3.4.2. Allergen Immunotherapy
Restrictions:
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.
Restrictions:
Restricted to specialist use for patients with severe asthma with type 2 inflammation and blood eosinophils ≥150 cells/microlitre and FeNO ≥25 parts per billion, and ≥4 exacerbations in the 12 months prior to initiating biologic treatment (anti-IgE or anti-IL-5 therapies) and who still experience ≥2 exacerbations per year despite this biologic treatment.
Prescribing Notes:
The following indication is not recommended by SMC and is non-Formulary:
- In adults as add-on maintenance treatment for uncontrolled chronic obstructive pulmonary disease (COPD) characterised by raised blood eosinophils on a combination of an inhaled corticosteroid (ICS), a long-acting beta2-agonist (LABA), and a long-acting muscarinic antagonist (LAMA), or on a combination of a LABA and a LAMA if ICS is not appropriate.
Restrictions:
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 three asthma exacerbations in the preceding year or are receiving maintenance treatment with oral corticosteroids (regional protocol in development).
Prescribing Notes:
The following indications are not recommended by SMC and are non-Formulary:
- Add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe chronic rhinosinusitis with nasal polyps for whom therapy with systemic corticosteroids and/or surgery do not provide adequate control
- Add-on treatment for adult patients with inadequately controlled hypereosinophilic syndrome without an identifiable non-haematologic secondary cause
- As an add-on treatment for patients aged 6 years and older with relapsing-remitting or refractory eosinophilic granulomatosis with polyangiitis (EGPA).
Restrictions:
Restricted to specialist use for the following indications:
- 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
Prescribing Notes:
Non-formulary indication:
As add-on therapy with intranasal corticosteroids (INC) for the treatment of adults (18 years and above) with severe chronic rhinosinusitis with nasal polyps for whom therapy with INC does not provide adequate disease control (non-submission to SMC).
Restrictions:
Restricted to specialist use in adults and adolescents 12 years and older with severe asthma who have either:
- Experienced at least three exacerbations in the previous year and are not receiving maintenance treatment with oral corticosteroids or
- Have blood eosinophils ≥150 cells/microlitre and are receiving maintenance treatment with oral corticosteroids.