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

Promethazine is RED traffic light for use in insomnia/sleep disorders see section 4.1

AMBER Alimemazine 7.5mg/5mL SF oral solution [Second line use after promethazine when initiated by tertiary centre for

indications that include insomnia/sedation]. Use restricted to paediatrics only.

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

Hereditary Angioedema

RED Lanadelumab [Takhzyro] NHS England Commissioned

NICE TA606 Lanadelumab is recommended as an option for preventing recurrent attacks of hereditary angioedema in people

aged 12 and older, only if:

> they are eligible for preventive C1-esterase inhibitor (C1-INH) treatment in line with NHS England's

commissioning policy, that is, they are having 2 or more clinically significant attacks (as defined in the

policy) per week over 8 weeks despite oral preventive therapy, or oral therapy is contraindicated or not tolerated

> the lowest dosing frequency of lanadelumab is used in line with the summary of product characteristics, that is,

when the condition is in a stable, attack-free phase (see section 2) and

> the company provides lanadelumab according to the commercial arrangement.

RED Berotralstat [Orladeyo] NHS England Commissioned

NICE TA738 Berotralstat is recommended as an option for preventing recurrent attacks of hereditary angioedema in people

12 years and older, only if:

> they have at least 2 attacks per month, and

> it is stopped if the number of attacks per month does not reduce by at least 50% after 3 months.

It is only recommended if the company provides berotralstat according to the commercial arrangement.

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

For information: Managing patients at risk of anaphylactic reactions

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®

Adrenaline (epinephrine) (EpiPen Auto-injector®) single dose pre-loaded syringe [for issue to patients at risk of anaphylaxis]

GREEN Epipen150micrograms, [19 month expiry see SPC]

Epipen 300micrograms [24 month expiry - see SPC]

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