jext® 300 Training Video
 
Emerade®  
GREEN       Adrenaline (epinephrine) (Emerade®) single dose pre-loaded syringe  
                   500micrograms (for issue to patients at risk of severe anaphylaxis)  
                   300micrograms (body weight 30Kg and above for self administration) 
                   150micrograms (body weight up to 15 Kg for self administration)  
                   See latest MHRA Emerade® recall information here 
 
Epipen® -  18th month expiry      
GREEN      Adrenaline (epinephrine) (EpiPen Auto-injector®) single dose pre-loaded syringe   

                   150micrograms, 300micrograms [for issue to patients at risk of anaphylaxis]                                                                                

                   EpiPen Website - information for Patients
                   EpiPen Patient information Leaflet - view here
                  The following links provide training materials for the Epipen devices: 
                  EpiPen® devices
                  EpiPen® 0.15mg
                  EpiPen® 0.3mg
 
 All material in this section is aimed at health care professionals, but is information currently held in the public domain, members of the 
 public seeking advice on medicine-related matters are advised to speak with their GP, pharmacist, nurse or contact NHS111 Service.
 Email: info.elmmb@nhs.net
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