Published: 1 October, 2021
Managing allergic reaction to COVID-19 vaccination
The Immunisation Advisory Centre (IMAC) has published
advice on managing patients who have had an allergic reaction to their first dose of COVID-19 vaccination.
They also include recommendations for people receiving COVID-19 vaccination with a history of allergy to another vaccination or allergy in general.
- Allergy to the Pfizer COVID-19 vaccine is more commonly reported than allergies to other vaccines (5-11 people
per million doses); it is most common in females and in people with a history of allergy, and usually occurs a short
time after administration of the first dose (within 30 minutes)
- It is thought that the most likely causative allergic component in the Pfizer COVID-19 vaccine is polyethylene
glycol (PEG); people with a PEG allergy should be discussed with an immunologist prior to receiving any doses
- People with an immediate anaphylactic reaction to the COVID-19 vaccine can usually receive a second dose but
only if it is able to be administered within a specialist immunology clinic (currently available in Auckland, Wellington
and Christchurch); if this is not possible, a second dose should not be given
- People with a delayed allergic reaction can usually receive the second dose of the COVID-19 vaccine; an antihistamine
can be given prior to or following the dose
- Most people with a history of anaphylaxis with another vaccine, medicine, food or venom, an atopic condition
such as asthma, dermatitis or rhinitis or a family history of allergy can safely receive COVID-19 vaccination
- People with a history of allergic reaction who are receiving the COVID-19 vaccination should be closely observed
for 30 minutes and given clear advice on symptoms to be alert for after they leave
- Delayed reactions such as facial swelling, urticaria or rash are usually self-limiting but can be treated with antihistamine if necessary
Read the full advice from IMAC
Bromocriptine to be withdrawn
Bromocriptine will no longer be funded from March, 2022; no new patients should be started on this medicine. Patients currently taking bromocriptine
will require an endorsed prescription for continued supply. Arrangements have been made so that women who are using bromocriptine during pregnancy can continue to do so.
Bromocriptine is a dopamine-receptor agonist most often used in Parkinson's disease, and also used for people with hypogonadism, galactorrhoea, prolactinoma, acromegaly, as part of fertility treatment (hyperprolactinemic amenorrhoea) and for prevention of lactation.
Bromocriptine is supplied in New Zealand by Apotex who are leaving the market, and PHARMAC have been unable to find an alternative ongoing supplier. To help to ensure supply for existing patients for as long as possible, no new patients can be prescribed bromocriptine. Only patients who have been taking bromocriptine before 1 March, 2021 will have access to funded bromocriptine. If there is a previous record that bromocriptine has been dispensed, pharmacists can endorse the prescription.
Short-term supply of an alternative unapproved brand of bromocriptine is available for use in pregnant women so they do not need to change their treatment. The brand is Parlodel (Novartis) and it has been funded since July, 2021 with supplies expected to last until January, 2022.
There are other fully funded dopaminergic medicines available for the treatment of people with Parkinson's disease: refer
to the NZF for options. Cabergoline may be a suitable funded alternative treatment for people who are currently taking bromocriptine for an endocrine condition such as hyperprolactinaemia. The Special Authority criteria have been amended to allow widened access.
Varenicline remains out of stock
A reminder that varenicline remains out
of stock in New Zealand. Varenicline is unavailable world-wide due to manufacturing concerns.
Stock of both Pfizer brands of varenicline has now been exhausted in New Zealand. There is currently no known resupply date. Alternative
funded treatments include nicotine patches, gums or lozenges, bupropion and nortriptyline. We first reported on this supply issue in
Bulletin 28 and then again in Bulletin
New Zealand Formulary updates for October
Significant changes to the NZF in the October, 2021, release include new monographs for naltrexone + bupropion, upadacitinib for moderate to severe
rheumatoid arthritis and vortiozetine for depression. There are some changes to existing monographs, including a new indication for rivoraxaban, an updated
monograph for apixaban and updates to cautions, contra-indications and dosing regimens for several vaccines. Changes to therapeutic notes include an update
for topical estrogen for vaginal atrophy and for the impaired immune response section of the adaptive
October changes for the New Zealand Formulary for Children (NZFC) include updates to therapeutic notes for adaptive immunity and
for the COVID-19 vaccines and changes to the monographs for several vaccines in terms of cautions, contra-indications and dosing.
- A new monograph for naltrexone + bupropion hydrochloride. This unfunded oral medicine is a centrally acting
appetite suppressant indicated as an adjunct for weight management.
- A new monograph for upadacitinib, a selective and reversible
inhibitor of the Janus-associated tyrosine kinases (JAK) which leads to a reduction in the activation of immune and
inflammatory process. It will be available under Special Authority criteria for patients with moderate to severe
- A new monograph for vortioxetine, a serotonin modulator which works in several ways to increase the amount
of available serotonin in the brain, resulting in antidepressant effects. It is indicated for use in patients with
major depressive disorder but is not funded.
- Changes to therapeutic notes including section updates for topical estrogen
for vaginal atrophy and COVID-19
- Changes to medicine monographs include an update for apixaban and a new indication for rivaroxaban for
the prophylaxis of cardiovascular events in patients with coronary artery disease or peripheral artery disease. Several
monographs for vaccines have had updates to cautions and contra-indications. The cautions section of the ivermectin monograph
has also been updated.
- The Patient Information Leaflet section contains a new link to patient information for empagliflozin (Health
Navigator) in the following languages: Cook Islands Māori, Samoan, Tongan, Tuvaluan, Tokelauan, Niuean, Traditional
Chinese, Simplified Chinese, and Hindi
Mental Health Awareness Week: Take time to kōrero
This week (27 September to 3 October) is mental health awareness
week. The theme for this year is "Take time to kōrero" – a little chat can go a long way.
Sometimes it's the smallest conversations that can make the difference. Many people who are struggling with their mental health and wellbeing find it difficult to
voice their worries and concerns, and often feel a great strain of maintaining a positive façade on the outside. A simple "are you ok" from a trusted friend,
colleague or health care professional may provide the pivot point they need to share their problems and start to find some solutions.
The guiding whakataukī (proverb) for Mental Health Awareness week 2021
Mā te whakarongo, ka mōhio
Through listening, comes knowledge
Mā te mōhio, ka mārama
Through knowledge, comes understanding
Mā te mārama, ka matau
Through understanding, comes wisdom
Mā te matau, ka ora
Through wisdom, comes wellbeing
Podcast of the week: The Good GP – Obsessive Compulsive Disorder
The Good GP is an Australian podcast series made by, and for, busy GPs; each episode is around 15 minutes. The content is likely to be relevant to
all primary health care professionals. In the most
recent episode, The Good GP covers the management of patients experiencing obsessive compulsive
disorder (OCD), which is often under recognised and under diagnosed. Many people have intrusive thoughts, but the key characteristic of a person with
OCD is how they respond to these thoughts.
In this episode, the Good GP interviews GP registrar Dr Lena Rennick who has OCD, and Dr Scott Blair-West a consultant psychiatrist and medical director of the OCD programme at the Melbourne Clinic.
OCD is under recognised and under diagnosed. There are often behaviours that are apparent in adolescence (even childhood) yet typically a diagnosis is not reached for many years. OCD is typified by intrusive thoughts, images, anxiety and compulsive behaviours and can have a significant impact on functionality. The effects on concentration and focus can adversely impact schoolwork or work and ultimately lead to depression.
The panel discusses the use of screening questions (e.g. do you check a lot? clean and wash a lot? go over things again and again? have rituals that you do every day?) and things to watch for (e.g. a patient presenting with dermatitis due to excessive hand washing). The COVID-19 pandemic has aggravated behaviours in many people with OCD, particularly regarding issues of excessive cleanliness and uncertainty. The panel notes that everyone has intrusive thoughts, but it’s an abnormal response to these thoughts that characterises OCD.
OCD behaviours can be obscure and irrational and provoke shame and embarrassment, making the patient reluctant to reveal them. One of the key aims is to encourage people to talk about their behaviours, to normalise the problem and to recognise the significance of the presenting features so that diagnosis is not delayed. OCD can underlie anxiety and depression and it is often not recognised that it can be at the root of these conditions.
One area not covered in the podcast is perinatal OCD. It is estimated that 2-3% of women, and some fathers/partners, experience perinatal OCD. Often the intrusive thoughts revolve around fears that the baby could come to harm in some way. Perinatal OCD is considerably more common than perinatal psychosis so it’s important that primary care health professionals consider this.
Listen to the full podcast on OCD here
Patient information on perinatal OCD for parents in New Zealand is available here:
An OCD-UK video on perinatal OCD is available here: https://vimeo.com/263327393
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