Drugs List

Therapeutic Indications

Uses

Seasonal allergic rhinitis - treatment when anti-allergy drugs ineffective

Administration

Slowly by subcutaneous route only. Do not rub the site of injection.

Contraindications

Administration site infection
Autoimmune disease
Children under 6 years
Disturbance in tyrosine metabolism
Febrile disorder
Immunopathological disorder
Inflammatory disorder
Systemic infection
Asthma
Bronchiectasis
Immunodeficiency syndromes
Inflammation of the respiratory tract
Ocular tuberculosis
Pregnancy
Pulmonary emphysema
Pulmonary tuberculosis
Severe psychiatric disorder

Precautions and Warnings

Cardiovascular disorder

Advise patient drowsiness may affect ability to drive or operate machinery
Do not use during the tree pollen season
Have available adrenaline injection 1:1000 for anaphylaxis
Resuscitation facilities must be immediately available
Observe patient for the first 60 minutes after each injection
Discontinue treatment if skin rash or other allergic reaction occurs
Do not exceed individual tolerated dose
Advise patient not to eat heavy meal immediately before injection
Advise patient not to take strenuous exercise for 12hrs following injection
Advise patient to contact the doctor immediately in the event of a reaction

The diagnosis should be based on the careful consideration of the patient's history and allergy tests, preferably skin tests.

Patients should be kept under observation for the first 60 minutes after each injection. This period should be extended if even mild symptoms or signs of hypersensitivity develop and patients should be maintained under observation until these have completely resolved. A severe and prolonged adverse reaction may necessitate hospital admission.

In the event of simultaneous vaccination against viral or bacterial pathogens, there should be an interval of at least one week between the last injection of the allergy vaccine and the day of vaccination provided all the side effects have completely disappeared. Hyposensitization therapy may be continued two weeks after the vaccination, providing all the side effects to the vaccination have completely disappeared using half of the last dose administered. Afterwards, this amount can be increased according to the dosage chart at intervals of 7 to 14 days.

Pregnancy and Lactation

Pregnancy

Alder, hazel and birch tree pollen vaccines are contraindicated in pregnancy.

If patient is pregnant or discover they become pregnant whilst receiving treatment the vaccine should not be started or continued during pregnancy as pregnancy may change the patient's sensitisation level to a degree that cannot be foreseen.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Highly limited information on alder, hazel and birch tree pollen vaccines during breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Allergic reaction
Anaphylactic shock
Anaphylaxis
Bronchospasm
Drowsiness
Exacerbation of pre-existing eczema
Fatigue
Granuloma (injection site)
Irritation (injection site)
Local reaction at injection site
Oedema
Rhinitis
Swelling (injection site)
Urticaria
Wheezing

Presentation

Injections containing three selectively purified allergen extracts of pollen

Drugs List

Therapeutic Indications

Uses

Seasonal allergic rhinitis - treatment when anti-allergy drugs ineffective

Dosage

It is recommended that the allergy vaccine should be given in each of three successive years.

Adults

Elderly

Children

Administration

Slowly by subcutaneous route only. Do not rub the site of injection.

Contraindications

Administration site infection
Autoimmune disease
Children under 6 years
Disturbance in tyrosine metabolism
Febrile disorder
Immunopathological disorder
Inflammatory disorder
Systemic infection
Asthma
Bronchiectasis
Immunodeficiency syndromes
Inflammation of the respiratory tract
Ocular tuberculosis
Pregnancy
Pulmonary emphysema
Pulmonary tuberculosis
Severe psychiatric disorder

Precautions and Warnings

Cardiovascular disorder

Advise patient drowsiness may affect ability to drive or operate machinery
Do not use during the tree pollen season
Have available adrenaline injection 1:1000 for anaphylaxis
Resuscitation facilities must be immediately available
Observe patient for the first 60 minutes after each injection
Discontinue treatment if skin rash or other allergic reaction occurs
Do not exceed individual tolerated dose
Advise patient not to eat heavy meal immediately before injection
Advise patient not to take strenuous exercise for 12hrs following injection
Advise patient to contact the doctor immediately in the event of a reaction

The diagnosis should be based on the careful consideration of the patient's history and allergy tests, preferably skin tests.

Patients should be kept under observation for the first 60 minutes after each injection. This period should be extended if even mild symptoms or signs of hypersensitivity develop and patients should be maintained under observation until these have completely resolved. A severe and prolonged adverse reaction may necessitate hospital admission.

In the event of simultaneous vaccination against viral or bacterial pathogens, there should be an interval of at least one week between the last injection of the allergy vaccine and the day of vaccination provided all the side effects have completely disappeared. Hyposensitization therapy may be continued two weeks after the vaccination, providing all the side effects to the vaccination have completely disappeared using half of the last dose administered. Afterwards, this amount can be increased according to the dosage chart at intervals of 7 to 14 days.

Pregnancy and Lactation

Pregnancy

Alder, hazel and birch tree pollen vaccines are contraindicated in pregnancy.

If patient is pregnant or discover they become pregnant whilst receiving treatment the vaccine should not be started or continued during pregnancy as pregnancy may change the patient's sensitisation level to a degree that cannot be foreseen.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Highly limited information on alder, hazel and birch tree pollen vaccines during breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Allergic reaction
Anaphylactic shock
Anaphylaxis
Bronchospasm
Drowsiness
Exacerbation of pre-existing eczema
Fatigue
Granuloma (injection site)
Irritation (injection site)
Local reaction at injection site
Oedema
Rhinitis
Swelling (injection site)
Urticaria
Wheezing

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: August 2013

Reference Sources

British National Formulary, 65th Edition (March - September 2013) Pharmaceutical Press, London.

BNF for Children (2013-2014) Pharmaceutical Press, London.

Summary of Product Characteristics: Pollinex Trees. Allergy Therapeutics (UK) Ltd. Revised July 2009.

Summary of Product Characteristics: Pollinex Trees extension course. Allergy Therapeutics (UK) Ltd. Revised July 2009.

The MATA (Modified Allergen Tyrosine Adsorbed) Range (e.g. POLLINEX Grasses +Rye/POLLINEX Trees) - Prescribing Information.
Available at: https://www.allergytherapeutics.com/uploads/a.11963mata_incrye_.api.gbgen002-31.10.08.pdf
Last accessed: 19 August 2013