Nice | Omalizumab for chronic urticaria

This is a new guideline from Nice recommending that omalizumab can be considered in chronic urticaria. Apparently it is already being used on occasion, though due to cost, it is more common for immunosuppressants like ciclosporin to be used. Omalizumab is preferred because of less need for monitoring. It is not disease modifying and repeat…
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Nice | Diagnosis and management of drug allergy

This is a new guideline from NICE which tries to rationalise how we manage potential drug allergy. There is a useful section on when to refer to a specialist and there is also a good outline of what different reactions may look like. Sadly it can't answer that question of whether the kid with a rash on…
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Omalizumab in severe allergic asthma

This guideline advises that Omalizumab can be used in the treatment of asthma. It is a monoclonal antibody that binds to IgE and is given every 2 to 4 weeks subcut. We may start seeing patients treated with this, so worth knowing about it. Treatment is to be started and maintained by specialists only. Quite…
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Venom prophylaxis with Pharmalgan

This guideline outlines the use of Pharmalgen, which is a subcut injection already in use in the UK. It is given in an initial course, then with maintenance injections every month for 3 years. It then provides up to 15 years cover. Although it is given by Allergy Specialists, we need to know the criteria…
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Anaphylaxis

There is really little difference for us in this guideline. Tryptase levels should be taken in AE immediately and between 1 and 4 hours. Raised levels suggest anaphylaxis. They should be referred to an allergy service, with an adrenaline injector whilst they wait to be seen. Louise HudmanI’m a freelance GP locum in Winchester &…
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Food Allergy in Children

This guideline is really quite complex. Unfortunately it basically says that if you or the parents suspect food allergy, test for that food. It gives IgE (immediate) and non IgE mediated (delayed) associated symptoms. For an IgE mediated reaction, a skin-prick test or IgE blood test should be used (aimed at the suspected target, rather…
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