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.
The panel requests prospective applications for all indications. Panel approval prior to treatment is required for all Class II-IV treatments. Apply using the eReferral link below.
Class I treatments can proceed without prospective panel approval. The clinical team is responsible for ensuring all eligibility criteria are met and treatment thresholds are not exceeded. Where treatment commences prior to panel review, liaise with the local pharmacy service for dosing and brand advice. NB: there are additional provisions for rapid access to treatment for some indications not considered Class I.
> Refer to the detail in the clinical guideline.
If there is a delay obtaining a panel opinion and there is a risk of avoidable patient harm, the panel suggests to make a local decision to proceed with treatment (or not). Once the panel view is available, treatment can be modified as needed.
There is a potential financial risk if treating prior to panel review a) for an uncommissioned indication, or b) for a case where eligibility criteria are not met. In such circumstances, senior hospital staff should be made aware of this risk prior to commencing treatment.
Clinical guidelines (Step 1: check the patient's clinical condition fulfils selection criteria)
The regional (EOE) immunoglobulin treatment guideline combines the latest guidelines as published by NHS England, NICE, UKHSA and the Department of Health, as well as regional standards as specified by the EoE IAP. Regional standards include further detail on the approvals required per indication, permission to treat out of hours and the agreed dosing strategies for indications that may not be covered in national commissioning guidance. This guidance should be used as the primary reference source by NHS clinicians in the East of England (in preference to other documents including those published by NHS England).
The guideline provides 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 risk.
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 the EoE IAP webpages.
A pathway exists for a second opinion to be sought from an associate SRIAP (sub-regional IAP). Please refer to the Panel page Appeals and Access to the Reserve Framework for further information.
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' > 'Create a treatment episode referral without an account'
- Users MUST be on an NHS networked computer to submit an eReferral.
- A walk-through guide is published below to support clinicians.
- Please include a local pharmacy email address in the 'additional recipients' section of the eReferral.
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. Only where eReferral is not available (IT issues), 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 for authorisation submitted 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 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 for any Class II-IV indications and periodically to continue treatment for long-term therapy. This information is included in the panel PIL which should be used to support consent.
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.