Grass pollen extract

Grazax

• Oral lyophilisates sugar free 75,000units SQ-T (£80.12)

Indications

• Seasonal allergic hay fever due to grass or tree pollen in patients who have failed to respond to anti-allergy drugs

Dose

• Adult and child over 5 years, 1 tablet daily; start treatment at least 4 months before start of pollen season

Notes

1. Treatment with Grazax will not be continued longer than 3 years.
2. Consultant initiated.

Bee and wasp allergen extracts

Pharmalgen

• Bee venom extract
• Wasp venom extract

Notes

1. NICE TA246: Pharmalgen is recommended as an option for the treatment of IgE-mediated bee and wasp venom allergy (February 2012) in people who have had:
   1. a severe systemic reaction to bee or wasp venom OR
   2. a moderate systemic reaction to bee or wasp venom and who have one or more of the following: a raised baseline serum tryptase, a high risk of future stings or anxiety about future stings.

Peanut allergy

Palforzia

• Oral powder in capsules for opening 0.5mg, 1mg, 10mg, 20mg, 100mg
• Oral powder in sachet 300mg

Notes

1. NICE TA769: Palforzia is recommended, within its marketing authorisation, as an option for treating peanut allergy in children aged 4 to 17 (February 2022)
   1. It can be continued in people who turn 18 while on treatment
   2. Palforzia should be used with a peanut-avoidant diet.
2. Each capsule/sachet contains peanut protein as defatted powder of Arachis hypogaea L., semen (peanuts).

Benralizumab

Benralizumab

• Solution for injection in pre-filled syringes 30mg/1ml

Notes

1. NICE TA565: Benralizumab (Fasenra), as an add-on therapy, is recommended as an option for treating severe eosinophilic asthma that is inadequately controlled in adults despite maintenance therapy with high-dose inhaled corticosteroids and long-acting beta-agonists (March 2019), only if:
   1. the person has agreed to and followed the optimised standard treatment plan AND
   2. the blood eosinophil count has been recorded as 300 cells per microlitre or more and the person has had 4 or more exacerbations needing systemic corticosteroids in the previous 12 months, or has had continuous oral corticosteroids of at least the equivalent of prednisolone 5mg per day over the previous 6 months (that is, the person is eligible for mepolizumab) OR
   3. the blood eosinophil count has been recorded as 400 cells per microlitre or more with 3 or more exacerbations needing systemic corticosteroids in the past 12 months (that is, the person is eligible for rezlizumab) AND
   4. the company provides it according to the commercial arrangement.
2. If benralizumab, mepolizumab or reslizumab are equally suitable, start treatment with the least expensive option (taking into account drug and administration costs).

Mepolizumab

Mepolizumab

• Powder for solution for injection vial 100mg

Notes

1. NICE TA671: Mepolizumab (Nucala), as an add-on therapy, is recommended as an option for treating severe refractory eosinophilic asthma (February 2021), only if:
   1. it is used for adults who have agreed to and followed the optimised standard treatment plan AND
   2. the blood eosinophil count has been recorded as 300 cells per microlitre or more and the person has had at least 4 exacerbations needing systemic corticosteroids in the previous 12 months, or has had continuous oral corticosteroids of at least the equivalent of prednisolone 5mg per day over the previous 6 months OR
   3. the blood eosinophil count has been recorded as 400 cells per microlitre or more and the person has had at least 3 exacerbations needing systemic corticosteroids in the previous 12 months (so they are eligible for either benralizumab or reslizumab) AND
   4. the company provides it according to the commercial arrangement.
2. If mepolizumab, benralizumab or reslizumab are equally suitable, start treatment with the least expensive option (taking into account drug and administration costs).

Omalizumab

Omalizumab

• Solution for injection in pre-filled syringes 150mg/1ml, 75mg/0.5ml

Notes

1. NICE TA278: Omalizumab (Xolair) is recommended as an option for treating severe persistent confirmed allergic IgE mediated asthma as an add on to optimised standard therapy in people aged 6 years and older (April 2013):
   1. who need continuous or frequent treatment with oral corticosteroids (defined as 4 or more courses in the previous year) AND
   2. only if the manufacturer makes omalizumab available with the discount agreed in the patient access scheme.
2. NICE TA339: Omalizumab (Xolair) is recommended as an option as add on therapy for treating severe chronic spontaneous urticaria in adults and young people aged 12 years and over (June 2015), only if:
   1. the severity of the condition is assessed objectively, for example, using a weekly urticaria activity score of 28 or more
   2. the person's condition has not responded to standard treatment with H₁-antihistamines and leukotriene receptor antagonists
   3. omalizumab is stopped at or before the fourth dose if the condition has not responded
   4. omalizumab is stopped at the end of a course of treatment (6 doses) if the condition has responded, to establish whether the condition has gone in spontaneous remission, and is restarted only if the condition relapses
   5. omalizumab is administered under the management of a secondary care specialist in dermatology immunology or allergy.
3. MHRA Drug Safety Update (February 2011): Use of omalizumab may be associated with an increased risk of arterial thrombotic events. Prescribers should be vigilant for possible thrombotic adverse reactions.

Reslizumab

Reslizumab

• Concentrate for solution for infusion vial 100mg/10ml, 25mg/2.5ml

Notes

1. NICE TA479: Reslizumab (Cinqaero), as an add-on therapy, is recommended as an option for the treatment of severe eosinophilic asthma that is inadequately controlled in adults despite maintenance therapy with high-dose inhaled corticosteroids plus another drug (October 2017), only if:
   1. the blood eosinophil count has been recorded as 400 cells per microlitre or more
   2. the person has had 3 or more severe asthma exacerbations needing systemic corticosteroids in the past 12 months
   3. the company provides it according with the discount agreed in the patient access scheme.

Tezepelumab

Tezepelumab

• Solution for injection pre-filled syringe 210mg/1.91ml

Notes

1. NICE TA880: Tezepelumab (Tezspire) as an add-on maintenance treatment is recommended as an option for severe asthma in people 12 years and over, when treatment with high-dose inhaled corticosteroids plus another maintenance treatment has not worked well enough (July 2023), only if people:
1. have had 3 or more exacerbations in the previous year OR
2. are having maintenance oral corticosteroids, AND
3. the company provides it according to the commercial arrangement.