Grazax treatment for patients with severe seasonal allergic rhino conjunctivitis (hay fever)

Grazax is a treatment for grass pollen allergic hay fever. It is used only for severe symptoms that have not responded to usual hay fever treatments. Grazax reduces allergic symptoms by giving you a regular fixed amount of grass pollen extract, allowing your immune system to build up tolerance to grass pollen and reduce symptoms on exposure to grass pollen during future hay fever seasons. This process is called de-sensitisation or immunotherapy.

Procedure

Grazax is a tablet taken daily and dissolved under the tongue. For optimal effect Grazax should be started four months before the grass pollen season. Treatment should be continued all year round for a total of three years.

The first Grazax tablet will be administered in the hospital’s allergy clinic by a doctor or nurse. This is to ensure that the tablet is taken correctly, to monitor any side effects and give you the opportunity to discuss possible side effects. Before taking the first tablet, you will be asked to complete a consent form and have your pulse, blood pressure and peak expiratory flow rate checked.

One to two hours before taking Grazax you should have taken an antihistamine such as Cetirizine 10mg or loratidine 10mg. The Grazax tablet should be carefully removed from the blister card, using dry fingers, and placed directly under the tongue. It will dissolve within seconds.

You should avoid swallowing for one minute and avoid food and drink for five minutes after taking the tablet. You will be asked to remain in the department for at least one hour under observation. On the second or third day after starting the medication you will be asked to phone or email the Allergy department to report any side effects or symptoms. After that, you will be reviewed annually through telephone by the Allergy clinic. We may ask you to complete questionnaires before, during and after treatment to inform us how you have responded. Your GP (general practitioner) will continue to prescribe the medication in the interim.

If you forget a Grazax tablet for 1 day please take it when you remember later that day. Otherwise continue with the normal dosing the following day (do not take a double dose in one day).

Side effects

The most common side effect of treatment with Grazax is itching and swelling of the mouth. These symptoms should be expected and are more common in the first few weeks of treatment. Therefore, we advise you to take daily antihistamines during the first month of treatment to prevent these symptoms. Some patients also experience tiredness in the first few weeks.

Contraindications

Grazax should not be taken if you have cancer/ malignancy, severe asthma, severe inflammation of the mouth (for example cuts or sores) or an illness which affects the immune system. Grazax contains fish-derived gelatine and although there does not appear to be an increased risk of allergic reactions in patients with fish allergy, you should inform your allergy doctor.

Very rarely patients may experience potentially severe side effects.

Including:

• difficulty swallowing
• difficulty breathing
• widespread itchy rash
• severe dizziness

If any of these symptoms occur you should not take any further Grazax treatment and seek medical help immediately by calling 999 or going to your local Emergency Department.

For any other non-urgent symptoms please inform the Allergy clinic.

Other medications

It is important to continue other prescribed medications including medications to treat hayfever, asthma and other allergic conditions.

Please do inform us if you medications change before or after you have started treatment.

Contraindications

Grazax should not be taken if you have cancer/ malignancy, severe asthma, severe inflammation of the mouth (for example cuts or sores) or an illness which affects the immune system. Grazax contains fish-derived gelatine and although there does not appear to be an increased risk of allergic reactions in patients with fish allergy, you should inform the Allergy clinic if this is the case.

Special care

Special care is required if you have a severe allergy to fish or you have experienced severe allergic reactions to grass pollen immunotherapy injections previously. If you are planning dental or mouth surgery please inform us as you may need to stop treatment for up to one week whilst healing.

Please contact the Allergy clinic for advice if any of these apply to you.

Vaccinations may be given without interrupting treatment with Grazax if you are well.

Pregnancy and breast feeding

Treatment with Grazax should not be started during pregnancy because of the risk to the baby should a severe reaction occur. There is limited evidence about using Grazax in pregnancy. If you become pregnant, or are thinking about getting pregnant please let the Allergy clinic know.

At present there is no experience for the use of Grazax during breast feeding. No effects on breast-fed infants are anticipated.

Help with this leaflet

If you have any questions regarding any aspect of your treatment, please do not hesitate to contact the allergy nurses on 01223 348112.

Please email the allergy secretaries after you commence treatment: allergy.secretaries@nhs.net