Soluprick SQ Grass Pollen is used in the diagnosis of specific IgE mediated allergic diseases.

Dosage:

Soluprick SQ Grass Pollen 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   µ l. (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 wheal (oedema) with a red flare (erythema). To record the wheal in the patient's report: mark the contour of the wheal with a pen, stick transparent tape over the wheal. Press and transfer the tape to the report. The flare can be recorded likewise.

Size of the wheal

The mean wheal diameter of the allergen product (D_a) and of the histamine control (D_h) is calculated as D = (D_l + d_p )/2, where D_l is the longest diameter and d_p is the diameter mid-ortogonal to D_l.

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 = D_a/D_h

- By use of a biological standardised allergen product a mean wheal diameter ≥ 3 mm indicates that the patient is sensitized to the respective allergen source.

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.

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.

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:

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.

Pregnancy is not an absolute contraindication for skin testing. Skin prick testing with Soluprick may be performed during lactation.

None

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).

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.

Not relevant

Soluprick SQ Grass Pollen 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 wheal 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.

Neither the doses applied in a SPT - in terms of weight less than 0.1 µ g - nor the route of administration indicate that Soluprick SQ Grass Pollen is used to acquire a clinical effect after systemic absorption.

No attempt has been made to account for the fate of the individual components.

No toxicological studies have been performed. However, long term clinical experience confirms that non- allergic reactions are hardly of any significance.

Disodium phosphate, dihydrate

Sodium dihydrogen phosphate, dihydrate

Phenol

Sodium chloride

Glycerol

Water for Injections

The sodium content of Soluprick SQ Grass Pollen is less than 1 mmol sodium (23 mg) per dose; therefore it is essentially “ sodium free”

None known. In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products.

Shelf life of medicinal product as packaged for sale: 3 years

Shelf life after opening the container: 6 months

Store in a refrigerator at 2-8 ° C

Do not freeze. Store in original packaging in order to protect from light.

Vial (type I glass) with a halobutyl rubber stopper and a screw cap (polypropylene).

No special requirements.