BNF for Children 2011-2012

BNFC 2011–2012 3.4.2 Allergen immunotherapy 157Zaditen c (Swedish Orphan) ATablets, scored, ketotifen (as hydrogen fumarate)1 mg, net price 60-tab pack = £7.53. Label: 2, 21Elixir, ketotifen (as hydrogen fumarate), 1 mg/5 mL,net price 300 mL (strawberry-flavoured) = £8.91.Label: 2, 21PROMETHAZINE HYDROCHLORIDECautions see notes above; also severe coronary arterydiseaseContra-indications see notes aboveHepatic impairment see notes aboveRenal impairment use with cautionPregnancy see notes aboveBreast-feeding see notes aboveSide-effects see notes above; also restlessnessIndication and doseSymptomatic relief of allergy such as hay fever,insomnia associated with urticaria and pruritus. By mouthChild 2–5 years 5 mg twice daily or 5–15 mg atnightChild 5–10 years 5–10 mg twice daily or 10–25 mg at nightChild 10–18 years 10–20 mg 2–3 times daily or25 mg at night increased to 25 mg twice daily ifnecessarySedation section 4.1.1Nausea and vomiting section 4.6Phenergan c (Sanofi-Aventis)Tablets, both blue, f/c, promethazine hydrochloride10 mg, net price 56-tab pack = £2.85; 25 mg, 56-tabpack = £4.34. Label: 2Dental prescribing on NHS May be prescribed as PromethazineHydrochloride Tablets 10 mg or 25 mgElixir, golden, promethazine hydrochloride 5 mg/5 mL. Net price 100 mL = £2.67. Label: 2Dental prescribing on NHS May be prescribed as PromethazineHydrochloride Oral Solution 5 mg/5 mL3.4.2 Allergen immunotherapyImmunotherapy using allergen vaccines containinghouse dust mite, animal dander (cat or dog), or extractsof grass and tree pollen can improve symptoms ofasthma and allergic rhino-conjunctivitis in children. Avaccine containing extracts of wasp and bee venom isused to reduce the risk of severe anaphylaxis and systemicreactions in children with hypersensitivity to waspand bee stings. An oral preparation of grass pollenextract (Grazax c ) is also licensed for grass polleninduced rhinitis and conjunctivitis. Children requiringimmunotherapy must be referred to a hospital specialistfor accurate allergy diagnosis, assessment, and treatment.In view of concerns about the safety of desensitisingvaccines, it is recommended that they are used byspecialists 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 avoidedor used with particular care in children with asthma.Desensitising vaccines should be avoided in pregnantwomen, in children under 5 years, and in those takingbeta-blockers (adrenaline will be ineffective if a hypersensitivityreaction occurs), or ACE inhibitors (risk ofsevere anaphylactoid reactions).Hypersensitivity reactions to immunotherapy (especiallyto wasp and bee venom extracts) can be lifethreatening;bronchospasm usually develops within 1hour and anaphylaxis within 30 minutes of injection.Therefore, facilities for cardiopulmonary resuscitationmust be immediately available and the child needs to bemonitored for at least 1 hour after injection. If symptomsor signs of hypersensitivity develop (e.g. rash,urticaria, bronchospasm, faintness), even when mild,the child should be observed until these have resolvedcompletely. The first dose of oral grass pollen extract(Grazax c ) should be taken under medical supervisionand the child should be monitored for 20–30 minutes.For details on the management of anaphylaxis, seesection 3.4.3.Each set of allergen extracts usually contains vials forthe administration of graded amounts of allergen. Maintenancesets containing vials at the highest strength arealso available. Product literature must be consulted fordetails of allergens, vial strengths, and administration.BEE AND WASP ALLERGENEXTRACTSCautions see notes above and consult product literatureContra-indications see notes above and consult productliteraturePregnancy avoidSide-effects consult product literatureIndication and doseHypersensitivity to wasp or bee venom (seenotes above). By subcutaneous injectionConsult product literaturePharmalgen c (ALK-Abelló) ABee venom extract (Apis mellifera) or wasp venomextract (Vespula spp.). Net price initial treatment set =£54.81 (bee), £67.20 (wasp); maintenance treatmentset = £63.76 (bee), £82.03 (wasp)GRASS AND TREE POLLENEXTRACTSCautions see notes above and consult product literature3 Respiratory system