l PRESCRIBING AND DISPENSING INFORMATION Each set of
allergen extracts usually contains vials for the
administration of graded amounts of allergen to patients
undergoing hyposensitisation. Maintenance sets
containing vials at the highest strength are also available.
Product literature must be consulted for details of
allergens, vial strengths, and administration.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Pollinex Trees (Allergy Therapeutics (UK) Ltd)
Pollinex Trees suspension for injection treatment and extension course
Pollinex Trees No 3 suspension for injection 1ml vials | 1 vial P s
Pollinex Trees No 2 suspension for injection 1ml vials | 1 vial P s
Pollinex Trees No 1 suspension for injection 1ml vials | 1 vial P s
Hypersensitivity to wasp venom
▶ Adult: (consult product literature)
In view of concerns about the safety of desensitising
vaccines, it is recommended that they are used by
specialists and only for the following indications:
. seasonal allergic hay fever (caused by pollen) that has
not responded to anti-allergic drugs;
. hypersensitivity to wasp and bee venoms.
Desensitising vaccines should generally be avoided or
used with particular care in patients with asthma.
l CONTRA-INDICATIONS Consult product literature
l CAUTIONS Consult product literature
l INTERACTIONS → Appendix 1: wasp venom extract
SIDE-EFFECTS, FURTHER INFORMATION Hypersensitivity
reactions to wasp venom extracts can be life-threatening;
cardiopulmonary resuscitation must be immediately
available and patients need to be monitored for at least
1 hour after injection. If symptoms or signs of
hypersensitivity develop (e.g. rash, urticaria,
bronchospasm, faintness), even when mild, the patient
should be observed until these have resolved completely.
l PRESCRIBING AND DISPENSING INFORMATION Each set of
allergen extracts usually contains vials for the
administration of graded amounts of allergen to patients
undergoing hyposensitisation. Maintenance sets
containing vials at the highest strength are also available.
Product literature must be consulted for details of
allergens, vial strengths, and administration.
l NATIONAL FUNDING/ACCESS DECISIONS
▶ Pharmalgen® for bee and wasp venom allergy (February
. a severe systemic reaction to bee or wasp venom;
. a moderate systemic reaction to bee or wasp venom and
who have a raised baseline serum-tryptase
concentration, a high risk of future stings, or anxiety
Treatment with Pharmalgen ® should be initiated and
monitored in a specialist centre experienced in venom
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Powder and solvent for solution for injection
▶ Pharmalgen Wasp Venom (ALK-Abello Ltd)
Wasp venom 120 nanogram Pharmalgen Wasp Venom
120nanogram powder and solvent for solution for injection vials |
Wasp venom 1.2 microgram Pharmalgen Wasp Venom
1.2microgram powder and solvent for solution for injection vials | 1 vial P s
Wasp venom 12 microgram Pharmalgen Wasp Venom 12microgram
powder and solvent for solution for injection vials | 1 vial P s
Wasp venom 120 microgram Pharmalgen Wasp Venom
maintenance set 120microgram vaccine powder and solvent for
solution for injection vials | 4 vial P £150.00
Other drugs used for Angioedema Adrenaline/epinephrine,
DRUGS USED IN HEREDITARY ANGIOEDEMA ›
COMPLEMENT REGULATORY PROTEINS
C1-esterase inhibitor 05-Dec-2017
Acute attacks of hereditary angioedema (under expert
▶ BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS
Short-term prophylaxis of hereditary angioedema before
dental, medical, or surgical procedures (under expert
▶ BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS
▶ Adult: 1000 units for 1 dose, to be administered less
Acute attacks of hereditary angioedema (under expert
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: 1000 units, repeated if necessary for 1 dose, dose
may be repeated if necessary after 60 minutes (or
sooner for patients experiencing laryngeal attacks or if
treatment initiation is delayed)
Short-term prophylaxis of hereditary angioedema before
dental, medical, or surgical procedures (under expert
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: 1000 units for 1 dose, to be administered up to
Long-term prophylaxis of severe, recurrent attacks of
hereditary angioedema where acute treatment is
inadequate, or when oral prophylaxis is inadequate or
not tolerated (under expert supervision)
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: 1000 units every 3–4 days, interval between
doses to be adjusted according to response
l CAUTIONS Vaccination against hepatitis A and hepatitis B
l PREGNANCY Manufacturer advises avoid unless essential.
l PRESCRIBING AND DISPENSING INFORMATION C1-esterase
inhibitor is prepared from human plasma.
l NATIONAL FUNDING/ACCESS DECISIONS
All Wales Medicines Strategy Group (AWMSG) decisions
The All Wales Medicines Strategy Group has advised
(October 2017) that C1-esterase inhibitor (Cinryze ®) is
recommended as an option for use within NHS Wales for
the treatment and pre-procedure prevention of
angioedema attacks in adults with hereditary angioedema
(HAE); routine prevention of angioedema attacks in adults
with severe and recurrent attacks of HAE, who are
intolerant to or insufficiently protected by oral prevention
treatments, or patients who are inadequately managed
with repeated acute treatment.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Powder and solvent for solution for injection
ELECTROLYTES: May contain Sodium
▶ Berinert P (CSL Behring UK Ltd)
C1-esterase inhibitor 500 unit Berinert 500unit powder and solvent
for solution for injection vials | 1 vial P £550.00 DT = £550.00
C1-esterase inhibitor 1500 unit Berinert 1,500unit powder and
solvent for solution for injection vials | 1 vial P £1,650.00 DT =
▶ Cinryze (Shire Pharmaceuticals Ltd) A
C1-esterase inhibitor 500 unit Cinryze 500unit powder and solvent
for solution for injection vials | 2 vial P £1,336.00
Acute attacks of hereditary angioedema in patients with
C1-esterase inhibitor deficiency
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult (body-weight up to 84 kg): 50 units/kg for 1 dose,
to be administered over 5 minutes, dose may be
repeated if necessary; maximum 2 doses per day
▶ Adult (body-weight 84 kg and above): 4200 units for
1 dose, to be administered over 5 minutes, dose may be
repeated if necessary; maximum 2 doses per day
l CONTRA-INDICATIONS Rabbit allergy
▶ Common or very common Headache
l PREGNANCY Use only if potential benefit outweighs risk—
l BREAST FEEDING Use only if potential benefit outweighs
risk—no information available.
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (August
2018) that conestat alfa (Ruconest ®) is accepted for use
within NHS Scotland for the treatment of acute
angioedema attacks in adults and adolescents with
hereditary angioedema due to C1 esterase inhibitor
deficiency. This advice is contingent upon the continuing
availability of the patient access scheme in NHS Scotland
or a list price that is equivalent or lower.
All Wales Medicines Strategy Group (AWMSG) decisions
The All Wales Medicines Strategy Group has advised
(November 2018) that conestat alfa (Ruconest ®) is
recommended as an option for use within NHS Wales for
the treatment of acute angioedema attacks in adults and
adolescents with hereditary angioedema due to C1
esterase inhibitor deficiency. This recommendation
applies only in circumstances where the approved Wales
Patient Access Scheme (WPAS) is utilised or where the
list/contract price is equivalent or lower than the WPAS
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Powder for solution for injection
▶ Ruconest (Pharming Group N.V.)
Conestat alfa 2100 unit Ruconest 2,100unit powder for solution for
injection vials | 1 vial P £750.00
DRUGS USED IN HEREDITARY ANGIOEDEMA ›
SELECTIVE BRADYKININ B2 ANTAGONISTS
Acute attacks of hereditary angioedema in patients with
C1-esterase inhibitor deficiency
▶ Adult: 30 mg for 1 dose, then 30 mg after 6 hours if
required, then 30 mg after 6 hours if required;
l CAUTIONS Ischaemic heart disease . stroke
l INTERACTIONS → Appendix 1: icatibant
▶ Common or very common Dizziness .fever. headache . nausea . skin reactions
l PREGNANCY Manufacturer advises use only if potential
benefit outweighs risk—toxicity in animal studies.
l BREAST FEEDING Manufacturer advises avoid for 12 hours
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (March
2012) that icatibant (Firazyr ®) is accepted for use within
NHS Scotland for the symptomatic treatment of acute
attacks of hereditary angioedema (HAE) in adults with
C1-esterase-inhibitor deficiency. This advice is contingent
upon the continuing availability of the patient access
All Wales Medicines Strategy Group (AWMSG) decisions
The All Wales Medicines Strategy Group has advised (June
2018) that icatibant acetate (Firazyr ®) is recommended as
an option for use within NHS Wales for the symptomatic
treatment of acute attacks of hereditary angioedema (HAE)
in adults, adolescents and children aged 2 years and older,
with C1 esterase-inhibitor deficiency. This
recommendation applies only in circumstances where the
approved Wales Patient Access Scheme (WPAS) is utilised
or where the list/contract price is equivalent or lower than
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Firazyr (Shire Pharmaceuticals Ltd)
Icatibant (as Icatibant acetate) 10 mg per 1 ml Firazyr 30mg/3ml
solution for injection pre-filled syringes | 1 pre-filled disposable
