ࡱ> x{uvw bjbj 845* * mmyyy8$<H%%%%%Y#Y#Y#MHOHOHOHOHOHOH$zKNJsHy%""|%%sHmm%%H'''%m8%%MH'%MH''FCC6G%2:&pFp9HH0HFfN 'fNGGfNyGY#v#T'#$Dg$|Y#Y#Y#sHsH'RY#Y#Y#H%%%%fNY#Y#Y#Y#Y#Y#Y#Y#Y#* 3:  18 March, 2010 Mr Stephen Woodruffe Therapeutic Group Manager PHARMAC PO Box 10 254 Wellington 6143 Email: stephen.woodruffe@pharmac.govt.nz Fax: 04 460 4995 Dear Mr Woodruffe Re: Proposal for Funding of and Access to Special Foods I am writing on behalf of the Allergy Special Interest Group of the Paediatric Society of New Zealand with respect to the proposals to change the funding and access in relation to special foods. In particular we would like to comment about the proposals as they relate to children with cows milk allergy. Access to special foods While relaxing access to special foods is being suggested to promote more equitable usage, we do not think that infants presenting with cows milk allergy should or can be managed in primary care. Management of these infants is not straightforward, with at least 50% of these children having other associated food allergies. Investigation of allergy is fraught, and interpretation of results requires considerable expertise. We believe prescription of extensively hydrolysed and amino acid formula should be restricted to vocationally registered paediatricians. Delisting of goat milk formula Supported Sole supply of each formula category The current sole supply of EHF is Pepti Junior, which in practise does not perform as expected to an EHF for children with IgE mediated cows milk allergy. We understand that Pepti Junior has characteristics that make it advantageous in the management of some gastrointestinal conditions, but in terms of management of IgE mediated cows milk allergy it results in clinical reaction in a significant proportion of infants. Should Pepti Junior remain the only EHF available in New Zealand we will continue to have a higher proportion of these infants requiring an AA formula. We note Australia has access to more appropriate EHF such as Nutramigen and Alfare; Nutramigen unfortunately stopped being imported into New Zealand in 2001. The Australian consensus guideline This document has been quoted selectively and some conditions included in the guideline have been excluded from the NZ criteria, specifically some of the gastrointestinal symptoms, and food protein induced proctocolitis. While a small minority of infants presenting with colic will have underlying cows milk protein intolerance as a contributing factor, this is well supported in the literature as being a factor for some infants (note level I NHMRC level of evidence for irritability). We believe there should be provision for specialist paediatricians to use these formulae in specific cases.  Separate applications This process could result in potentially harmful delays, particularly for practitioners who do not use the electronic special authority system. Criteria Severe food allergy or multiple food allergies (not infant colic, constipation or gastroesophageal reflux) where the child has failed to respond to . This criterion is not well worded, as applies to each of soy, EHF and AA formulae. These criteria relate specifically to cows milk allergy, not to food allergy in general. Infants who have multiple food allergies, or who have severe food allergies, but who are now cows milk allergic do not require special formula. Many children will manifest allergy with reactions to a food (e.g. yoghurt, soy as an ingredient in a food) rather than formula. Severity of reaction is not relevant when deciding whether an infant needs an alternate formula. Many infants will have relatively mild allergic reactions on minimal exposure to an allergen, but still clearly need an alternate formula. Where the child has failed to respond to a cows milk formula is poor wording. Infants with allergy do have a response, albeit adverse, to cows milk or soy formula. This should read failed to tolerate. The criteria have not tried to include any definition of food allergy. Unfortunately definition and hence diagnosis of allergy can be very complicated. As it stands, the criteria could be interpreted in a widely varied fashion and could be used to support a prescription of EHF / AA formula for infants who dont require these formulae. Alternatively other infants who should be managed as allergic (e.g. those who are very highly sensitised) may be put at risk by a perception that there needs to be a clinical reaction prior to consideration of these formulae. Amino Acid based formula criteria Severe food allergy where the child has responded to cows milk formula with anaphylaxis) This criterion should be simplified to Anaphylaxis to cows milk formula / dairy products. We appreciate that development of criteria for these formula are complicated. The allergy SIG would be happy to assist PHARMAC with development of criteria as pertains to management of infants with cows milk allergy. Thank you for the opportunity to comment on these proposals. Yours sincerely Dr Thorsten Stanley On behalf of the Allergy Special Interest Group     THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington 6441 Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz  Allergy SIG Feedback re Proposal for Funding of and Access to Special Foods Health of our children: Wealth of our nation m c " $ ; < C t u rsz UVab./013HI hah0hhah0h5jhgh0hUhC* hd5 hd5\hahd5\hahdB*phhahdB*phhahd5 hahdhdh0h>&@HVf# $ < = t u $ & F$ d*$a$gdd 7$8$H$gddgddgd0hu ./023gd0h$ & F& d*$a$gddgdd$ & F% d*$a$gdd3IJGHIJK89    FG$ & F' d*$a$gd0hgd0h 7$8$H$gd0h$ & F' d*$7$8$H$a$gd0hIJ}/Lg}FHKg6ej  FQ14\]hjDGlݵ h`56h`bhC*hrh` h0h56hahr56hah0h56 h0h5 hah0hh0hhah0h5GG'(CDEFVWXYZ[\]q$ d*$a$gdv 7$8$H$gd0h$ & F' d*$7$8$H$a$gd0h(BCDEF]`qͺ짡yihd5B*CJ$OJQJphhd5OJQJ%jhd5OJQJUmHnHuhyZjhyZU hgCCJh{/ hahvh%)hv$hvhv@CJOJQJnH tH h`b@CJOJQJnH tH  hahhh`h0h hah0hhah0h5"  !Sn#$If !Sn#$If$ x$Ifa$  $Ifd 0gdgC`abdgiŷūŞŚ hgCCJh$GhyZhd5CJaJh,hd5CJaJjhdUmHnHuhdhd5B*CJOJQJphhdB*CJOJQJphhd5OJQJhd5B*CJ(OJQJph$8Labcdhixrpecpc $ !n#a$ !ekdQC$$If\u+#a  $If  $If  !Sn#$If  0gdgC $ !a$ !gdgC 6&P 1+:pC*. 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" # $ % & Oh+'0p   , 8 DPX`h TAX INVOICEracp Normal.dotmT6Microsoft Office Word@J6@`uC@6`#@2՜.+,0 hp  racp#   TAX INVOICE Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdfghijklnopqrstyz}Root Entry Fr<:|Data C1Table=OWordDocument 84SummaryInformation(eDocumentSummaryInformation8mMsoDataStore:2:OBN4UCSEQ==2:2:Item  PropertiesUCompObj y   F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q Paediatric Society of New Zealand: Submissions
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Submissions

The Paediatric Society believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing.  By working as a coordinated national network of health professionals the Society dedicates its efforts and resources to making official submissions to both Government and Non-Government organisations on issues that will impact on the health and wellbeing of children and young people.

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