Immunotherapy resources

Information for those already on immunotherapy

 

IMPORTANT The information provided is of a general nature and should not be used as a substitute for professional advice. If you think you may suffer from an allergic or other disease that requires attention, you should discuss it with your family doctor. The content of the information articles and all illustrations on this website remains the intellectual property of Dr Raymond Mullins and cannot be reproduced without written permission.

ALLERGEN IMMUNOTHERAPY TABLETS FOR HAY FEVER and ALLERGIC ASTHMA – obtaining more supplies

Any doctor can write prescriptions to initiate therapy or continue maintenance therapy:

Oralair grass tablets (taken ~ June through to December)

Initiation prescription (3+28) tablets

Maintenance treatment (boxes of 30 with 5-6 repeats; or boxes of 90 with two repeats)


Note re cost of Oralair: Boxes of 90 are generally less expensive per month, but if you get rebates for medication from your private health fund, you usually get a rebate per box, which means that multiple boxes of 30 might be less expensive. Talk to your health fund and pharmacist before making a decision about which prescription to ask for.


Actair dust mite tablets (taken daily all year round)

Initiation prescription (3+28) tablets

Maintenance treatment (boxes of 30 with 5-6 repeats; or boxes of 90 with three repeats).


* Even though manufactured by the same company, there does not appear to be a major price difference between boxes of 30 and 90 for Actair tablets, when calculated as cost/month.


Acarizax dust mite tablets (taken daily all year round)

These can be prescribed in boxes of 30 with 11 repeats or boxes of 90 with three repeats. There does not appear to be a significant price difference per month based on box size, but the same issues about private health rebates/box apply.


Immunotherapy tablet instructions (downloadable documents)

SLIT_Patient_Oralair_June 2022.pdf

SLIT_Patient_ACTAIR_April 2020.pdf

SLIT_Patient_ACARIZAX_April 2020.pdf



ALLERGEN IMMUNOTHERAPY INJECTIONS FOR HAY FEVER and ALLERGIC ASTHMA - obtaining more supplies

As it takes up to 2-3 months to obtain more allergen from Europe, you need to always think a few months ahead.

•Each bottle contains enough liquid for 4-5 injections/4-5 months. Thus in most cases it is probably better to order 2 maintenance bottle/time = 9-10 injections = 9-10 months supply Immunotek (ALK) brand distributed by AMSL) or ~12 months supply (Ferrer Pharma: Diater brand).

•When you finish the first bottle (leaving 1 bottle left) you order another 2 bottles so you always end up having 10-12 months supply in the fridge. Put this on your calendar and in your diary so you don’t forget. By the time the new supply arrives, you are alraedy half way through the second bottle of the first supply box.

•If you have previously been supplied with order forms, these all have 6 repeats authorised for 5 years. The pharmaceutical companies will also have copies on file.

•Any GP can also write order forms if they contact the pharmaceutical company directly and ask for guidance to continue treatment that has already been initiated.

•Ensure that the delivery address is the GP, NOT DR Mullins



ADMINISTRATION FORMS FOR HAY FEVER IMMUNOTHERAPY INJECTIONS

I always post your GP at least 2 copies and give you a backup copy too in case the GP loses it or scans it into their computer system and can’t find a hard copy.

•If the GP cannot find their copy, tell them to check they have not scanned it into their system, or give them a copy of your backup sheet.

•But in reality, it is only a piece of paper. Apart from a 20% reduction in dose when starting a new bottle (and a reminder note to say when to order more allergen), the dose does not change.

•As long as you order more injections when you have finished your first bottle, you should be fine.

•Injection templates without more specific individual details are listed below.... in case the GP practice has lost the paper, they can download generic paperwork here.


INJECTION ADMINISTRATION TEMPLATES (downloadable)

Alutek Start Protocol.pdf

Alutek Maintenance Protocol.pdf


Alxoid Start Protocol.pdf

Alxoid MAINTENANCE.pdf


Clustek_Clustek MAX Start protocol.pdf

Clustek_Clustek MAX Maintenance protocol.pdf


Diater Allergoid START Protocol.pdf

Diater Allergoid MAINTENANCE Protocol.pdf



PATIENT INFORMATION ON IMMUNOTHERAPY

General information on immunotherapy tablets and injections

Immunotherapy_General Information1Sept_2023.pdf


Patient Injection Start instructions

SCIT_Patient_START_May2019.pdf


What to do if immunotherapy works and what to do if it does not:

2023_Patient_ONGOING SCIT_SLIT_Aug 2023.pdf



AUSTRALIAN ALLERGEN EXTRACT SUPPLIERS

AMSL AUSTRALIA (Alutek, Alxoid, Clustek injections; Oraltek oral liquids)

https://www.amsl.com.au/products/allergy/

https://www.amsl.com.au/contact-amsl/


FERRER PHARMA (Diater injectable and oral extracts)

https://ferrerpharma.com.au

https://ferrerpharma.com.au/contact/


STALLERGENESGREER (Oralair grass and Actair dust mite tablets, insect venom extracts)

https://www.stallergenesgreer.com/australia


CSL Sequiris (Acarizax dust mite tablets, Grazax grass tablets)

https://www.cslseqirus.com.au




PRESCRIPTIONS and RECONSTITUTION INSTRUCTIONS for HYMENOPTERA INSECT VENOM EXTRACTS (honey bee, paper wasp/Polistes or Yellow jacket/European wasp)

  1. Any GP can write initial and ongoing PBS subsidized prescriptions for these products. The prescription is “Hymenoptera (honey bee OR Paper wasp OR Yellow Jacket) 550ug”.

  2. Check the label at the pharmacy as the packaging is identical except for the venom name on the label.

•The product box contains 2 bottles; a freeze-dried venom powder and a sterile diluent bottle. If you take 5.5ml of the sterile diluent liquid and put into the freeze-dried venom powder bottle, you now have a venom concentration of 100 ug/ml for ongoing therapy.

•For those initiating therapy, however, one needs to start at 1/100 of that concentration which requires a doctor to get two diluent bottles from Stallergenesgreer, as above. These USED to be contained in the venom kit; now they need to be purchased separately. Contact Stallergenes to sort out how to get these ampoules.


Downloadable venom protocol and reconstitution instructions: clink to download below

Venom start protocol.pdf

Venom maintenance protocols.pdf


IMMUNOTHERAPY: Frequently asked questions


Has it worked?

If you have found treatment to be effective, the best advice is to continue maintenance immunotherapy tablets or injections for at least 3-5 years. Follow-up studies are now showing long-term benefit many years after stopping, at least 7 years from grasses and at least 3 years (studies so far) for dust mite immunotherapy.


Medication can be used as well

Unfortunately, there is no treatment that is 100% effective for 100% of people. As a rough rule of thumb, 65-75 % of people seem to benefit for a similar proportion of their symptoms. So you can still use medications if you wish.


Allergen storage

Tablets are stored at room temperature. Injectable extracts should be refrigerated but not frozen. They will be fine if stored at room temperature by mistake for a few days but need to be replaced if they are frozen.


Side effects from immunotherapy

Don’t forget; an antihistamine a few hours before the injections reduces side effects and increases safety. It is wise to take antihistamines for the first few weeks of oral tablets as well, for the same reason.


Using expired injectable extracts

Every now and again, people forget to order more allergen and run out, or there are unexpected gaps so that allergen is till left in the bottle but the expiry date has passed. Don’t get too worried. An expired extract may be slightly less potent but will still be effective many months after the expiry date. So keep using the old expired allergen, but order a new supply and swap over when the new bottles arrive.


Check injectable allergen bottle delivery

Check your credit card statement and check that the 2 bottles have arrived.


Note: Injection frequency

If you have the injections every 4 weeks, you will end up having 13 injections/year, and run out of allergen a month earlier than you expected! The Administration sheet for your doctor also gives you a warning, as long as you keep an eye on it.


I stopped immunotherapy by mistake; what do I do?

TABLETS: just restart with your GP. For some brands like Oralair and Actair, you will need a script from the GP for an initiation pack (3+28).

INJECTIONS: Just dig up the old paperwork provided in the past and follow the restart protocol (lower dose first) and keep going. If you have run out of allergen, just order more and use the old paperwork. You do not need more pieces of paper from me.


If it used to work and now it doesn’t…

If your symptoms start to return while on immunotherapy tablets or injections, even though it used to help quite well, there are 2 things to consider. The first is that you have developed a new allergic trigger (uncommon but possible) or are now exposed to a new allergic trigger (eg. You bought a pet). The second is that you have a second problem, like nasal polyps or sinus infection.


What if it does not work at all?

There are a few options:

1. Continue more of the same for longer; immunotherapy is usually better in the 2nd year than the first.

2. Change method. Eg. Injections to tablets or vice versa, or allergoid (less hassle) injections to the traditional method.

4. Consider whether there is another problem that has developed. Eg. A new allergy (eg. Moving to an older dusty house, purchasing a cat, sinus infection, nasal polyps

Last reviewed 7 February 2024

2023_Patient_ONGOING SCIT_SLIT_Aug 2023.pdf on what to do if immunotherapy works and what to do if it does not. Click to download the pdf. Similar information is listed below.

The resources below are for those who are currently on immunotherapy.

What to do if you did NOT get around to organising a review appointment after having started immunotherapy in 2023?


Note that treatment is usually better in the second year, and that improvement, even if you still need medicines, is still an improvement. As a rule, tablets are more effective than injections. So first, decide if immunotherapy is helping reduce symptoms severity and the need for medication.


IF TABLETS WORKED

Dust mite tablets: If you are happy with dust mite tablet immunotherapy, any GP can do prescriptions. See information below on how to get more supplies. Take them daily all year round for a total of 3 years.

Oralair grass tablets: If you are happy with the treatment, which is usually better in the second year than the first, restart again ~ June with your GP, and take them daily for 6-7 months. Repeat this process for 3 years running. Any GP can do prescriptions – see below.


IF TABLETS DID NOT WORK

You have a few options; keep taking them for another year (the best advice) and then decide or perhaps switch to injections. If so, I will not be available to prescribe, initiate or supervise this treatment.


IF INJECTIONS WORKED

Keep going for a total of 3 years. The dose does not change/month so you do not really need more administration forms, but if they are desired, links to generic pdf templates are on this web page. Your original order form has 6 repeats authorised to keep you going for another few years so you can order more using your old order form, and keep going BUT change the delivery address to your GP, NOT DR Mullins. In addition, your GP can contact the distributors and ask for THEIR paper order forms too, and the administration people there will be able to advise on the right codes to help ongoing orders of the same extract.


IF INJECTIONS DID NOT WORK

Again there are two options: order more and give it another year and then decide OR switch to tablets (more expensive but more effective). Your GP could initiate tablet immunotherapy if they felt comfortable doing so or refer you elsewhere to do so.