Soluprick Sq Horse Dander
SUMMARY OF PRODUCT CHARACTERISTICS
1 NAME OF THE MEDICINAL PRODUCT
Soluprick SQ Animal Hair and Dander Equus caballus (Horse Dander) 10 HEP, Solution for skin prick test, 2 ml per vial
2 QUALITATIVE AND QUANTITATIVE COMPOSITION
Soluprick SQ Animal Hair and Dander is a glycerinated preparation containing standardised allergen extracts dissolved in equal parts of buffered saline and sterile glycerol.
Active ingredients:
The active ingredient is a partly purified pollen allergen extract which contains the relevant allergen. The active ingredient is standardised with respect to the content of major allergen and the biological activity is controlled by a total potency assay. The potency is expressed in HEP (Histamine Equivalent in Prick testing). The biological activity of Soluprick SQ Animal Hair and Dander is related to the reaction in the skin of an allergic patient measured relative to a histamine dihydrochloride solution.
For a full list of excipients, see section 6.1
3 PHARMACEUTICAL FORM
Solution for a skin prick test (SPT)
4 CLINICAL PARTICULARS
4.1 Therapeutic indications
Soluprick SQ Animal Hair and Dander is used in the diagnosis of specific IgE mediated allergic diseases.
4.2 Posology and method of administration
Dosage:
Soluprick SQ Animal Hair and Dander 10 HEP is recommended as the optimal biological potency of the allergen when taking into account the meaning of high sensitivity related to high specificity. The potency is expressed in HEP (Histamine Equivalent in Prick testing) which is related to the allergenic activity of the allergen product in the skin of the allergic patient.
ALK Positive control (histamine dihydrochloride 10 mg/ml) is used as reference and ALK Negative control (Saline solution) is used to evaluate unspecific reactions.
When performing a SPT the amount of solution introduced into the superficial layer of the skin is extremely low, approximately 3 x 10"3 pl. (S. Dreborg, Allergy no. 10, Vol 44, 1989)
Paediatric population
Prick testing in children is already possible after the first year of life depending on the child’s constitution, but in general should not be performed before the age of 4.
Skin prick test technique
- The SPT is preferably performed on the volar side of the forearm. Alternatively the test can be performed on the back of the patient.
- The skin must be dry and clean and may be disinfected with 70% alcohol.
- Each test preparation and the controls are applied in droplets on the skin in an appropriate distance from each other (a numbered tape can be used).
- The superficial layer of the skin is pierced with an ALK Lancet perpendicular to
the skin through the droplet. Hold it for 1 second and draw back the lancet. For each test preparation and control a new sterile, disposable ALK Lancet is used. The positive control is applied last.
- The droplets are wiped off with a tissue. Do not mix the preparations by sweeping!
- Start to read the reaction of the preparations after 15 minutes beginning with the positive control. A positive reaction is a pale weal (oedema) with a red flare (erythema). To record the weal in the patient's report: mark the contour of the weal with a pen, stick transparent tape over the weal. Press and transfer the tape to the report. The flare can be recorded likewise.
Size of the weal
The mean weal diameter of the allergen product (Da) and of the histamine control (Dh) is calculated as D = (Dl + dp)/2, where Dl is the longest diameter and dp is the diameter mid-ortogonal to Dl.
Interpretation of results
- Reactions of the allergen product can be graded in relation to the histamine control reaction. This relation is called the skin index (SI).
SI = Da/Dh
|
0 |
negative reaction |
|
+ |
SI < 0.5 |
|
++ |
0.5 < SI < 1.0 |
|
+++ |
1.0 < SI < 2.0 |
|
++++ |
2.0 < SI |
By use of a biological standardised allergen product a mean weal diameter >3 mm indicates that the patient is sensitized to the respective allergen source.
4.3 Contraindications
In extremely rare cases allergic reactions may occur and therefore, a SPT should be avoided when patients are treated with beta-blockers. Recovery from an anaphylactic reaction through the action of adrenaline may be hindered by beta-blockers since these drugs might influence an effective anti-anaphylactic treatment. Therapy with beta-blockers has to be considered an absolute contra-indication.
4.4 Special warnings and precautions for use
Any diseases seriously affecting the patient's general condition; skin lesions in the area used for the testing; dermatographism; dermatitis. Atopic eczema may hamper the reliability of the test.
4.5 Interaction with other medicinal products and other forms of interaction
Concomitant treatment with antiallergic symptomatics may affect the result of the test.
It is recommended that patients who are going to have a skin prick test performed discontinue treatment with:
|
Therapeutic agent |
Interval between last given dose and the SPT |
|
Short-acting antihistamines |
2-3 days |
|
Long-acting antihistamines |
8 weeks |
|
Hydroxyzine |
2 weeks |
|
Ketotifen |
2 weeks |
|
Tricyclic antidepressants |
2 weeks |
|
Local application of potent steroid ointment |
2-3 weeks |
Corticosteroids in doses lower than 30 mg of prednisone/prednisolone per day for up to one week do not reduce the response to skin tests.
Oral low dose glucocorticoids (doses less than 10 mg of prednisolone per day) need not to be discontinued prior to skin testing.
4.6 Pregnancy and lactation
Pregnancy is not an absolute contraindication for skin testing. Skin prick testing with Soluprick may be performed during lactation.
4.7 Effects on ability to drive and use machines
None
4.8 Undesirable effects
Undesirable effects associated with the skin-prick test can be attributed to an immunological response (local and/or systemic) provoked by the allergen (see section 5.1).
Adverse reactions are divided into groups according to the MedDRA- Convention frequencies: Very common (>1/10), Common (>1/100 to <1/10), Uncommon (>1/1,000 to <1/100), Rare (>1/10,000 to <1/1,000), very rare (<1/10,000; not known (cannot be estimated from the available data).
|
System Organ Class |
Frequency |
Adverse Drug Reaction |
|
General disorders and administration site conditions |
Very common |
Application site reactions, Continuously increasing diameter of the wheal, cell shape changes (pseudopodia), diffuse swelling (delayed reaction). |
|
Immune system |
Rare |
Systemic allergic reactions such as rhinitis, |
|
disorders |
conjunctivitis, urticaria, angioedema and | |
|
asthma. | ||
|
Very rare |
Anaphylactic reaction/shock |
Very commonly reported adverse reactions in patients tested with Soluprick are local allergic reactions at the site of application. The diameter of the wheal can continue to increase and cell shape changes (pseudopodia) may appear after the test. In some cases a delayed reaction in the form of a diffuse swelling may occur 6-24 hours after application of the skin-prick test.
In rare cases systemic allergic reaction, such as rhinitis, conjunctivitis, urticaria, angioedema or asthma may develop after the skin-prick test.
In very rare cases anaphylactic reaction/shock may develop within minutes after the skin-prick test and requires immediate treatment with adrenaline and other intensive anaphylactic treatment.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the MHRA Yellow Card Scheme. Website: www.mhra.gov.uk/yellowcard.
4.9 Overdose
Not relevant
5 PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
Soluprick SQ Animal Hair and Dander is used for specific diagnosis by skin prick testing. The preparation is mixtures of molecules with high molecular weight compounds.
The allergenic substance of the preparation can react with the immune system of an allergic patient provided IgE antibodies to the corresponding allergen are released. An immediate allergic reaction will occur within 10-20 minutes, characterised by a weal and flare.
This reaction is mainly caused by binding the allergen to specific IgE attached to mast cells, resulting in release of vaso-active agents like histamine. Some patients also develop a late phase reaction, i.e. a diffuse swelling and redness, starting 2 to 3 hours after the allergen piercing, peaking at 6-12 hours and disappearing within 12-24 hours. Lymphocytes are involved in the late phase response; the exact mechanism has not yet been elucidated.
5.2 Pharmacokinetic properties
Neither the doses applied in a SPT - in terms of weight less than 0.1 pg - nor the route of administration indicate that Soluprick SQ Animal Hair and Dander is used to acquire a clinical effect after systemic absorption.
No attempt has been made to account for the fate of the individual components.
5.3 Preclinical safety data
No toxicological studies have been performed. However, long term clinical experience confirms that non- allergic reactions are hardly of any significance.
6 PHARMACEUTICAL PARTICULARS
6.1 List of excipients
Disodium phosphate, dihydrate Sodium dihydrogen phosphate, dihydrate Phenol
Sodium chloride Glycerol
Water for Injections
The sodium content of Soluprick SQ Animal Hair and Dander is less than 1 mmol sodium (23 mg) per dose; therefore it is essentially “sodium free”
6.2 Incompatibilities
None known. In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products.
6.3 Shelf life
Shelf life of medicinal product as packaged for sale: 3 years Shelf life after opening the container: 6 months
6.4 Special precautions for storage
Store in a refrigerator at 2-8 °C
Do not freeze. Store in original packaging in order to protect from light.
6.5 Nature and contents of container
Vial (type I glass) with a halobutyl rubber stopper and a screw cap (polypropylene).
6.6 Special precautions for disposal
No special requirements.
7 MARKETING AUTHORISATION HOLDER
ALK-Abello A/S Boge Alle 6-8 DK-2970 Horsholm Denmark
8 MARKETING AUTHORISATION NUMBER
PL 10085/0048
9 DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
04/09/2007
10 DATE OF REVISION OF THE TEXT
27/10/2015