BNF for Children 2011-2012

56 1.5.4 Food allergy BNFC 2011–20121 Gastro-intestinal systemdevelops); history of prolonged immunosuppressantor PUVA treatment in patients with psoriasis; interactions:Appendix 1 (infliximab)Tuberculosis Children should be evaluated for tuberculosisbefore treatment. Active tuberculosis should be treated withstandard treatment (section 5.1.9) for at least 2 monthsbefore starting infliximab. Children who have previouslyreceived adequate treatment for tuberculosis can startinfliximab but should be monitored every 3 months forpossible recurrence. In those without active tuberculosis butwho were previously not treated adequately, chemoprophylaxisshould ideally be completed before starting infliximab.In children at high risk of tuberculosis who cannot beassessed by tuberculin skin test, chemoprophylaxis can begiven concurrently with infliximab. Children and their carersshould be advised to seek medical attention if symptomssuggestive of tuberculosis (e.g. persistent cough, weight loss,and fever) developHypersensitivity reactions Hypersensitivity reactions(including fever, chest pain, hypotension, hypertension,dyspnoea, pruritus, urticaria, serum sickness-like reactions,angioedema, anaphylaxis) reported during or within 1–2hours after infusion (risk greatest during first or secondinfusion or in children who discontinue other immunosuppressants).All children should be observed carefully for1–2 hours after infusion and resuscitation equipment shouldbe available for immediate use. Prophylactic antipyretics,antihistamines, or hydrocortisone may be administered.Readministration not recommended after infliximab-freeinterval of more than 16 weeks—risk of delayed hypersensitivityreactions. Children and carers should be advisedto keep Alert card with them at all times and seek medicaladvice if symptoms of delayed hypersensitivity developContra-indications severe infections (see also undercautions)Pregnancy use only if essential; manufacturer advisesadequate contraception during and for at least 6months after last doseBreast-feeding amount probably too small to beharmfulSide-effects see under Cytokine Modulators (section10.1.3) and Cautions above; also diarrhoea, dyspepsia;flushing, chest pain; dyspnoea; dizziness,fatigue; sinusitis; rash, increased sweating, dry skin;less commonly constipation, gastro-oesophagealreflux, cholecystitis, palpitation, arrhythmia, hypertension,hypotension, vasospasm, cyanosis, bradycardia,syncope, oedema, thrombophlebitis, epistaxis,pleurisy, confusion, agitation, nervousness, amnesia,sleep disturbances, vaginitis, demyelinating disorders,antibody formation, pyelonephritis, myalgia, arthralgia,eye disorders, abnormal skin pigmentation,ecchymosis, cheilitis, and alopecia; rarely hepatitis,intestinal stenosis, intestinal perforation, gastrointestinalhaemorrhage, pancreatitis, lymphoma(including hepatosplenic T-cell lymphoma), circulatoryfailure, meningitis, and seizure; very rarely pericardialeffusion, and skin reactions (including Stevens-Johnsonsyndrome and toxic epidermalnecrolysis); also reported interstitial lung disease,transverse myelitis, neuropathy, paraesthesia, newonset or worsening psoriasisLicensed use not licensed for fistulating Crohn’sdisease in childrenIndication and doseSevere active Crohn’s disease. By intravenous infusionChild 6–18 years initially 5 mg/kg, then 5 mg/kg2 weeks and 6 weeks after initial dose, then 5 mg/kg every 8 weeks; interval between maintenancedoses adjusted according to response; discontinueif no response within 10 weeks of initial doseFistulating Crohn’s disease. By intravenous infusionChild 6–18 years initially 5 mg/kg, then 5 mg/kg2 weeks and 6 weeks after initial dose, then ifcondition has responded, consult literature forguidance on further dosesAdministration for intravenous infusion reconstituteeach 100-mg vial of powder with 10 mL Water forInjections; to dissolve, gently swirl vial without shaking;allow to stand for 5 minutes; dilute required dosewith Sodium Chloride 0.9% to a final volume of250 mL and give through a low protein-binding filter(1.2 micron or less) over at least 2 hours; start infusionwithin 3 hours of reconstitutionRemicade c (Schering-Plough) AIntravenous infusion, powder for reconstitution,infliximab, net price 100-mg vial = £419.62. Label: 10,alert card, counselling, tuberculosis and hypersensitivityreactions1.5.4 Food allergyAllergy with classical symptoms of vomiting, colic anddiarrhoea caused by specific foods such as cow’s milkshould be managed by strict avoidance. The conditionshould be distinguished from symptoms of occasionalfood intolerance in children with irritable bowelsyndrome. Sodium cromoglicate (sodium cromoglycate)may be helpful as an adjunct to dietary avoidance.SODIUM CROMOGLICATE(Sodium cromoglycate)Pregnancy not known to be harmfulBreast-feeding unlikely to be present in milkSide-effects occasional nausea, rashes, and joint painIndication and doseFood allergy (in conjunction with dietaryrestriction). By mouthChild 2–14 years 100 mg 4 times daily beforemeals, dose may be increased after 2–3 weeks to amax. 40 mg/kg daily and then reduced accordingto responseChild 14–18 years 200 mg 4 times daily beforemeals, dose may be increased after 2–3 weeks tomax. 40 mg/kg daily and then reduced accordingto responseAsthma section 3.3.1Allergic conjunctivitis section 11.4.2Allergic rhinitis section 12.2.1Administration capsules may be swallowed whole orthe contents dissolved in hot water and diluted withcold water before takingNalcrom c (Sanofi-Aventis) ACapsules, sodium cromoglicate 100 mg. Net price100-cap pack = £59.75. Label: 22, counselling,administration