Information updates

ASCIA’s involvement in the National Allergy Council Shared Care project includes:

• Advocacy to increase access to care, including food and drug challenges, to improve diagnosis and management of allergic conditions.
• Education, training and mentorship of health professionals, to improve knowledge and experience in managing allergic conditions.

Current areas of focus for ASCIA are:

• ASCIA workforce surveys for Full and Associate Medical ASCIA members will be conducted from mid December 2023 to February 2024. The data from these surveys will be used to advocate for improved access to allergy/immunology education, training and services, include in ASCIA submissions for MBS item numbers for food and drug challenges, and identify regions with significant waiting times for patient appointments.   

• An ASCIA education and training survey https://www.allergy.org.au/hp is currently being conducting that is directed towards institutions and results will be used to make recommendations about what anaphylaxis and training should be included in health professional courses and ways to deliver the training.

• ASCIA e-training courses for health professionals https://etraininghp.ascia.org.au/ continue to be well utilised, and reports from mandated 2023 feedback surveys will guide course updates in 2024. A report from 2022 surveys has already been developed and is available at https://www.allergy.org.au/ascia-reports

• ASCIA website resources https://www.allergy.org.au/ are highly utilised by health professionals, patients and carers, attracting more than 3 million pageviews and 2 million visits from 1.5 million users (unique visitors) each year. ASCIA is constantly updating its website and online resources, to improve content, access and the user experience, and this will be a major focus in 2024.

• ASCIA communications include monthly e-newsletters https://www.allergy.org.au/about-ascia/updates/archive/listing, regular website information updates https://www.allergy.org.au/about-ascia/info-updates and social media posts based on the newsletter content. In 2024 ASCIA will be developing a communications plan to increase the reach of its communications to health professionals.

• ASCIA online meetings https://www.allergy.org.au/conferences/online-meetings have expanded in 2023, and will continue to expand in 2024, to improve case based learning, which has the potential to be expanded for other health professionals.

• The ASCIA Food Allergy and Adverse Food Reactions Courses for Dietitians https://www.allergy.org.au/members/dietitians has been held twice in 2023, in March (Melbourne) and November (Sydney). The next course is scheduled for May 2024 in Adelaide, South Australia.

• The ASCIA 2023 Conference https://www.allergy.org.au/conferences/ascia-annual-conference was held in early September in Sydney, and included significantly more content that is targeted to improve knowledge in managing allergic disease for a range of health professionals. The ASCIA 2024 Conference will continue to include more sessions for a range of health professionals.

ASCIA members and staff also participated in the National Allergy Council Shared Care meetings on Friday 10 November 2023 and Saturday 11 November 2023 in Sydney.

The previous ASCIA Update for the Shared Care project is available at https://www.allergy.org.au/about-ascia/info-updates/ascia-progress-report-nac-shared-care-for-allergy-project

Jorveza® (budesonide) is an orally disintegrating tablet for the treatment of eosinophilic oesophagitis (EoE) in adults, that was first listed on the Pharmaceutical Benefits Scheme (PBS) on 1 May 2022. Several changes have been made to PBS prescribing criteria (from 1 November 2023) that should enable easier access to Jorveza for all patients with EoE, particularly those being treated in the public health system, but also in regional or remote areas where access to a Gastroenterologist may be limited. These changes have now been recommended by the Pharmaceutical Benefits Advisory Committee (PBAC) and implemented by PBS, with prescribing criteria changes to be implemented on 1 November 2023. 

ASCIA made a submission in January 2023  to support the main changes requested:

• For ‘other specialists experienced in the management of EoE’ to be able to prescribe Jorveza (whilst respecting the need for histological confirmation of the condition prior to initiating treatment - through endoscopic tissue sample collection and analysis. 
• The requirement for re-examination by endoscopy at 8 -10 weeks to confirm remission was considered too rigid (particularly within the public health system) meaning that some patients were unable to access treatment simply due to these scheduling of endoscopy limitations.

In summary these changes affect three treatment ‘phases’ as listed below. The new ‘First Continuing Treatment’ phase allows patients to stay on treatment (if it is providing a benefit) whilst waiting for the 2^nd histology for confirmation of remission, and should ensure doctors feel confident to commence treatment without being concerned by when they can schedule the 2^nd endoscopy.

Treatment Phase 1: Initial treatment - Induction of remission

Clinical criteria:

Patient must have a history of symptoms of oesophageal dysfunction,

AND

Patient must have eosinophilic infiltration of the oesophagus, demonstrated by oesophageal biopsy specimens obtained by endoscopy confirming the presence of at least 15 eosinophils in at least one high power field (hpf); corresponding to approximately 60 eosinophils per mm² hpf,

AND

Patient must not receive more than 90 days of treatment under this restriction.

Treatment criteria:

Must be treated by a prescriber who is either: (i) gastroenterologist, (ii) surgeon experienced in the management of patients with eosinophilic oesophagitis, (iii) physician experienced in the management of patients with eosinophilic oesophagitis

**NEW** Treatment Phase 2: First continuing treatment - until remission is confirmed

Clinical criteria:

Patient must have previously received PBS-subsidised initial treatment with this drug for this condition,

AND

Patient must have demonstrated an adequate response to treatment with this drug for this condition,

AND

Patient must not receive more than 36 weeks of treatment under this restriction.

Treatment criteria:

Must be treated by a prescriber who is either: (i) gastroenterologist, (ii) surgeon experienced in the management of patients with eosinophilic oesophagitis, (iii) physician experienced in the management of patients with eosinophilic oesophagitis, (iv) medical practitioner who has consulted at least one of the above-mentioned prescriber types.

Treatment Phase 3: Subsequent continuing treatment - Maintenance of remission

Clinical criteria:

Patient must have previously received PBS-subsidised treatment with this drug for this condition under the First continuing treatment restriction,

AND

Patient must have documented evidence of having achieved histologic remission while receiving Initial and First continuing PBS-subsidised treatment with this drug for this condition, defined as a peak eosinophil count of less than 5 eosinophils per high power field (hpf), corresponding to less than 16 eosinophils per mm² hpf on oesophageal biopsy,

AND

The condition must not have progressed while being treated with this drug.

Treatment criteria:

Must be treated by a prescriber who is either: (i) gastroenterologist, (ii) surgeon experienced in the management of patients with eosinophilic oesophagitis, (iii) physician experienced in the management of patients with eosinophilic oesophagitis, (iv) medical practitioner who has consulted at least one of the above-mentioned prescriber types.

These changes should  provide benefits to patients with  EoE by improving ease of access to Jorveza as the only TGA registered and PBS reimbursed treatment for EoE.

Thank you to the the faculty and delegates who participated in the ASCIA Food Allergy and Adverse Food Reactions Course in Sydney, in Sydney 23rd-24th November 2023

The next course is scheduled for early May 2024 in Adelaide, South Australia.

For information about this course go to https://www.allergy.org.au/members/dietitians

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Shingrix^®  is a varicella zoster virus recombinant vaccine that can provide protection from herpes zoster (shingles) and post-herpetic neuralgia (long-term nerve pain). Funding of Shingrix from 1 November 2023 was announced by the hon Mark Butler (Minister for Health and Aged Care) on Sunday 8^th October 2023.  The extended vaccine eligibility for 'high/medium risk' immunocompromised individuals iwill be considered at the November 2023 meeting of the Pharmaceutical Benefits Advisory Committee (PBAC), so an announcement about this will be made after the transition from Zostavax to Shingrix on 1 November 2023.

ASCIA made a submission in January 2023  to support the PBS listing of Shingrix.

For details refer page 22 - https://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/agenda/november-2023-pbac-meeting  

From 1 November 2023 funding of Shingrix will be available for:

1. All Australians over 65 (and over 50 for First Nation Australians), which includes all immunocompromising conditions above those ages.

2. Immunocompromised adults aged 18 years and over with the following medical conditions;  haemopoietic stem cell transplant, solid organ transplant, haematological malignancy and advanced or untreated HIV.

https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/shingles-vaccine-now-free-for-nearly-5-million-australians

Once funding of Shingrix vaccination for other immunocompromised individuals is confirmed, ASCIA will finalise and publish ASCIA Consensus Recommendations: Vaccination with Shingrix to Prevent Shingles for Immunosuppressive Conditions and Therapies on the ASCIA website https://www.allergy.org.au/hp/papers/immunodeficiency

People who are involved in the development and/or delivery of tertiary healthcare degrees in Australia are invited to complete a survey about allergy training. ASCIA is conducting this survey as part of the National Allergy Council Shared Care for Allergy Project.

The survey is available here from 17 October to 17 February 2024 and will take approximately 10 minutes to complete.

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ASCIA anaphylaxis e-training for children's education and care services has been approved by the Australian Children's Education and Care Quality Authority (ACECQA) until October 2026. 

The ASCIA course is now published on ACECQA’s approved anaphylaxis management course list https://www.acecqa.gov.au/qualifications/nqf-approved (Section 3. Search the NQF approved qualifications list - under general search enter "ASCIA October 2026"):

ACECQA is an independent statutory authority that assists governments in implementing the National Quality Framework for early childhood education and care throughout Australia.  The content of the previous version of the ASCIA course was ACECQA approved until the end of September 2023.

ASCIA anaphylaxis e-training for children's education and care services will remain on ACECQA’s approved list until the end of September 2026 unless it undergoes significant changes. 

Feedback reports on ASCIA anaphylaxis e-training courses are available at https://www.allergy.org.au/ascia-reports