The East of England Immunoglobulin Assessment Panel (EoEIAP) is hosted by Cambridge University Hospitals. All treatment with immunoglobulins is subject to review or authorisation by the Panel.
Clinical guidelines (Step 1: check the patient's clinical condition fulfils selection criteria)
The regional (EOE) immunoglobulin treatment guidelines combine the latest guidelines as published by NHS England and the Department of Health, as well as regional standards as specified by the EoE IAP. Local standards include further detail on the approvals required per indication, permission to treat out of hours and the agreed dosing strategies for indications that previously have not been covered by national commissioning guidance. This guidance should be used as the primary reference source by NHS providers in the East of England, and in preference to other documents including those published by commissioners.
The guidelines provide information about the classification of each indication, the level of approval required and the likely need to commence treatment 'out of hours'. Where clinically appropriate, the panel recommend to treat during standard day hours to minimise risks.
Associate Trusts of the EoE IAP agree to adhere to the standards specified by the EoE IAP and to accept the decisions of the EoE IAP as binding. This stance is supported by the medical directors of the Trusts in the East of England. A summary of the agreed principles of working is outlined in the Core Practice Standards document published on this webpage.
A pathway exists for a second opinion to be sought from an associate SRIAP (sub-regional IAP). Where the EoE IAP has declined to support treatment with immunoglobulins, please email the EoE IAP coordinator to formally request a clinical review by an associate SRIAP. Ensure communications are appropriately secure when sending patient identifiable data. We recommend sending from an nhs.net account.
The panel does not review applications where the treating consultant does not support the use of immunoglobulin therapy.
Email addresses for the panel are:
- add-tr.iap-eastofengland@nhs.net (Triaging team for clinical requests)
- cuh.add-tr.eastofengland-iapcoordinator@nhs.net (Panel coordinator)
Clinical requests (Step 2: Seek clinical approval from the EoEIAP)
Applications for treatment with immunoglobulins require an eReferral form to be completed and submitted to the EoE IAP.
- This form is available on the NHS England Immunoglobulin Database website (opens in a new tab). There is no need to have a profile to create or submit a treatment request. Click 'Access Database' > 'New Referral'
- A walk-through guide is published below to support clinicians.
Trusts in the East of England will be adopting the eReferral system with advertised launch dates in 2025, though eReferrals are already supported by the EoE panel.
If the eReferral system is not yet implemented in your Trust or there are technical difficulties, complete the appropriate Immunoglobulin Clinical Approval Request Form below before treating the patient (± funding authorisation, depending on the condition to be treated; see Clinical Guideline). Download and complete the form (below) and submit to the EoE IAP by email for panel consideration.
Applications for immunoglobulin replacement therapy (correction of hypogammaglobulinemia) should also complete and submit the immunodeficiencies application form below.
Where eReferral is not available or not implemented, requests for immunomodulation or HNIg in the absence of hyperimmune globulin should be make using the following form:
All requests for immunoglobulin replacement therapy (in primary or secondary immunodeficiency) should be made using the following form. If using the eReferral system, this is in addition to the eReferral application which does not capture the range of clinical information required:
Unless submitted using the eReferral platform, all clinical requests to authorisation to the panel should be emailed to EoE IAP - for patients from any member Trust (from an nhs.net or other secure NHS account)
All authorised treatment requests require the treating consultant to review the patient’s clinical response in accordance with the specified clinical measures for the indication, or as specified by the panel at the point of approval to treat.
Patients should be informed that panel approval is required before treatment can begin for any Class II-V indications (Class I indications may proceed within defined limits without panel approval).
As part of the process of consent to treatment, patients with capacity should be given a copy of the Immunoglobulin Patient Information Leaflet (below) prior to treatment, along with the opportunity to read and ask questions about treatment before treatment proceeds.
Patient Information Leaflet (Step 3: Provide information to the patient before taking informed consent)
Once clinical approval has been obtained from the panel, the patient should be informed about the risks of treatment inherent with immunoglobulins (it is a blood product), his / her / their data being recorded on a national database, the risk of interruptions in supply. This information and more is contained in the Patient Information Leaflet (PIL) below. The panel suggest this leaflet is given to all patients who have capacity before obtaining informed consent and commencing therapy.
There is no regional consent form. Please use locally available generic consent forms in conjunction with this PIL.
The following patient information leaflet has been designed to provide useful information on the storage of immunoglobulin at home for people self-administering immunoglobulin.
Patient Information Leaflets
Immunodeficiency UK - Switching immunoglobulin products (opens in a new tab)
Immunodeficiency UK produce a leaflet to support patients who are considered for a switch in immunoglobulin product.
The Cambridge University Hospitals Immunoglobulin Pharmacy Team have provided a table which may help with questions regarding the storage of particular immunoglobulin medicines.
Further support with implementation of the NHS Framework for Immunoglobulins (2025)
To support patients during the implementation of the 2025 NHS Immunoglobulin Framework, the EOEIAP panel has produced this letter which can be used by any NHS service or hospital in the East of England
To support healthcare professionals during the implementation of the 2025 NHS Immunoglobulin Framework, the EOEIAP panel has produced this letter which can be used by any NHS service or hospital in the East of England
Reserve Framework criteria and process
Only immunoglobulin products listed on the NHS framework may be prescribed to treat patients with human normal immunoglobulin in the NHS, unless exceptionality can be proven and the suggested alternative product is commercially available with an appropriate funding pathway. Clinicians wishing to request access to the Reserve Framework for Immunoglobulins should follow the process described in the EOEIAP Core Practice Standards. This is to ensure equity in access, engagement with manufacturers who supply product and with NHS England / DHSC. All parties need to plan carefully for any non-Framework product use in order to ensure both availability of product and treatment cost reimbursement.
Exceptionality is considered on a case-by-case basis by the EOEIAP following a submission from the patient's clinical team. While not comprehensive, factors that the panel will take into account when assessing exceptionality include:
1) Failure to tolerate two or more brands of immunoglobulin (SCIG or IVIG), including following change in rate of administration and use of appropriate supportive medicines including antihistamine and paracetamol (IVIG) AND are now stable on current therapy;
2) Dexterity issues that would affect ability to self-administer using vials, including arthritis in the hand or arm (fingers, wrist, elbow) OR relevant amputation or loss of function of a limb OR peripheral nerve weakness affecting finger(s), hand(s) or arm(s);
3) Relevant sensory impairment (including significant visual impairment);
4) Significant cognitive or psycho-social issues where the patient's well-being or ability to comply with treatment could be impaired following a change to the mode of delivery or administration.
In all cases, the EOEIAP will review applications for access to the Reserve Framework, seeking further information as needed, and are required to approve exceptionality formally before acceptance onto the Reserve Framework.
Latest news and updates
Submission of data to the East of England IAP
The following email distribution list should be used for the submission of purchasing data, allocation change requests and other communications of a general nature that do not involve clinical decision making or data that is patient-confidential:
Regional allocations are monitored by the IAP and a summary of the set allocations can be requested from the regional IVIG coordinator.
Email addresses for the panel are:
- add-tr.iap-eastofengland@nhs.net (Triaging team for clinical requests)
- cuh.add-tr.eastofengland-iapcoordinator@nhs.net (Panel coordinator)
- david.demonteverde-robb@nhs.net (Regional Pharmacist Lead, EOEIAP)
EoEIAP regulatory documents
Current version 2.0; April 2025
Other websites
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