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Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 3: Respiratory system - Full Chapter
Notes:

Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.

Formulary approved "off-label" use is detailed separately.

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03.04.02  Expand sub section  Allergen Immunotherapy
 note  Refer to BNF for advice, safety information and cautions for allergen immunotherapy.  RESTRICTED USE - SPECIALIST USE ONLY
Bee and wasp allergen extracts (Alutard SQ® injection)
View adult BNF View SPC online
Restricted Drug Restricted

SPECIALIST ALLERGIST USE ONLY

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

 
   
Grass and tree pollen extract subcutaneous injection (Pollinex®)
View adult BNF View SPC online
Restricted Drug Restricted

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

 
   
Grass pollen extract oral lyophilisates (Grazax®)
View adult BNF View SPC online
Restricted Drug Restricted
Red

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)
 
   
Birch pollen extract subcutaneous injection (Allergovit®)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Initial therapy (pre-seasonal)

 
   
Cat epithelial extract subcutaneous injection (novo-helisen depot®)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Initial and maintenance therapy

 
   
Dog epithelial extract subcutaneous injection (novo-helisen depot®)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Initial and maintenance therapy

 
   
Grass and birch pollen mixture extract subcutaneous injection (Allergovit®)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Initial therapy (pre-seasonal)

 
   
Grass pollen extract or mixed tree pollen extract subcutaneous injection (Allergovit®)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Initial and maintenance therapy

 
   
Grasses and rye pollen extract or tree pollen extract subcutaneous injection (Pollinex® Quattro)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Available on a named-patient basis

 
   
House dust mite extract subcutaneous injection (Acaroid®)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Initial and maintenance therapy

 
   
House Dustmite allergen extract (Acarizax 12-SQ HDM oral lyophilisates®)
Unlicensed Drug Unlicensed
Red

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

 
   
Mixed grass pollen extract subcutaneous injection (Allergovit®)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Initial therapy (pre-seasonal)

 
   
Horse epithelial extract sublingual immunotherapy (Oralvac®)
Unlicensed Drug Unlicensed
Red

SPECIALIST ALLERGIST USE ONLY

Restricted to paediatric use only

 
   
Mixed tree pollen, cat epithelial, dog epithelial extract sublingual immunotherapy (Oralvac®)
Unlicensed Drug Unlicensed
Red

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.
 
   
Birch pollen extract sublingual immunotherapy (Oralvac®)
Unlicensed Drug Unlicensed
Red
SPECIALIST ALLERGIST USE ONLY
Restricted to paediatric use only

 
   
03.04.02  Expand sub section  Omalizumab, mepolizumab and other therapies
 note 
Benralizumab injection
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
BlueTeq

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

 
Link  NICE TA565: Benralizumab for treating severe eosinophilic asthma
   
Mepolizumab injection
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
BlueTeq

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

 
Link  NICE TA431: Mepolizumab for treating severe refractory eosinophilic asthma
   
Omalizumab injection (asthma)
View adult BNF View SPC online
Restricted Drug Restricted
Red
High Cost Medicine
BlueTeq

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

 
Link  NICE TA278: Asthma (severe, persistent, patients aged 6+, adults) - omalizumab (rev TA133, TA201)
   
Omalizumab injection (urticaria)
View adult BNF View SPC online
Restricted Drug Restricted
Red
High Cost Medicine

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. 

 
Link  NICE TA339: Omalizumab for previously treated chronic spontaneous urticaria
Link  SE London APC recommendation: Omalizumab for the treatment of inducible urticarias (symptomatic dermographism, cholinergic, delayed pressure, cold and solar) in adults
   
Reslizumab injection
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
BlueTeq

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

 
Link  NICE TA479: Reslizumab for treating severe eosinophilic asthma
   
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Specialist or hospital prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.   

Amber 1

Treatment can be initiated in primary care after a recommendation from an appropriate specialist  

Amber 2

Specialist initiation followed by maintenance prescribing in primary care  

Amber 3

Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation  

Green

Specialist and non-specialist initiation  

Grey

Not recommended for prescribing  

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