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 the panel
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 eReferral Form (opens in a new tab). There is no need to have a profile to create or submit a treatment request. Alternatively access via ivig.nhs.uk (opens in a new tab) --> click 'Access Database' > 'New Referral'
- Users MUST be on an NHS networked computer to submit an eReferral.
- A walk-through guide is published below to support clinicians.
All Trusts in the East of England adopted the eReferral system in 2025. eReferrals are the preferred route for treatment requests nationally for all immunomodulation indications.
If there are technical difficulties using the eReferral platform, complete the appropriate Immunoglobulin Clinical Approval Request Form (see 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.
eReferral application is the standard mechanism used across the NHS. Where eReferral is not available (IT issues) or not yet implemented, requests for immunomodulation or HNIg in the absence of hyperimmune globulin should be make using the following forms. Note there are separate forms for immunomodulation (autoimmune disease) and immunoreplacement therapy.
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.