Beclometasone diproprionate aerosol inhalers should be prescribed by brand name

Different brands are not dose equivalent

Specialist recommendation only

For control of asthma in adults who acquire repeated oropharyngeal candidiasis and/or hoarsness from other inhaled carticosteroids

Restricted to use in asthma where high strength inhaled corticosteroids are required

Only 100/6 micrograms strength is licensed for COPD

Only 100/6 micrograms strength is licensed for COPD

Only 92/22 micrograms strength is licensed for COPD

Max dose 100mg for adults, 50mg for elderly. Refer to MHRA for recent advice re risks of QT interval prolongation

Approved for:

Food protein gastrointestinal allergies in adults and children aged ≥3 years

Allergy clinic initiation only

Approved off-label indication:

• Treatment of serotonin syndrome
• Loading dose of 12 mg, further doses may be given following clinical review

Prescribing must be initiated under the supervision of the Clinical Toxicology team at the GSTFT Poisons Unit

SPECIALIST ALLERGIST USE ONLY

Initial and maintenance subcutaneous immunotherapy treatment of hypersensitivity to wasp or bee venom

SPECIALIST ALLERGIST USE ONLY

Initial and extension subcutaneous immunotherapy treatment of seasonal allergic hay fever due to grass or tree pollen in patients who have failed to respond to antiallergy drugs

SPECIALIST ALLERGIST USE ONLY

For seasonal allergic grass pollen allergy in those who have failed to respond to medication and at least one of the following apply:

• Monosensitised to grass pollen or polysensitised with symptoms predominantly related to grass pollen allergy;
• Perennial asthma which would be considered an unacceptable risk for administration of standard subcutaneous immunotherapy (SCIT);
• A prior severe reaction to grass pollen SCIT;
• Unable to undertake SCIT for logistical reasons (distance, working hours, etc)

SPECIALIST ALLERGIST USE ONLY

Initial therapy (pre-seasonal)

SPECIALIST ALLERGIST USE ONLY

Initial and maintenance therapy

SPECIALIST ALLERGIST USE ONLY

Initial and maintenance therapy

SPECIALIST ALLERGIST USE ONLY

Initial therapy (pre-seasonal)

SPECIALIST ALLERGIST USE ONLY

Initial and maintenance therapy

SPECIALIST ALLERGIST USE ONLY

Available on a named-patient basis

SPECIALIST ALLERGIST USE ONLY

Initial and maintenance therapy

SPECIALIST ALLERGIST USE ONLY

Restricted to use in persistent allergic rhinitis due to house dust mite allergy, uncontrolled by conventional treatment (nasal steroids, oral antihistamines ± leukotriene receptor antagonists) in adults and children >5 years

Acarizax oral lyophysilates is an imported product, licensed for use in Germany for allergic rhinitis due to house dust mite allergy in adults and adolescents aged 12-17, and allergic asthma due to house dust mite allergy in adults

SPECIALIST ALLERGIST USE ONLY

Initial therapy (pre-seasonal)

SPECIALIST ALLERGIST USE ONLY

Restricted to paediatric use only

SPECIALIST ALLERGIST USE ONLY

These five extracts are first line immunotherapy in paediatrics and second line choice after to subcutaneous immunotherapy (SCIT) in adult patients if one of the following apply:

• A phobia of injections
• Insurmountable problems with attending clinic for injections (e.g. immobility, working hours)
• Previous systemic reactions with SCIT
• Significant risk of systemic reactions from SCIT.

For use in asthma within the specialist service as per NICE TA 

For use in asthma within the specialist service as per NICE TA 

For use in asthma within the specialist service as per NICE TA 

For use in chronic spontaneous urticaria (as per NICE TA below), and chronic inducible urticarias (approved off-label use).

NOTE: see formulary section 3.4.4 (management of urticaria), and the SEL APC Urticaria Treatment Pathway for more detailed advice on the management of urticaria (link below)

For use in inducible urticaria (i.e. off-label use), a category B* form must be completed. 

For use in asthma within the specialist service as per NICE TA

Approved off-label indication:

When required for the short term management of stridor (via nebuliser)

• 1mL, diluted to 4mL with sodium chloride 0.9% and given via nebuliser.
• In patients requiring repeat doses within 2 hours of administration contact respiratory, intensive care or palliative care for advice as approrpiate

Prescribers should specify the brand to be dispensed

Brands available:

• Jext
• Epipen
• Emerade

Refer to product literature for dosing information

Acute attacks of hereditary angioedema, and prophylaxis of attacks as per NHSE Policy 16045/P

Initiation by consultants specialising in hereditary angioedema only

Symptomatic treatment of acute attacks of hereditary angioedema (HAE) in adults with C1-esterase inhibitor deficiency. Conditional on the there being a clear rationale for prescribing icatibant instead of C1-esterase inhibitor.

Use in accordance with local guidelines

Acute attacks of hereditary angioedema,  as per NHSE Policy B09/P/b

(see page 7 for specific comissioning criteria that apply)

For angioedema Dose: 2-4 sprays to be applied topically, up to hourly as required

Note: this product is currently not available

Up to a four-fold increase from the licensed dose is approved for all types of urticaria i.e. up to 360mg BD (off-label use)

2nd choice antihistamine after cetirizine/loratidine

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Approved for idiopathic pruritis (off-label use)

Dose = up to 75mg ON

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Approved for various chronic urticaria subtypes (off-label use)

Refer to formulary section 13.05.03 for use of azathioprine in dermatology indications and for the link to the SE London Shared Care Guidance

Approved for various chronic urticaria subtypes (off-label use)

See SEL APC Urticaria Treatment Pathway for more detailed advice, including recommended dosing depending on urticaria subtype (link below)

Refer to formulary section 13.05.03 for use of ciclosporin in dermatology indications and for the link to the SE London Shared Care Guidance

Approved off-label use

Dose = 0.5mg BD up to 2.5mg daily (in divided doses)

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Approved off-label use in men only

Dose = 200-600mg daily 

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Approved off-label use

Dose = 50mg/day up to max. 150mg/day

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Approved for treatment of coexisting anxiety and/or depressive illness (off-label use)

Dose = 25-50mg at night 

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Approved for idiopathic pruritis (off-label use)

Dose = up to 600mg TDS

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Approved for various chronic urticaria subtypes (off-label use)

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Refer to formulary section 13.05.03 for use of hydroxychloroquine in dermatology indications and for the link to the SE London Shared Care Guidance

Approved off-label use, where cholinergic urticaria has not responded/patient is intolerant to danazol (in men)/propranolol/oxybutynin

Dose = 10mg TDS, increased to 20mg QDS if neccessary 

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Approved for various chronic urticaria subtypes (off-label use)

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Refer to formulary section 13.05.03 for use of methotrexate in dermatology indications and for the link to the SE London Shared Care Guidance

Approved for use in all urtcaria subtypes (off-label use). 

Dose = 10mg daily

See SEL APC Urticaria Treatment Pathway for more detailed advice on management of urticaria (link below) 

Approved for chronic urticaria spontaneous urticaria where automimmune urticaria is suspected (off-label use)

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Refer to formulary section 13.05.03 for use of mycophenolate in dermatology indications and for the link to the SE London Shared Care Guidance

Approved for chronic urticaria spontaneous urticaria where automimmune urticaria is suspected (off-label use)

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Refer to formulary section 13.05.03 for use of mycophenolate in dermatology indications and for the link to the SE London Shared Care Guidance

Approved for idiopathic pruritus, that has not responded to optimised doses of amitriptyline, pregabalin or gabapentin (off-label use)

Dose = initially 25mg daily increased to 50mg per day. Total weekly dose may be divided and given on 3 days of the week – max. 350mg per week. 

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Approved off-label use 

Dose = 5mg 2-3 times daily 

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Approved for idiopathic pruritis (off-label use)

Dose = up to 75mg BD

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Approved off-label use, where cholinergic urticaria has not responded/patient is intolerant to danazol (in men)/propranolol/oxybutynin

Dose = up to 30mg QDS

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Approved off-label use 

Dose = up to 40mg BD

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Approved for use in all types of urticaria (off-label use). 

Dose = 150mg BD/300mg daily

See SEL APC Urticaria Treatment Pathway for more detailed advice on management of urticaria (link below)

Approved off-label use (if not aspirin sensitive)

See SEL APC Urticaria Treatment Pathway for more detailed advice on management of urticaria (link below)

Refer to formulary section 13.05.03 for use of sulfasalazine in dermatology indications and for the link to the SE London Shared Care Guidance

Approved for use in chronic spontanous urticaria, for the treatment of angiodema without weals specifically (off-label use). 

Dose = 500mg BD - 1.5g TDS

See SEL APC Urticaria Treatment Pathway for more detailed advice on management of urticaria (link below)

This product is for diagnostic use only

For identifying bronchial hyperresponsiveness in subjects with a baseline FEV1 of 70% or more of the predicted value.

Acute Respiratory Distress Syndrome (ARDS) in combination with Nitric Oxide inhalation:

Dose: 4-16 micrograms/kg/min by IV injection.

COPD:

Dose: 8 micrograms/kg/min by IV injection

Approved off-label indication:

Use prior to HALO radio frequency ablation (RFA) in Barrett’s Oesophagus

Approved off-label indication:

Severe respiratory failure with tenacious sputum in adult patients receiving ECMO. Either via a nebuliser, or endotracheal instillation

Maximum 3 doses

Consultant ICU specialist only

Use under specialist supervision in line with NHS England Commissioning Policy

Approved off-label indication:

Cough suppressant and treatment of breathlessness in palliative care

Approved off-label indication:

Cough suppressant and treatment of breathlessness in palliative care

Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)

Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)

Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)

Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)