Information updates

Updated 2020 versions of ASCIA Action Plans are now available

10 January 2020

ASCIA Action Plans for Anaphylaxis (RED) and ASCIA Action Plan for Allergic Reactions (GREEN) ASCIA Action Plans for Anaphylaxis (RED) and ASCIA Action Plan for Allergic Reactions (GREEN) have been updated in January 2020 and are available at www.allergy.org.au/hp/anaphylaxis/ascia-action-plan-for-anaphylaxis

The main update to ASCIA Action Plans was to change the weight range for adrenaline autoinjectors (150 mcg) from 10-20kg to 7.5-20kg, to be consistent with ASCIA Guidelines and consensus expert opinion. For more information about the changes to ASCIA Action Plans go to www.allergy.org.au/hp/anaphylaxis/action-plans-for-allergic-reactions-faq   

Whilst the 2020 ASCIA Action Plans are the latest versions, the 2018 and 2017 versions of ASCIA Action Plans are still valid for use throughout 2020 and 2021, or until the due date for review stated on the plan. The 2020 versions of ASCIA Action Plans will be included in updated ASCIA anaphylaxis e-training courses around mid-January 2020. 

ASCIA First Aid Plans for Anaphylaxis (ORANGE) have replaced the general versions of ASCIA Action Plans for Anaphylaxis (ORANGE) and are also available at www.allergy.org.au/hp/anaphylaxis/ascia-action-plan-for-anaphylaxis and translated versions are available at www.allergy.org.au/hp/anaphylaxis#ta5  

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ASCIA Highlights 2019

3 January 2020

As we enter a new decade in 2020, we take this opportunity to wish you a happy new year and reflect on the highlights of 2019. 

ASCIA 2019 HighlightsThere were several highlights in 2019 for ASCIA, including:

  • Highly acclaimed and successful meetings - ASCIA Annual Conference, ASCIA Primary Immunodeficiency (APID) training meeting and the TAPID (Transplantation and PID) meeting.
  • Updating of more than 80 online educational resources on the ASCIA website, which attracted over 1.8 million visits from 1 July 2018 to 30 June 2019.  
  • Continuing increase in ASCIA e-training course registrations – over 100,000 registrations from 1 July 2018 to 30 June 2019.  
  • More than ten submissions, including the parliamentary inquiry into allergies and anaphylaxis.
  • Awarding of $120,000 in AIFA grants for allergy and immunology research.
  • The first meeting of National Immunodeficiency Strategy stakeholders.
  • National launch of National Allergy Strategy Nip Allergies in the Bub food allergy prevention project.

For a summary of the highlights and a preview of plans for 2020 go to www.allergy.org.au/about-ascia/highlights 

From an operational perspective, a major highlight of 2019 was the move to a new office suite which has enabled ASCIA to sustain its operations. In 2020 we will develop a new ASCIA sustainability plan, to support ASCIA training programs and further reduce ASCIA’s impact on the environment. In the meantime you can read about ASCIA’s sustainability initiatives at www.allergy.org.au/about-ascia/ascia-initiatives#sustain 

In 2019 there was also some extremely sad news, when Dr Velencia Soutter passed away In September 2019. Dr Soutter was a long term ASCIA member who was passionate about her family and work in paediatric allergy, and her loss she will be felt far and wide. 

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EpiPen® supply update

2 January 2020

Mylan, the supplier of 150 mcg EpiPen® Jr and 300 mcg EpiPen® adrenaline (epinephrine) autoinjectors in Australia and New Zealand, recently advised the Therapeutic Goods Administration (TGA) of the outcomes of testing of EpiPen® products. Meridian Medical Technologies, the manufacturer of EpiPen® products, has undertaken a thorough investigation into the presence of very low levels of another medicine, pralidoxime, in EpiPen® Jr products. This included testing of batches of both the 150 mcg and 300 mcg versions of the product. The investigation has identified that a batch of 300 mcg EpiPen® (batch number 9KB643), which is available in Australia, also contains trace levels of pralidoxime. However, the trace levels in this batch are in the nanogram range (one billionth of a gram), and these levels are considered to be negligible.

The TGA has reviewed the outcomes of the investigation and is satisfied that these products meet the required standards for safety. The manufacturing issue has now been fully corrected and production has resumed.

EpiPen® products are critical, life-saving medicines. The TGA is committed to facilitating the ongoing availability of these medicines for Australians and continues to work closely with Mylan to ensure supply.

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NPS MedicineWise Immunoglobulin Consortium

16 December 2019: 

A new grant will fund a project which will increase national efforts to improve health outcomes for patients prescribed immunoglobulin products. This project involves the National Prescribing Service (NPS) MedicineWise and a consortium of health organisations, including ASCIA and SHPA (Society of Hospital Pharmacists of Australia).  The grant was awarded to NPS MedicineWise under the Australian Government’s Value in Prescribing program (Immunoglobulin Products stream). 

The funding will see NPS MedicineWise working with the National Blood Authority and  stakeholders to develop and deliver educational resources, tools and interventions to support clinicians in optimising the use of precious immunoglobulin products, as well as to educate consumers on the role of these products. The project may expand to include other consortium partners and is being managed in collaboration with the Australian Government Department of Health and the National Blood Authority.

The substantial annual growth in immunoglobulin use, both in Australia and internationally, together with the relatively high cost of immunoglobulin products and the potential for supply shortages mean that good governance, education and quality improvement are essential to ensure that use remains appropriate, consistent and evidence-based.

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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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