Listing of Pharmaceutical Benefits (NHL) - Schedule 4 part 1

Cows' milk anaphylaxis

Must be treated by a specialist allergist or clinical immunologist, or in consultation with a specialist allergist or clinical immunologist; AND

Patient must be up to the age of 24 months.

Anaphylaxis is defined as a severe and/or potentially life threatening allergic reaction.

The name of the specialist and the date of birth of the patient must be included in the authority application.

Listing of Pharmaceutical Benefits (NHL) - Schedule 4 part 1

Cows' milk protein enteropathy

Continuing treatment

Must be treated by a specialist allergist, clinical immunologist or specialist paediatric gastroenterologist and hepatologist, or have an appointment to be assessed by one of these specialists; AND

The condition must not be isolated infant colic or reflux; AND

Patient must be intolerant to both soy protein and protein hydrolysate formulae, as demonstrated when the child has failed to respond to a strict cows' milk protein free and strict soy protein free diet with a protein hydrolysate (with or without medium chain triglycerides) as the principal formula; AND

Patient must be up to the age of 24 months.

The name of the specialist and the date of birth of the patient must be included in the authority application.

Listing of Pharmaceutical Benefits (NHL) - Schedule 4 part 1

Severe cows' milk protein enteropathy with failure to thrive

Continuing treatment

Must be treated by a specialist allergist, clinical immunologist or specialist paediatric gastroenterologist and hepatologist, or have been assessed at least once or have an appointment to be assessed by one of these specialists; AND

The condition must not be isolated infant colic or reflux; AND

Patient must have had failure to thrive prior to commencement with initial treatment; AND

Patient must be up to the age of 24 months.

The name of the specialist and the date of birth of the patient must be included in the authority application.

Listing of Pharmaceutical Benefits (NHL) - Schedule 4 part 1

Combined intolerance to cows' milk protein, soy protein and protein hydrolysate formulae

Continuing treatment

Must be treated by a specialist allergist, clinical immunologist or specialist paediatric gastroenterologist and hepatologist at intervals not greater than 12 months; AND

The condition must not be isolated infant colic or reflux; AND

Patient must be older than 24 months of age.

The name of the specialist and the date of birth of the patient must be included in the authority application.

Listing of Pharmaceutical Benefits (NHL) - Schedule 4 part 1

Proven combined immunoglobulin E (IgE) mediated allergy to cows' milk protein and soy protein

Continuing treatment

Must be treated by a specialist allergist, clinical immunologist or specialist paediatric gastroenterologist and hepatologist; AND

Patient must have failed a trial of protein hydrolysate formulae (with or without medium chain triglycerides) prior to commencement with initial treatment; AND

Patient must be up to the age of 24 months.

The name of the specialist and the date of birth of the patient must be included in the authority application.

Listing of Pharmaceutical Benefits (NHL) - Schedule 4 part 1

Severe intestinal malabsorption including short bowel syndrome

Patient must have failed to respond to protein hydrolysate formulae; or

Patient must have been receiving parenteral nutrition.