BSACI guideline for the set-up of penicillin allergy de-labelling services by non-allergists working in a hospital setting.

The Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and a committee of experts and key stakeholders have developed this guideline for the evaluation and testing of patients with an unsubstantiated label of penicillin allergy. The guideline is intended for UK clinicians who are not trained in allergy or immunology, but who wish to develop a penicillin allergy de-labelling service for their patients. It is intended to supplement the BSACI 2015 guideline "Management of allergy to penicillin and other beta-lactams" and therefore does not detail the epidemiology or aetiology of penicillin allergy, as this is covered extensively in the 2015 guideline (1). The guideline is intended for use only in patients with a label of penicillin allergy and does not apply to other beta-lactam allergies. The recommendations include a checklist to identify patients at low risk of allergy and a framework for the conduct of drug provocation testing by non-allergists. There are separate sections for adults and paediatrics within the guideline, in recognition of the common differences in reported allergy history and likelihood of true allergy.

Cost-effectiveness of personalized omalizumab dosing for chronic spontaneous urticaria.

The licensed dose for omalizumab within Europe for chronic spontaneous urticaria (CSU) is 300 mg every 4 weeks, and is based on the most effective dose identified in clinical trials. However, many patients require longer-term treatment with omalizumab and there is limited guidance on how to manage these patients. We report on a large cohort of 357 patients with CSU who have been treated over a 10-year period on a personalized dosing regimen. Our results showed a 4% reduction in drug cost for this personalized dosing regimen compared with having all patients on the standard regimen of omalizumab 300 mg every 4 weeks. In addition, by increasing the dose, we were able to treat 22% of patients more effectively, using the principle aim of zero CSU symptoms; prior to this regimen, these patients had been achieving only partial response. Omalizumab doses and frequency should be adjusted depending on clinical response to allow for improved benefits for both patients and healthcare systems.

Variation in lung function as a marker of adherence to oral and inhaled medication in cystic fibrosis.

The aim of this study was to characterise adherence in an adult population with cystic fibrosis (CF) and to investigate if variation in lung function was a predictor of adherence to treatment.The adherence of patients aged ≥16 years from an adult CF centre was measured by medication possession ratio (MPR) and self-report. Patients were assigned to one of three adherence categories (<50%, 50 to <80%, ≥80%) by their composite score (MPR). Ordinal regression was used to identify predictors of adherence, including coefficient variation measures for forced expiratory volume in 1 s (FEV1), weight and C-reactive protein concentration, measured from 6 months and 12 months before baseline.MPR data for 106 of 249 patients (mean age 29.8±9.2 years) was retrieved, indicating a mean adherence of 63%. The coefficient of variation for FEV1 was inversely related to adherence and was a univariate predictor of adherence (6 months: OR 0.92, 95% CI 0.87-0.98, p=0.005; 12 months: OR 0.94, 95% CI 0.93-0.99, p=0.03) and remained significant in the final models. The coefficient of variation of weight and C-reactive protein were not predictive of adherence.The coefficient of variation of FEV1 was identified as an objective predictor of adherence. Further evaluation of this potential marker of adherence is now required.

Multicentre experience of home omalizumab treatment for chronic spontaneous urticaria.

INTRODUCTION: Due to perceived risk of anaphylaxis, home treatment with omalizumab has been limited. Within the UK, most centres administer omalizumab in a hospital setting. However, the reported prevalence of anaphylaxis is low and in December 2018 home treatment became licensed. A home treatment pathway was previously reported by one UK centre, and this update describes three UK centres' experience of home omalizumab treatment. METHODS: The medical records of omalizumab patients were retrospectively reviewed. RESULTS: A total of 137 adult patients have received home omalizumab treatment; home treatment duration 0-44 months. There was no increase in adverse effects seen in patients treated at home. There were no reported adherence issues and no reduction in efficacy. Patients report they prefer home treatment due to increased flexibility and reduced impact on daily life/work. CONCLUSION: Home treatment with omalizumab is a safe and effective alternative to hospital administration.

Developing an automated process of uploading immunoglobulin batch numbers to the UK National Immunoglobulin Database.

OBJECTIVES: To develop a more efficient and robust process for entering patient-specific, immunoglobulin batch number data onto the UK National Immunoglobulin Database. METHODS: A manual method of input, which relied on paper records, was replaced with an automated upload that was developed by linking the pharmacy dispensing system, JAC, with a number of information technology support systems to produce a batch number report. Both systems ran parallel for a period of 7 weeks, and administration time and completeness of data for both were analysed. RESULTS: Over the 7-week period, 550 g of immunoglobulin would not have been entered using the manual method (=4108 g per annum; 4.66% of total immunoglobulin usage). The time taken to enter the data was reduced from 4 h to 30 min per week. CONCLUSIONS: An automated process of uploading batch numbers increases accuracy and completeness of data, reduces administrative time and risk of financial loss; therefore, significantly increasing efficiency.