Information updates

Further important information about EpiPen® Jr Supply

5 December 2019

ASCIA has been notified that EpiPen® Jr will not be available from 5 December 2019. See notice from Mylan Australia here. People who are newly diagnosed or who have used their last EpiPen® Jr may not be able to purchase an EpiPen® Jr device until stock arrives from the United States on 17 December or shortly thereafter. In light of this critical development ASCIA recommends that all remaining stock in pharmacies should be provided to newly diagnosed infants and children weighing 7.5-20kg, and those who have used their EpiPen® Jr and have no other dose available.

It was reported on the TGA website https://www.tga.gov.au/alert/epipen-jr that due to the critical nature of the ongoing EpiPen® Jr shortage, the TGA is allowing one batch of EpiPen® Jr, that has not met all the required quality specifications, to be supplied. This batch has been found to be affected by very low-level contamination with another medicine, pralidoxime. The TGA in conjunction with Mylan Australia has assessed the level of pralidoxime per EpiPen® Jr to be far below 0.1% of the usual dose for both adults and children. This was caused by a manufacturing issue between production batches of different medications. The manufacturer has taken action to prevent the issue for future batches. Pralidoxime is an antidote used to treat people who have been poisoned by organophosphates (a pesticide), and its safety profile has been well established in humans, including children. It is important to note that this batch is not yet available in Australia, but will hopefully arrive in Australia on 17 December or shortly thereafter. The TGA is working with Mylan Australia on details of its supply and will publish updated information as it becomes available. The conditional release applies to batch number 9KC652.

The TGA have reviewed data provided by Mylan Australia on the contaminated EpiPen® Jr batch and determined that the risk of not having adrenaline available to treat anaphylaxis is far greater than the risk of being exposed to a very small amount of pralidoxime.

Please note that supply of EpiPen® 300mcg adrenaline (epinephrine) autoinjectors is NOT affected.

Mylan Australia, the supplier of EpiPen® and EpiPen® Jr in Australia and New Zealand, has set up the following process to ensure that people at risk of a potentially life-threatening allergic reaction (anaphylaxis) have access to the emergency treatment they may need:

  • Parents/carers requiring an EpiPen® Jr are to contact their local pharmacy.
  • Pharmacies can then contact the Mylan Customer Support team on 1800 274 276 or the EpiPen® Customer Service Toll Free hotline on 1800 931 625 or This email address is being protected from spambots. You need JavaScript enabled to view it. to obtain instructions on how to access EpiPen® Jr once the batch of EpiPen® Jr autoinjectors arrives on 17 December 2019 or shortly thereafter.
  • During this supply crisis only ONE EpiPen® Jr will be dispensed to each patient once the batch 9KC652 arrives from the United States.

Patients with an EpiPen® Jr that has recently expired should keep and use this EpiPen® Jr in an emergency according to instructions on the ASCIA Action Plan. Whilst the use of an expired EpiPen® Jr adrenaline autoinjector is not ideal, research suggests that recently expired devices retain potency. Therefore, if no other EpiPen® Jr is available, use of a recently expired EpiPen® Jr to treat anaphylaxis is advised, as stated on the ASCIA website allergy.org.au/hp/anaphylaxis/adrenaline-autoinjector-storage-expiry-and-disposal

To ensure that people at risk of anaphylaxis have access to the treatment they may need, ASCIA recommends that supply should be restricted to patients with an EpiPen® Jr prescription for a new diagnosis or where an EpiPen® Jr device has recently been used and there is no other EpiPen® Jr available.

Schools and early childhood education/care (ECEC) centres

ASCIA requests that schools and early childhood education/care (ECEC) centres take into account the current supply issues, by not requesting additional EpiPen® Jr devices to be brought to the school or ECEC centre for each child at risk of anaphylaxis, and to limit the replacement of general use devices at this time.

Where there is no alternative available ASCIA advises schools and ECEC that it may be necessary to accept recently expired EpiPen autoinjectors during nation-wide shortages.

Parents should be able to bring EpiPen® Jr devices to and from school each day with the child.

Parents and carers requiring documentation for schools and ECEC during the out of stock period can use this ASCIA document:

pdfASCIA EpiPen Jr Out of Stock ECEC December 201997.98 KB

Further information:

www.allergy.org.au/hp/anaphylaxis/epipen-jr-out-of-stock

www.allergy.org.au/hp/anaphylaxis/adrenaline-autoinjector-storage-expiry-and-disposal

General advice during this EpiPen® Jr supply crisis:

  • Identify your closest hospital and ways to access emergency care in your local area.
  • Reconsider travel and other activities in remote locations away from medical help and hospitals.
  • Always have a mobile phone that is sufficiently charged to call an ambulance.
  • Carry an ASCIA Action Plan with you in case of emergency.

ASCIA recommends the following general advice to reduce the risk of allergic reactions: 

Food allergy:

  • If possible prepare food at home and use fresh ingredients for meals.
  • Always read ingredient lists and labels on packaged foods carefully and look for variations in ingredients.
  • Make treat foods to take to social occasions/Christmas parties.
  • Supervise young children around food at all times.
  • For adults consider not consuming alcohol as this can diminish the level of supervision provided for children, and increase the risk of a food allergic adult accidentally consuming their food allergen/s.
  • If eating away from home, take food that has been prepared at home.

Insect sting allergy:

  • Always wear shoes outdoors.
  • Avoid grass and gardens.
  • Wear long pants and long sleeve shirts that are not brightly coloured.
  • Drive with car windows closed.

Emergency treatment if you do not have an EpiPen

  • ASCIA recommends calling 000 (Australia) or 111 (New Zealand) if a person has any signs of anaphylaxis (severe allergic reaction) after using an EpiPen (in date or expired) if available.
  • If there is no access to adrenaline call an ambulance early if there are signs of an allergic reaction and you are uncertain if there are signs of anaphylaxis.
  • Always follow the ASCIA Action Plan. Keep the person with allergy lying flat or sitting on the ground/lap with legs outstretched in front of them (not dangling).
  • The person having an allergic reaction should not stand or walk as this can cause a sudden drop in blood pressure. Babies/children should not be held upright.

Prescribing of adrenaline autoinjectors

Clinicians should continue to provide prescriptions for EpiPen® Jr according to current ASCIA recommendations www.allergy.org.au/hp/anaphylaxis/adrenaline-autoinjector-prescription

While two EpiPen® Jr autoinjectors are usually prescribed, please advise parents/carers that only ONE EpiPen® Jr will be dispensed to each patient during this time, until Australia has normal stock levels.

ASCIA recommends that in public hospitals priority for dispensing EpiPen® Jr is given to patients who have received adrenaline in the emergency department and who have no other access to an EpiPen® Jr.

ASCIA does not recommend prescribing adrenaline ampoules in place of adrenaline autoinjectors due to the significant risk of overdose.

Optimal storage of EpiPen® and EpiPen® Jr

  • EpiPen® should be stored between 15 ͦC and 25 ͦC, and out of direct sunlight. As temperatures in Australia far exceed 25 ͦC people need to be aware of where they keep/place their EpiPen®.
  • If an EpiPen® is kept in hot locations for extended periods it is likely to be less effective if it has expired.
  • Always try to keep EpiPen® in a cooler location out of direct sunlight during the summer months. Never store the EpiPen® in the car. If going camping or to the beach consider purchasing a temperature control device through Allergy & Anaphylaxis Australia’s online shop.

Further Information

Can a higher dose of adrenaline be given to a young child if no EpiPen® Jr is available?

In Australia and New Zealand, there are currently two doses of adrenaline autoinjectors available:

  • EpiPen® (0.3mg) is usually prescribed for adults and children over 20 kg.
  • EpiPen® Jr (0.15mg) is usually prescribed for children 7.5*-20 kg.

*Whilst 10-20kg was the previous weight guide for a 0.15mg adrenaline autoinjector device, a 0.15mg device may now also be prescribed for an infant weighing 7.5-20kg by health professionals who have made a considered assessment. Use of a 0.15mg device for treatment of infants weighing 7.5kg or more poses less risk, particularly when used without medical training, than use of an adrenaline ampoule and syringe.

A general guide to adrenaline autoinjector dose:

  • Children under 7.5kg are not usually prescribed an adrenaline autoinjector. If anaphylaxis is suspected only a 0.15mg device should be given. Higher dose adrenaline autoinjectors should NOT be administered to children under 7.5kg.
  • In children weighing 7.5-20kg, a 0.15mg adrenaline autoinjector should be used. However, if only a 0.3mg device is available, this should be used in preference to not using one at all.
  • ASCIA Guidelines for adrenaline autoinjector prescription are available at www.allergy.org.au/hp/anaphylaxis/adrenaline-autoinjector-prescription

We thank you in advance for your consideration of others at this challenging time.

Important notice about EpiPen® Jr Supply

20 November 2019

Supply of EpiPen® Jr 150mcg adrenaline (epinephrine) autoinjectors has been affected due to manufacturing delays from the manufacturer in the US, Meridian Medical Technologies, a Pfizer company. This means that there is currently a shortage of EpiPen® Jr as noted on the TGA website https://apps.tga.gov.au/prod/MSI/search and normal supply is expected by 31 January 2020.  Mylan will continue to provide updates about the supply situation and their latest update can be viewed here pdfNotification of EpiPen Jr supply constraint Nov 201991.72 KB.

Please note that supply of EpiPen® 300mcg adrenaline (epinephrine) autoinjectors is NOT affected. 

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Parliamentary Inquiry into Allergies and Anaphylaxis

19 November 2019

There were two hearings this week for the Parliamentary Inquiry into Allergies and Anaphylaxis, in Melbourne on Monday 18th November 2019 (10am-5pm) and in Sydney on Tuesday 19th November 2019 (9.30-4.30pm). Hansard records of the hearings will soon be on the APH website

ASCIA lodged a submission to the Inquiry on 24 October 2019 and an opening statement was presented by the ASCIA President, Dr Brynn Wainstein at the Tuesday hearing, conducted by the House of Representatives Standing Committee on Health, Aged Care and Sport committee. Both documents can be viewed on the ASCIA website allergy.org.au/about-ascia/ascia-initiatives#collab
 

More than twenty ASCIA members were involved as witnesses in the Sydney and Melbourne hearings, including:

  • Four ASCIA Council members (Dr Lara Ford, Dr Preeti Joshi, Dr Brynn Wainstein and Dr Melanie Wong).
  • Four past ASCIA Presidents - Professor Tony Basten AO, Professor Jo Douglass, Professor Connie Katelaris AM and Dr Melanie Wong.

Two ASCIA staff members (Jill Smith, ASCIA CEO and Sandra Vale, National Allergy Strategy Manager) were also involved as witnesses for the Sydney hearing. 

The ASCIA submission focuses on the following ten key issues: 

  1. Support is required for quality allergy and anaphylaxis educational and training resources for patients, carers and health professionals.
  2. Support is required for quality, evidence-based allergy and anaphylaxis education and training for all health professionals.
  3. Improved access to timely, equitable and quality care for patients with allergic disease is needed.
  4. Improved access to skin testing reagents for allergy diagnosis by clinical immunology/allergy specialists is needed.
  5. A specific food allergen challenge MBS item number is needed.
  6. A specific drug allergen challenge MBS item number is needed.
  7. Improved access to evidence-based and cost-effective treatments is needed.
  8. Support is required for further research into all allergic diseases.
  9. Support is required for further research into food allergy treatments including oral immunotherapy.
  10. National anaphylaxis and drug allergy registers do not exist.

Individuals or organisations wish to make a submission the deadline has recently been extended to Friday 29 November 2019 and hearings will be held in other cities.

For details go to aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport    

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ASCIA 2019 Conference Report

12 September 2019

The 30th ASCIA Annual Conference was a great success, with more than 600 registrations and an acclaimed program. Congratulations and thank you to Prof Michaela Lucas and the organising committee (Dr Chris Bundell, Rachael Dunn, A/Prof Mina John, A/Prof Richard Loh, Prof Dominic Mallon, Dr Tracy Markus, Dr Patricia Martinez, Dr Andrew McLean-Tooke, Valerie Noble, Dr Richard Nolan, Ingrid Roche, Sandra Vale).

Thank you to ASCIA staff led by Jill Smith (Rikki Dunstall, Michelle Haskard, Nadene Dorling) and ICMSA staff led by Rebecca Smith, who all worked tirelessly behind the scenes on the event logistics. Whilst ASCIA Annual Conferences are challenging to organise, they are also exciting events which provide an international standard of education and networking opportunities, that ASCIA members can look forward to each year.

Highlights of the ASCIA 2019 Conference included:

  • The ASCIA 2019 Conference opening address by the Minister for Health, the Hon Greg Hunt MP, including and announcement that a parliamentary inquiry into allergic diseases will be undertaken by the Standing Committee on Health. For details go to Allergies and anaphylaxis under the microscope
  • A highly acclaimed program that included talks by more than 60 presenters, including ten international speakers (Prof Mark Boguniewicz, Prof Mariana Castells, Prof Timothy Craig, Prof Evan Dellon, Prof Philippe Eigenmann, Dr Tomaz Garcez, A/Prof Matthew Greenhawt, Prof Peter Hellings, Prof Hugh Sampson, A/Prof Carina Venter.)
  • An excellent Antibiotic and Allergy expert panel discussion chaired by Dr Norman Swan, and supported by the University of Western Australia.
  • More than 120 abstracts submitted for posters, clinical grand rounds and clinical research presentations. Congratulations to the poster and clinical grand rounds award winners, who are listed at www.allergy.org.au/health-professionals/awards-grants/ascia-award-grant-scholarship-recipients 
  • Presentations of five AIFA research grants (a total of $120,000) at the closing function.
  • A record number of sponsors and exhibitors, which continue to contribute to ASCIA Annual Conferences.
  • Participation of eight past ASCIA Presidents (Prof Connie Katelaris AM, A/Prof Robert Heddle, Prof Dominic Mallon, Dr Ray Mullins, Prof Jo Douglass, Dr Melanie Wong, A/Prof Richard Loh, Dr William Smith), as well as the current ASCIA President and President Elect (Dr Brynn Wainstein, Prof Michaela Lucas). 
  • The 14th annual Basten Oration presented by A/Prof Richard Loh www.allergy.org.au/conferences/ascia-annual-conference/annual-ascia-basten-oration
  • An engaging Welcome to Country from Marie Taylor. 
  • An outstanding gala dinner in the stunning Postal Hall at the historic State Buildings in Perth.

The ASCIA 2019 Conference was held in conjunction with the highly successful sixth annual CFAR Symposium, the eighth Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) Symposium and the third ASCIA-DAA CAL (Centre for Advanced Learning) Food Allergy and Intolerance Course for Dietitians. 

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ASCIA 2019 Conference Update

30 August 2019

ASCIA 2019 CONFERENCE APP 

To improve your meeting experience, ASCIA has partnered with myINTERACT, to provide delegates with an ASCIA 2019 Conference App. Downloading the App before the conference is recommended, to ensure convenient access to all the information you may need.  The myINTERACT App is available in the Apple and Google app stores and instructions are available here pdfASCIA 2019 APP Use Guide4.02 MB

Once connected to the App you will have access to :

  • Abstracts, posters and speaker bios.
  • An interactive program with the ability to take notes.
  • A competition to win free ASCIA 2020 Conference registration with our Sponsor and Exhibitor Passport.
  • Interactive sessions with live Q&A, polling, and in-session evaluations. 

ANTIBIOTICS AND ALLERGY EXPERT PANEL

Dr Norman Swan will host an Antibiotics and Allergy expert panel in conjunction with the ASCIA 2019 Conference, on Thursday 5 September at 5.15 pm to 6.15 pm in Bellevue Ballroom 2, Perth Convention and Exhibition Centre.  This event is supported by the University of Western Australia and is open to the public, as well as ASCIA 2019 Conference delegates.  pdfASCIA_2019_Drug_Allergy_Expert_Panel277.49 KB

If you are not registered for the ASCIA 2019 Conference and wish to register for this free event go  to: 

SPONSORED DINNERS

Several  sponsored dinner meetings are being held on Tuesday, Wednesday and Friday nights during the ASCIA 2019 Conference week. Whilst there are no fees for these events, registrations are required. For details go to

We look forward to seeing you in in Perth next week.

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Updated ASCIA Guidelines for the acute management of anaphylaxis

30 August 2019

ASCIA Guidelines for the acute management of anaphylaxis have been updated, and the main changes are as follows:

  • Adrenaline dosage in infants, and addition of infant positioning image and wording.
  • Adrenaline dosage in pregnant women.
  • Under signs of anaphylaxis, “sudden” has been added to “Wheeze or sudden persistent cough” and an explanation how this differs to the cough in asthma.
  • Under signs of anaphylaxis, addition of “injected drug (medication) allergy” to read “Abdominal pain, vomiting (for insect sting or injected drug (medication) allergy”.

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ASCIA 2019 Conference Week: Sponsored dinner meetings

23 August 2019
In addition to the outstanding ASCIA 2019 Conference scientific program, the ASCIA 2019 Gala Dinner and the ASCIA Welcome/Closing Functions, the following  sponsored dinner meetings are being held on Tuesday, Wednesday and Friday nights during the ASCIA 2019 Conference week. Whilst there are no fees for these events, registrations are required, as shown below.

TUESDAY 3 SEPTEMBER 2019

DBV: Update on Investigational Epicutaneous Immunotherapy (EPIT) in Clinical Trials
Tuesday 3 September 2019, 6.00-9.00 pm
Fraser’s Restaurant, Kings Park
Speakers: Prof Hugh Sampson, Prof Dianne Campbell, Maria Said
To register email Ryan Chang This email address is being protected from spambots. You need JavaScript enabled to view it. 
 
Mylan: Allergic Diseases of the Airways – Novel Insights
Tuesday 3 September 2019, 6.30-9.15 pm
Kailis Bros, 101 Oxford Street, Leederville
Speakers: Prof Peter Hellings, Prof Pete Smith
To register email Lindsay Taylor This email address is being protected from spambots. You need JavaScript enabled to view it. or phone 61 419 644 563
 
Abbott:  Eosinophilic Oesophagitis (EOE) Symposium
Tuesday 3 September 2019
Old Brewery on the Swan River, 173 Mounts Bay Rd, Perth
Speakers: A/Prof Carina Venter, Prof Evan Dellon
This event is full, so no more registrations are possible.

WEDNESDAY 4 SEPTEMBER 2019

The following events are being held directly after the ASCIA 2019 Conference Welcome Function (including poster rounds) on Wednesday 4 September 2019, 4.30-6.00 pm
 
ASCIA 2019 Conference Dinner Meeting for Trainees and Supervisors 
Supported by CSL Behring
Wednesday 4 September 2019, 6.30-9.30 pm 
Perth Convention and Exhibition Centre, Liberty Bar
To register email Rikki Dunstall This email address is being protected from spambots. You need JavaScript enabled to view it. 
 
Abbott: Allergy Nurses Dinner Meeting
Optimising eczema care to reduce the risk of food allergy: A multidisciplinary approach
Wednesday 4 September 2019, 6.00-9.00 pm
Parmelia Hilton Hotel
Speakers: Dr Meera Thalayasingam, Jemma Weidinger
To register email Fiona Bannister This email address is being protected from spambots. You need JavaScript enabled to view it. 
 
Novartis: Targeted Immune Pathways in Asthma – an Immunology Update
Wednesday 4 September 2019, 6.30-9.00pm
Parmelia Hilton Hotel
Speakers: Dr Li Ping Chung, Prof Jo Douglass, Prof Philip Thompson
To register email Alex Sharpe This email address is being protected from spambots. You need JavaScript enabled to view it.
pdfASCIA 2019_Novartis_dinner_meeting_invitation_Sep_4173.04 KB 

FRIDAY 6 SEPTEMBER 2019

Abacus dx: Allergy dinner
Friday, 6th September 2019, 6.00-8.00pm (The night before ASCIA Immunopathology Day)
Room 6, Perth Convention and Exhibition Centre 
Speakers: Dr Chris Bundell, Maria Bello, Prof Janet Davies, Chiara Campo, Dr Stephanie Richard 
 

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ASCIA 2019 Conference deadlines have been extended to 22 July

In response to several requests, the ASCIA 2019 earlybird registration and abstract submission deadline has been extended by one more week, to midnight on Monday 22nd July. Please note that no further extensions will be possible.

To register at the discounted earlybird rate go to https://www.ascia2019.com/registration.php

To submit an abstract go to https://www.ascia2019.com/abstracts.php  

Abstracts are invited for:

  • ASCIA 2019 posters (displayed from Wednesday 4 to Friday 6 September 2019)
  • ASCIA 2019 clinical grand rounds oral presentations (for advanced trainees only)
  • ASCIA 2019 short oral presentations for ASCIA 2019 Conference (clinical research)
  • CFAR Symposium short oral “hot publication” presentations (for food allergy research recently published or accepted for publication in a peer-reviewed journal). 

Acceptance of abstracts will be confirmed in August and they will be published online in the Internal Medicine Journal (IMJ) in September 2019.

ASCIA-ANZAAG Drug Allergy Symposium 

This Symposium is being held on Friday afternoon, as part of the ASCIA 2019 Conference.  The 8th Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) Symposium on “Perioperative allergy – A sensitive subject” is also being held in Perth, on Saturday 7 September 2019. To register for the Saturday Symposium go to http://www.anzaag.com/Events.aspx

Dietitians’ Course and Day

ASCIA-DAA Centre for Advanced Learning (CAL) Dietitians Course is a two day course on food allergy and intolerance will be held on Friday 6 and Saturday 7 September 2019. Pre-requisites for this course include completion of ASCIA anaphylaxis, food allergy, and food service etraining courses, all of which are available online free of charge. For information and to register for this course go to 

https://daa.asn.au/member-community/blog/centre-for-advanced-learning/food-allergy-and-intolerance/

The ASCIA Dietitians Day is being held on Thursday 5 September as part of the ASCIA 2019 Conference.  There are no pre-requisites, but it is generally of most benefit to dietitians with experience with food allergy. Delegates can register just for this day, or combine it with day registration for Wednesday 4 September, registration for the CFAR Symposium on Tuesday 3 September and registration for the ASCIA-DAA CAL course (see above). 

To view the program go to https://www.ascia2019.com/downloads/ASCIA2019_Program_Dietitians_Day.pdf

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