NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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3 Respiratory system

3.4 Antihistamines, hyposensitisation, and allergic emergencies

3.4.1 Antihistamines

Preferred list
Total Formulary

Prescribing Notes:

The MHRA published advice relating to hydroxyzine in April 2015 advising that the maximum adult daily dose is now 100mg and advising that, due to the risk of QT interval prolongation and Torsade de Pointes, it should not be prescribed to people with prolonged QT interval or risk factors for QT interval prolongation.

For further information, seen the MHRA guidance.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3092.htm

3.4.2 Allergen Immunotherapy

Total Formulary

Restrictions: Restricted to use by appropriate specialists only at specialist centres.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/60107.htm#_60107



Use as add-on maintenance treatment in adult patients with severe eosinophilic asthma inadequately controlled despite high-dose inhaled corticosteroids plus long-acting beta-agonists is restricted to specialist use only in patients with blood eosinophils ≥150 cells/microlitre, and either ≥4 prior asthma exacerbations needing systemic corticosteroids in the previous 12 months or treatment with continuous oral corticosteroids over the previous 6 months.

MEPOLIZUMAB (injection)

Restrictions: Restricted as outlined in the Prescribing Notes section below.

Prescribing Notes:

Add-on treatment for severe refractory eosinophilic asthma in adult patients: restricted to specialist use in patients who have at least 150 cells per microlitre (0.15 x 109/L) at initiation of treatment and have had at least four asthma exacerbations in the preceding year or are receiving maintenance treatment with oral corticosteroids (regional protocol in development).


Restrictions: Restricted to specialist use in accordance with the indications and restrictions listed in the prescribing notes section below:

Prescribing Notes:

  • Use in adults with severe persistent allergic asthma is restricted to use in accordance with local protocols and SMC advice.
  • Use to improve asthma control in children with severe persistent allergic asthma is restricted to those patients who are prescribed chronic systemic steroids and in whom all other treatments have failed.  
  • Use as an add-on therapy for chronic spontaneous urticaria is restricted to specialist use in accordance with local protocol in patients who have an inadequate response to combination therapy with H1 antihistamines, leukotriene receptor antagonists (LTRA) and H2 antihistamines

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129492.htm

3.4.3 Allergic emergencies

Preferred list

Prescribing Notes:

  • Includes autoinjector devices for self-administration (e.g. Jext®, Epipen® and Emerade® range of devices)
  • It should be noted that the recommended administration technique for different devices can vary. When a device is changed, either by the manufacturer or by changing brand,  it is essential that patients and carers receive clear instructions on the use of the device prescribed.
    Patients should be made aware of the importance of checking expiry dates.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/100078.htm

Total Formulary

Restrictions: It is restricted to specialist use only on the advice of the Immunology Service.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/201199.htm

CONESTAT ALFA (injection)


Treatment of acute angioedema attacks in adults and adolescents with hereditary angioedema (HAE) due to C1 esterase inhibitor deficiency is restricted to specialist use only.

BNF Link: https://www.medicinescomplete.com/#/content/bnf/_449230410



Restricted to specialist use only in patients with hereditary angioedema (HAE) type I or II, who would otherwise be considered for long-term prophylaxis treatment with C1-esterase inhibitor.

BNF Link: https://doi.org/10.18578/BNF.440421225