Preliminary draft guidance (appraisal consultation document – ACD) from the National Institute for Health and Clinical Excellence (NICE) makes the following recommendations on the use of Pharmalgen immunotherapy for bee and wasp venom allergy:

1. Pharmalgen is recommended as an option for the treatment of IgE-mediated bee and wasp venom allergy in people who have had:

• a severe systemic reaction to bee or wasp venom or

• a moderate systemic reaction to bee or wasp venom and who have one or more of the following: a raised baseline serum tryptase,  a high risk of future stings or anxiety about future stings.

2. Treatment with Pharmalgen should be initiated and monitored in a specialist centre experienced in venom immunotherapy.

Although the appraisal committee considered the available evidence to be poor quality and limited, it was persuaded that Pharmalgen had demonstrated efficacy in reducing rate and severity of systemic reactions. However, the relative effect could not be quantified with certainty. The Committee concluded that it is appropriate to use a time horizon of longer than 10 years, and that with reduced anxiety about re-stings after treatment with Pharmalgen the most plausible ICER would be less than £20,000 per QALY gained.

The key dates for this appraisal are:
Closing date for comments: 21 October 2011
Second Appraisal Committee meeting: 01 November 2011

Final guidance is expected to be published in February 2012.